Chronic renal failure

Red flags

Consider urgent referral to DEM for patients with the following

Sudden deterioration of renal function
Development of signs of fluid overload/heart failure in known CKD
Significant biochemical derangement

This is defined, irrespective of cause, over a 3 month period, as

An estimated (eGFR) or measured glomerular filtration rate < 60ml/min/1.73m2 and/or
Evidence of kidney damage
- Albuminuria
- Proteinuria
- Haematuria (after exclusion of haematological causes)
- Structural abnormalities on kidney imaging tests

Kidney function classification and staging

This is based on combined GFR and evidence of kidney damage (albuminuria/proteinuria)

Stage 1 GFR greater than 90 (Normal or increase in GFR)
Stage 2 GFR 60-89 (Normal or slightly decrease in GFR)
Stage 3A GFR 45-59 (Mild-Moderate decrease in GFR)
Stage 3B GFR 30-44 (Moderate-Severe decrease in GFR)
Stage 4 GFR 15-29 (Severe decrease in GFR)
Stage 5 GFR <15 or on dialysis (End-stage kidney failure)

Albuminuria (albumin/creatinine ratio in mg/mmol)

Normoalbuminuria
- Less than 2.5mg/mmol (M) or less than 3.5mg/mmol (F)
Microalbuminuria
- 2.5- 25mg/mmol (M) or 3.5-35mg/mmol (F)
Macroalbuminuria
- Greater than 25mg/mmol (M) or greater than 35mg/mmol (F)

Risk stratification

Albuminuria Stage
Kidney Function Stage	GFR (ml/min/1.73m2)	Normal	Microalbuminuria	Macroalbuminuria
1	>90	Not CKD unless haematuria, structural or pathological abnormalities are present	Moderate	Very high
2	60-89		Moderate	Very high
3a	45-59	Moderate	High	Very high
3b	30-44	High	High	Very high
4	15-29	Very high	Very high	Very high
5	<15 or on dialysis	Very high	Very high	Very high

Other important information for referring practitioners

Lifestyle changes

Encourage low salt, healthy diet and exercise
Encourage self-monitoring of fluid balance with daily weighs

Medical management

Monitor BP and renal function using eGFR
Attend to any biochemical abnormalities if required (particularly to potassium and bicarbonate)
Avoid the use of renotoxic medications e.g. NSAIDs
Educate patient regarding OTC potentially nephrotoxic medications
Perform regular medication reviews to avoid drug interactions

Referral requirements

A referral may be rejected without the following information.

Essential referral information

Reason for referral
Presence of any Red Flags
Timeline of symptoms
- Include underlying cause of renal disease if known
Current management
If previously seen by renal specialist include the last 2-3 letters
Co-morbid conditions
Medication list and allergies
Relevant examination findings
- BP
- Diabetic control (HBA1c) if present
Investigations
- FBC, E/LFT with eGFR
- If anaemic include iron studies, B12 and folate, CRP and PTH
- Urine microscopy for RBC morphology, casts
- Random urine protein, albumin/creatinine ratio
- KUB ultrasound

Additional referral information (useful for processing the referral)

Renal CT/ intravenous pyelogram if done
Renal doppler
24 hr urinary protein excretion
Renal biopsy result

Out of catchment!

Metro North Health is responsible for providing public health services to the people who reside within its boundaries. Special consideration is made for patients requiring tertiary care or services that are not provided by their local Hospital and Health Service. If your patient lives outside the Metro North Health area and you wish to refer them to one of our services, inclusion of information regarding their particular medical and social factors will assist with the triaging of your referral.

Clinical Modifiers (where relevant)

Impact on employment
Impact on education
Impact on home
Impact on activities of daily living
Impact on ability to care for others
Impact on personal frailty or safety
Identifies as Aboriginal and/or Torres Strait Islander

Reason for Referral (essential)

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

Clinical Information (essential)

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
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
Current medications and dosages
Drug allergies
Alcohol, tobacco and other drugs use

Patient’s Demographic Details (essential)

Full name (including aliases)
Date of birth
Residential and postal address
Telephone contact number/s – home, mobile and alternative
Medicare number (where eligible)
Name of the parent or caregiver (if appropriate)
Preferred language and interpreter requirements
Identifies as Aboriginal and/or Torres Strait Islander

Referring Practitioner Details (essential)

Full name
Full address
Contact details – telephone, fax, email
Provider number
Date of referral
Signature

Other Information (where relevant)

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.)

Send referral

Hotline: 1300 364 938

Fax: 1300 364 952

Electronic: eReferral system

Mail: Metro North Central Patient Intake
Aspley Community Centre
776 Zillmere Road
ASPLEY QLD 4034

Health pathways

Access to Health Pathways is free for clinicians in Metro North Brisbane.

For login details email:
healthpathways@brisbanenorthphn.org.au

Locations

Resources

Specialists list