Diabetic kidney disease

Red flags

Consider urgent referral for patients with the following

Sudden rapid deterioration of renal function
Haematuria with renal function deterioration
Uncontrolled BP with proteinuria
Hyperosmolar diabetic state

Other important information for referring practitioners

Lifestyle changes

Encourage healthy diabetic diet and activity
Encourage self- monitoring of fluid balance with daily weighs

Medical management

Control BP
Maintain tight control of diabetes
Monitor for side effects from drugs with adverse renal side effects
- Avoid NSAID use
- Care using metformin

Referral requirements

A referral may be rejected without the following information.

Essential referral information

Reason for referral
Presence of any Red Flags
Timeline of diabetes
- List other co-existing diabetic complications
Co-Morbidities (e.g. IHD, obesity, hypercholesterolaemia, hypertension etc)
Current Medication List and allergies
Relevant examination findings
- BP, weight, BMI
- Presence of oedema
Investigations
- FBC, E/LFTs with eGFR, HBA1c
- If anaemic include iron studies, B12 and folate, CRP and PTH
- MSU microscopy for RBC with morphology, casts
- Random urinary albumin/creatinine ratio

Additional referral information (useful for processing the referral)

24hr urinary protein
Renal ultrasound
Letters containing opinion or comment from any other health workers involved in diabetic care e.g. diabetic educators, dieticians, endocrinologists etc.

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