Information for Referring Doctors

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Items Needed for Referrals
We prefer that all patients be referred by a physician.
     • Demographic face sheet
     • Last 1-2 years of blood work and urine studies
     • Last 1-2 office visit notes
     • Any Abdominal or Renal Ultrasounds, and/or CT Abdomen/Pelvis

When to Refer Patients
We recommend referral to a nephrologist in the following circumstances, even if the primary care doctor has done an extensive workup:
     • Acute kidney injury or abrupt sustained fall in GFR
     • GFR <30 ml/min/1.73m2
     • Persistent proteinuria (Protein to Creatinine Ratio >0.5mg/mg or 24 hour protein urine >500mg/24 hours or Albumin to Creatinine Ratio >300mg/g or 24 hour Albumin urine >300mg/24 hours)
     • Progression of CKD (A decline in GFR category accompanied by 25% or greater drop in eGFR from baseline and/or rapid progression of CKD defined as a sustained decline in eGFR or more than 5ml/min/1.73m2/year)
     • Nephrotic Syndrome (heavy proteinuria, edema, hypoalbuminemia, hyperlipidemia, and/or hypertension)
     • Patients with a combination of proteinuria and hematuria
     • Urinary red cell casts, RBC > 20 per high power field sustained and not readily explained
     • Severe or uncontrolled hypertension in a person on 4 or more antihypertensive medications
     • Persistent abnormalities of serum potassium
     • Persistent abnormalities of serum sodium
     • Recurrent or extensive nephrolithiasis
     • Incidental diagnosis of polycystic kidney disease on Ultrasound, CT or MRI
     • Patients with a history of nephrectomy and/or a solitary kidney who have any degree of kidney insufficiency
     • Pregnant woman with any degree of kidney 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