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Proteinuria / nephrotic syndrome


Minimum Referral Criteria

  • Category 1
    (appointment within 30 calendar days)
    • Proteinuria > 1g/m2/24hrs without any of the following concerning features:
      • significant peripheral oedema
      • signs of pulmonary oedema
      • severe hypertension
      • signs of DVT/PE
      • infection
      • acute kidney injury
    • Proteinuria with other evidence of kidney disease (eg oedema, haematuria)
  • Category 2
    (appointment within 90 calendar days)
    • Persistent asymptomatic sub-nephrotic proteinuria (PCR < 200g/mol) with no other evidence of kidney disease (eg oedema, haematuria)
  • Category 3
    (appointment within 365 calendar days)
    • No category 3 criteriua

1. Reason for request Indicate on the referral

  • To establish a diagnosis
  • For treatment or intervention not otherwise accessible to the patient
  • For advice regarding management
  • To engage in an ongoing shared care approach between primary and secondary care
  • Reassurance for GP/second opinion
  • Reassurance for the patient/family
  • For other reason (e.g. rapidly accelerating disease progression)

2. Essential referral information Referral will be returned without this

  • Presence of comorbid conditions
  • List of medications
  • BP records (if available)
  • Serial ELFTs including urea and creatinine results
  • FBC
  • Urine protein creatinine ratio (PCR) (ideally early morning sample)
  • Urine midstream M/C/S (includng testing for red cell morphology and casts preferable)
  • Ultrasound (kidney, ureters & bladder) and any other available renal imaging results

3. Additional referral information Useful for processing the referral

  • Timeline of symptoms
  • Presence or absence of oedema
  • Other supportive investigative tests as indicated including:
    • If significant proteinuria present, include ANCA, ANA, ENA & anti DNA Abs, C3/C4 and Hepatitis B/C serology
    • If myeloma suspected, include, paraprotein testing eg FLC, SEPP, BJP

4. Request

Last updated: 13 June 2023