• 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 >220/140180or >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