When to Refer to Nephrology
February 15, 2015
To answer this better please refer to the list of items below:
- All patients with calculated GFR < 60 and concomitant proteinuria, hematuria and/or pyuria or GFR declining.
- All patients with GFR < 30.
- A patient expected to need dialysis
- Incidental diagnosis of polycystic kidney disease on CT, US or MRI
- Unexplained proteinuria quantitated greater than 500 mg/day.
- Nephrotic syndrome (Heavy proteinuria, edema, hypoalbuminemia, hyperlipidemia, +/- hypertension)
- Patients with the combination of proteinuria and hematuria or pyuria (even when proteinuria is low-grade). See note below.
- Patients who have a kidney transplant
- Sudden worsening of blood pressure in a previously stable patient
- Severe and/or uncontrolled hypertension:
- In a person under the age of 35
- In a person on 3 or more antihypertensive medications
- In a person with any degree of kidney disease
- Medium range proteinuria (1+ or 2+)
- Unexplained hematuria
- Kidney stones
- Diabetes mellitus with difficult to control hypertension and/or proteinuria (see Note below)
- Patients with a history of nephrectomy and/or a solitary kidney who have any degree of renal insufficiency
- Medullary sponge kidney
- Electrolyte abnormalities such as hyponatremia, hypercalcemia, acid base disturbances, and hyperkalemia, among others.
- Recurrent flash pulmonary edema
- Refractory edema
- Pregnant women with any degree of kidney disease
- Low bone density in patients with GFR < 60 cc/min- often related to metabolic bone disease
There are some common conditions that generally do not require nephrology consultation:
- Solitary simple renal cysts
- Controlled hypertension in the absence of diabetes and/or abnormal calculated GFR