When to Refer

When Should You Refer A Patient to Denver Nephrology?

There are several “absolute” criteria. To us this means that no matter how extensive the workup and treatment are at the primary care office, these conditions will require nephrology intervention at some point:

  • All patients with calculated GFR < 60 and concomitant proteinuria, hematuria and/or pyuria.
  • All patients with GFR < 60 and GFR declining.
  • 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

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

Finally, there are several conditions for which you may desire having us consult, at your discretion:

  • 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

Note: patients with newly discovered proteinuria with hematuria may have underlying acute nephritis, which requires rapid work-up and treatment. Nephrology consultation should occur urgently even when creatinine/GFR appear normal. Diabetics with proteinuria should be seen at least once by a nephrologist.

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