Acute renal failure

(Acute kidney injury and chronic kidney disease)

Red flags

Consider urgent referral for patients with the following

Haematuria associated with fever and or confusion
Unable to pass urine
Severe renal colic with inability to pass urine or reduced urine output
Hyperkalaemia (over 6.0)

Causes of Acute Renal Failure

Pre-Renal
- Shock related
  - Post MI
  - Sepsis
  - Burns
  - Placental abruption
- Dehydration
- Interruption of blood flow
  - Emboli to renal arteries
  - Abdominal aortic aneurysm/dissection
Renal
- Infection related
  - Acute pyelonephritis
- Drug related
  - Aspirin, NSAIDs
- Trauma
  - Direct to kidneys
  - Secondary to shock
  - Massive muscle damage
- Rhabdomyolysis
Post Renal
- Outflow Obstruction
- Acute from stone, bladder retention

Other important information for referring practitioners

Medical management

Restore BP if evidence of hypovolaemia using IV fluids
- This should not delay urgent transfer to DEM
Arrange urgent transfer to DEM

Referral requirements

A referral may be rejected without the following information.

Essential referral information

Presence of any Red Flags
Time line of symptoms
Medication list and allergies
Co-morbid conditions
Relevant examination findings
- BP
- Any evidence of infection
Investigations
- Urine stick testing results
- Send urine sample with patient if available

Additional referral information (useful for processing the referral)

Include last FBC, E/LFTs if available to use as baseline
Renal Ultrasound if available

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