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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



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