If any of the following are present or suspected, please refer the patient to the emergency department (via ambulance if necessary) or follow local emergency care protocols or seek emergent medical advice if in a remote region.
* At the level of nephrotic range proteinuria, albumin accounts for 60-70% of total urinary protein. Within the CPC, ACR > 300mg/mmol OR PCR > 300g/mol has been used for simplicity and ease of application.
Before waiting 3 months to refer, it is important to establish that there is no evidence of acute kidney injury
In the absence of other referral indicators, referral may not be necessary if following conditions are met:
The decision to refer or not must always be individualised, and particularly in younger individuals the indications for referral may be less stringent. Discuss management issues with a specialist by letter, email or telephone in cases where it may not be necessary for the person with CKD to be seen by the specialist.
NB: eGFR units: mL/min/1.73m2
Please note that where appropriate and where available, the referral may be streamed to an associated public allied health and/or nursing service. Access to some specific services may include initial assessment and management by associated public allied health and/or nursing, which may either facilitate or negate the need to see the public medical specialist.
A change in patient circumstance (such as condition deteriorating, or becoming pregnant) may affect the urgency categorisation and should be communicated as soon as possible.
Please indicate in the referral if the patient is unable to access mandatory tests or investigations as they incur a cost or are unavailable locally.