Acute decline in kidney function
Adult

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Emergency Referrals

Important

If you believe your patient requires immediate attention, please refer the patient to the emergency department (via ambulance if necessary) or seek emergent medical advice.

Kidney transplant patients with significant intercurrent illness (eg diarrhoea and vomiting)

Acute decline in kidney function

Any acute kidney injury or significant decline in kidney function where the treating doctor believes the patient requires urgent hospital care (especially if evidence of abrupt increase in serum creatinine by > 50% of baseline)
Oliguria/anuria
Severe acute electrolyte disturbance for example:
- hyperkalaemia with K+ > 6.5 mmol/L OR > 6.0 mmol/L with ECG changes
- hypokalaemia with K+ < 2.5 mmol/L OR < 3.0mmol/L with symptoms
- severe metabolic acidosis (HCO3 < 15mmol/L)
Kidney transplant recipients with an acute decline in kidney function (e.g. > 20% increase in serum creatinine)
Suspected glomerulonephritis (proteinuria and haematuria) associated with acute kidney injury

Chronic kidney disease

Severe acute electrolyte disturbance for example:
- hyperkalemia with K+ > 6.5 mmol/L OR > 6.0 mmol/L with ECG changes
- hypokalemia with K+ < 2.5 mmol/L OR < 3.0mmol/L with symptoms
- severe metabolic acidosis (HCO3 < 15mmol/L)
Severe hypertension especially when accompanied with declining kidney function
Patients with severe uraemic symptoms or signs
Evidence of acute fluid overload or heart failure in a patient with known CKD
Kidney transplant recipients with acute intercurrent illness
Peritoneal or haemodialysis patients with acute issues or problems with dialysis access (eg vascular access issues or peritoneal dialysis catheter issues)
Peritoneal dialysis patients with suspected peritonitis (abdominal pain, cloudy dialysis fluid)

Cystic kidney disease

Significant cyst haemorrhage, suspected septicaemia related to cyst infection, suspected rupture of berry aneurysm

Glomerular Disease

Suspected Glomerular Disease (proteinuria and haematuria) with acutely declining kidney function or patient systemically unwell

Haematuria

Severe macroscopic haematuria

Hypertension

Severe hypertension (systolic BP >220/140~~180~~or >180/110 if under 50 years of age) with no known ischaemic heart disease, cardiomyopathy, or chronic kidney disease AND any of the following concerning features:
- headache
- confusion
- blurred vision
- retinal haemorrhage
- reduced level of consciousness
- seizures
- proteinuria
- papilloedema
- signs of heart failure
- chest pain
- acute kidney injury
- suspicion of aortic dissection
- new neurological deficits
If suspected gestational hypertension or pre-eclampsia refer patient to the emergency department of a facility that offers obstetric services where possible
If hypertension service available refer to hypertension service

Kidney Stones

Suspected urolithiasis / nephrolithiasis with infection or severe pain
Suspected urinary retention/obstruction (eg anuria, oliguria)

Proteinuria

Nephrotic syndrome (proteinuria > 3.5 grams/24 hours OR urine ACR > 300mg/mmol* or PCR > 300g/mol*) with any of the following concerning features:
- significant peripheral oedema
- signs of pulmonary oedema
- severe hypertension
- signs of DVT / PE
- infection
- acute kidney injury

Useful Management Information

Refer to local Healthpathways or local guidelines
Consider withholding ACE-Inhibitor, ARB, diuretics, NSAIDs, metformin, sulphonylureas, SGLT2 inhibitors
Consider dose adjustment of medication

Clinician resources

KHA-CARI – Acute kidney injury

Patient resources

Kidney Health Australia – Acute kidney injury

Minimum Referral Criteria

Does your patient meet the minimum referral criteria?

