This site is intended for healthcare professionals

Go to /sign-in page

You can view 5 more pages before signing in

Referral criteria from primary care - kidney disease

Last reviewed dd mmm yyyy. Last edited dd mmm yyyy

Authoring team

NICE suggest referral criteria for patients with CKD as (1):

  • people with CKD in the following groups should normally be referred for specialist assessment:

    • a 5-year risk of needing renal replacement therapy of greater than 5% (measured using the 4-variable Kidney Failure Risk Equation)
    • an ACR of 70 mg/mmol or more, unless known to be caused by diabetes and already appropriately treated
    • an ACR of more than 30 mg/mmol (ACR category A3), together with haematuria
    • a sustained decrease in eGFR of 25% or more and a change in eGFR category within 12 months
    • a sustained decrease in eGFR of 15 ml/min/1.73 m2 or more per year
    • hypertension that remains poorly controlled (above the person's individual target) despite the use of at least 4 antihypertensive medicines at therapeutic doses
    • known or suspected rare or genetic causes of CKD
    • suspected renal artery stenosis

  • Refer children and young people with CKD for specialist assessment if they have any of the following:
    • an ACR of 3 mg/mmol or more, confirmed on a repeat early morning urine sample
    • haematuria
    • any decrease in eGFR
    • hypertension
    • known or suspected rare or genetic causes of CKD
    • suspected renal artery stenosis
    • renal outflow obstruction

  • people with CKD and renal outflow obstruction should normally be referred to urological services, unless urgent medical intervention is required - for example, for the treatment of hyperkalaemia, severe uraemia, acidosis or fluid overload

More detailed guidance regarding nephrology referrals was previously stated as (2):

  • Immediate review
    • if suspected acute renal failure (ARF)
    • if ARF superimposed on CKD
    • if newly detected ERF (GFR < 15 mL/min/1.73 m2)
    • accelerated or malignant phase hypertension with suspicion of underlying kidney disease (or if there is no specialist hypertension service available locally)
    • hyperkalaemia, serum potassium >= 6.5 mmol/L (3)
  • Urgent outpatient review
    • nephrotic syndrome
    • if newly detected stage 4 (unless known to be stable) or stable stage 5 CKD
    • multisystem disease (e.g. SLE, systemic vasculitis) with evidence of kidney disease
    • hyperkalaemia, serum potassium 6.0-7.0 mmol/L (after exclusion of artefactual and treatable causes)
  • Routine outpatient review
    • refractory hypertension (defined as sustained BP >150/90 mm Hg despite combination therapy with 3 drugs from complementary classes)
    • acute deterioration in kidney function (defined as a fall of GFR of >20% or rise of serum creatinine concentration of >30% from baseline) associated with use of ACEIs or ARBs
    • proteinuria (urine protein >100 mg/mmol) without nephrotic syndrome
    • proteinuria with haematuria
    • diabetes with increasing proteinuria but without diabetic retinopathy
    • stage 3 CKD with haematuria
    • urologically unexplained macroscopic haematuria (with or without proteinuria)
    • recurrent unexplained pulmonary oedema with clinical suspicion of atherosclerotic renal artery stenosis (ARAS)
    • falling GFR (>15% fall over 12 months) with clinical suspicion of ARAS
    • PTH >70 ng/L (7.7 pmol/L) after exclusion or treatment of vitamin D deficiency
    • stable stage 4 CKD if referred
  • Conditions appropriate for GP care +/- 'virtual' nephrology support/advice  
    • isolated microscopic haematuria (after negative urological evaluation where appropriate)
    • isolated proteinuria with urine protein:creatinine ratio < 100 mg/mmol
    • known or suspected polycystic kidney disease with GFR > 60 ml/min/1.73 m2
    • known reflux nephropathy in stage 1-3 without the above
    • all other stage 1-2 CKD
    • stable stage 3 or 4 CKD with no other indication for referral

Notes (3):

  • the threshold for emergency treatment varies, but most guidelines recommend that emergency treatment should be given if the serum K+ is >= 6.5 mmol/L with or without ECG changes

Reference:

  1. NICE (August 2021). Chronic kidney disease: assessment and management
  2. The Renal Association (2007).UK CKD Guidelines
  3. The Renal Association UK (March 2014). The management of hyperkalaemia in adults.

Related pages

Create an account to add page annotations

Annotations allow you to add information to this page that would be handy to have on hand during a consultation. E.g. a website or number. This information will always show when you visit this page.