Immediate review
Refer to A and E for initial exclusion of obstructive cause. Contact on call renal team for urgent review as below:
- acute kidney injury stage 3 (after exclusion of urinary tract obstruction if lower tract symptoms), requires discussion with on call renal team.
- newly detected estimated glomerular filtration rate (eGFR) <15ml/min (after exclusion of obstruction if lower tract symptoms)
- hyperkalaemia, serum potassium >6.5mmol/L (after exclusion of artefactual and treatable causes)
- accelerated or malignant phase hypertension with suspicion of underlying kidney disease
Queen Elizabeth Hospital Birmingham (QEHB) on-call registrar phone:
Birmingham Heartlands Hospitals (BHH) on-call registrar or consultant is available via switchboard.
Direct referral to nephrology services via A and R
- Nephrotic syndrome – albumin to creatinine ratio (ACR) or protein creatinine ration (PCR) >300mg/mmol) with albumin <30g/L (urgent appointment required)
- Possible multisystem disease (e.g. systemic lupus erythematosus (SLE), systemic vasculitis) with evidence of kidney disease (urgent appointment required)
- Five-year risk of needing renal replacement therapy of greater than 5%* (A and G may be all that is required, if marginal benefit to patient and already on optimal medication)
- Urine ACR of >70mg/mmol (unless known to be caused by diabetes and already on appropriate management) (routine review)
- ACR of >30mg/mmol together with non-visible haematuria
- **sustained decrease in eGFR of >25% or >15ml/min AND a change in chronic kidney disease (CKD) category within 12 months
- Known or suspected rare or genetic cause of CKD
- Suspected renal artery stenosis
- Uncontrolled (>150/90) BP despite 4 agents at therapeutic doses in a patient with CKD (non CKD patients refer directly to hypertension service via separate A and R)
Last reviewed: 23 November 2023