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Specialist referral (proteinuria)

Last reviewed dd mmm yyyy. Last edited dd mmm yyyy

Authoring team

  • in general referral to a nephrologist is indicated if significant proteinuria (protein:creatinine ratio> 100 mg/mmol)
    • however proteinuria > 50 mg/mmol may be significant if other features of renal disease are present (e.g. impairment of renal function, coexistent microscopic haematuria, hypertension, features indicating an underlying systemic disease) (1)
    • other guidance suggests referral for protein:creatinine ratio >100 mg/mmol, or >45 mg/mmol if co-existing microscopic haematuria or estimated GFR <60mL/min (2)
      • prot/creat ratio at levels <= 45mg/mmol then manage as Chronic Kidney Disease (CKD), according to stage
    • if referring a patient for nephrology review then consider initiating other investigations such as renal tract ultrasonography, immunology (serum and urine protein electrophoresis, antinuclear antibodies, antineutrophil cytoplasmic antibodies, complements), and hepatitis B and C serology


  1. Haynes J, Haynes R. Proteinuria. BMJ 2006; 332:284.

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