• 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