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.
- 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.
- 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
- 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
- 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
- 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
- Full name
- Full address
- Contact details – telephone, fax, email
- Provider number
- Date of referral
- Signature
- 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
Medical Objects ID: MQ40290004P
HealthLink EDI: qldmnhhs
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
Login to Brisbane North Health Pathways:
brisbanenorth.
Locations
- Redcliffe Hospital
- Royal Brisbane and Women's Hospital
- Nundah Community Health Centre
- North Lakes Health Precinct
- Stafford Kidney Health Centre