Indications for referring an adult patient with a chronic kidney disease to a nephrologist:
(1) systemic collagen vascular disease (autoimmune disorder)
(2) resistant hypertension (requires > 4 drugs including a diuretic)
(3) family history of a kidney disorder
(4) Stage 4 or 5 chronic kidney disease with significant reduction in the estimated glomerular filtration rate (GFR < 30 mL per min per 1.73 square meter)
(5) rapid decline in estimated GFR (change > 5 mL per min per 1.73 square meter in 1 year or > 10 mL per min per 1.73 square meter in 5 years)
(6) suspected renal arterial stenosis
(7) proteinuria
(7a) urine albumin to creatinine ratio > 70 mg/mmol without hematuria
(7b) urine protein to creatinine ratio > 100 mg/mmol without hematuria
(7c) urine albumin to creatinine ratio > 30 mg/mmol with hematuria
(7d) urine protein to creatinine ratio > 50 mg/mmol with hematuria
(7e) nephrotic range (urine protein to creatinine ratio > 300 mg/mmol AND serum albumin < 30 g/L)
where:
• The referral should be prompt if nephrotic range proteinuria or if there has been a rapid deterioration in renal function.
• If the only finding is proteinuria and the patient has diabetes that is being adequately treated then referral may not be necessary.