Category 1 (appointment within 30 calendar days)	Abrupt and significant decline in kidney function that does not require referral to emergency but where specialist review is required, for example Increase in serum creatinine by >26.5µmol/L known to have occurred in the last 48 hours OR creatinine increase 1.5-2-fold from baseline which has presumed to have occurred within the last 7 days
Category 2 (appointment within 90 calendar days)	No category 2 criteria
Category 3 (appointment within 365 calendar days)	No category 3 criteria
If the patient does not meet the criteria for referral but the referring practitioner believes the patient requires specialist review, a clinical override may be requested: Please explain why (e.g. warning signs or symptoms, clinical modifiers, uncertain about diagnosis, etc.) Please note that your referral may not be accepted or may be redirected to another service.

Standard Referral Information

Reason for request

To establish a diagnosis
For treatment or intervention
For advice and management
For specialist to take over management
Reassurance for GP/second opinion
For a specified test/investigation the GP can't order, or the patient can't afford or access
Reassurance for the patient/family
For other reason (e.g. rapidly accelerating disease progression)
Clinical judgement indicates a referral for specialist review is necessary

Relevant clinical information about the condition

Presenting symptoms (evolution and duration)
Physical findings
Details of previous treatment (including systemic and topical medications prescribed) including the course and outcome of the treatment
All conservative options that have been pursued unsuccessfully prior to referral
Body mass index (BMI)
Details of any associated medical conditions which may affect the condition or its treatment (e.g. diabetes), noting these must be stable and controlled prior to referral
Any special care requirements where relevant (e.g tracheostomy in place, oxygen required)
Current medications and dosages
Drug allergies
Alcohol, tobacco and other drugs use

Patient's Demographic Details

Full name (including aliases)
Date and country of birth
Residential and postal address including whether patient resides at an aged care facility
Telephone contact number/s – home, mobile and alternative
Medicare number (where eligible)
Name of the parent or caregiver (if appropriate)
Name of delegate and contact details (Department of Corrective Services)
Preferred language and interpreter requirements
Identifies as Aboriginal and/or Torres Strait Islander
Any special needs, access requirements and/or disability relevant to the referral

Referring Practitioner Details

Full name
Full address
Contact details – telephone, fax, email
Provider number
Date of referral
Signature
Nominated general practitioner’s details (if known), if the nominated general practitioner is different from the referring practitioner

Other relevant information

Willingness to have surgery (where surgery is a likely intervention)
Choice to be treated as a public or private patient
Compensable status (e.g. DVA, Work Cover, Motor Vehicle Insurance, etc.)

Essential Referral Information

Presence of comorbid conditions such as hypertension, diabetes or vascular disease
List of medications
BP records (if available)
Serial ELFTs including urea, creatinine and eGFR results
FBC
Urine albumin-to-creatinine ratio (ACR) or urine protein-to-creatinine ratio (PCR) (ideally early morning sample, but a random sample is acceptable)
Urine midstream M/C/S (including testing for red cell morphology and casts preferable)
Ultrasound (kidney, ureters & bladder) and any other available relevant imaging results

Additional Referral Information

Timeline of symptoms
Presence or absence of oedema
Other supportive investigative tests indicated including:
- If urine ACR>30mg/mmol or haematuria present with acute decline in kidney function include ACNA, ANA, ENA & anti DNA Abs, C3/C4 and Hepatitis B/C serology
- If myeloma suspected, include paraprotein testing eg FLC, SEPP, Urine BJP

Send Referrals To

Smart Referrals

Preferred Method
About Smart Referrals

Secure Web Transfer

Medical Objects Account: GQ42150009Z

HealthLink EDI: Qldgchsd

Internal Referrals

Nephrology qhRefer

Fax

(07) 5687 4497

Post

Booking and Referral Centre
Gold Coast University Hospital
1 Hospital Boulevard
Southport QLD 4215

Enquiries

1300 559 083

Related HealthPathways

No directly related pathways found

HealthPathways home page

Service Availability

Dr Jagadeesh Kurtkoti

Medical Director Nephrology/Renal Medicine

Facilities

Gold Coast University Hospital

If you would like to send a named referral, please address it to the specialist listed above, who will allocate a suitably qualified specialist to see the patient. Alternatively, you can view a full list of our specialists.

Acute decline in kidney functionAdult