When to Refer a Patient?

There are several “absolute” criteria. Here are few things to consider:

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 or proteinuria
Low bone density in patients with GFR < 60 cc/min- often related to metabolic bone disease

**Note:

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.

How to Refer a Patient?

Easy 3 Steps >>>

1. Download the referral form

2. Complete the form with basic information

3. Fax the form, labs, insurance info at (614)556-4804

Have a question?

Please do not hesitate to call us at 614.839.0581