Referring Physicians
Partnering with other physicians to deliver the best patient care
When to Refer
There are several “absolute” criteria. As physician colleagues, we recommend 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
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.
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 at bottom of page)
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
Renal artery stenosis, also known as kidney stenosis
Electrolyte abnormalities - sodium, potassium, bicarbonate, calcium, phosphorus
Genetic abnormality concerns involving renal tubules
