Referral to emergency

If any of the following are present or suspected, please refer the patient to the emergency department (via ambulance if necessary) or seek emergent medical advice if in a remote region.

  • oliguria/anuria over 24 hours
  • severe electrolyte disturbance for example:
    • hyperkalaemia with potassium (K+) > 6.5 mmol/L
    • hypokalaemia with K+ < 2.5 mmol/L
  • blood pressure > 180/120 mm Hg requires careful monitoring and consideration of referral to emergency department if there are any other concerns
  • evidence of acute fluid overload or heart failure
  • acute decompensated liver failure

Please contact the on-call registrar to discuss your concerns prior to referral.

For clinical advice, please telephone the relevant specialty service.

Central Adelaide Local Health Network

Northern Adelaide Local Health Network 

Southern Adelaide Local Health Network

Category 1 (appointment clinically indicated within 30 days)

  • stage 5 chronic kidney disease (CKD) (estimated glomerular filtration rate [eGFR] < 15mL/min/1.73m2) that does not require referral to emergency
  • stage 4 CKD (eGFR 15-29 mL/min/1.73m2) with any of the following:
    • severe complications - renal bone disease, acidosis, hyperkalaemia
    • symptoms of CKD - fatigue, restless legs, itch, weight loss, mild uremic symptoms
    • multiple contributing comorbidities
    • rapid deterioration
  • known CKD with severe anaemia (< 80g/L)
  • persistent nephrotic range proteinuria - urine albumin to creatinine ratio (ACR) > 220mg/mmol or protein-creatinine ratio (PCR) > 350g/mol

Category 2 (appointment clinically indicated within 90 days)

  • stage 4 CKD (eGFR 15-29 mL/min/1.73m2) that does not meet category 1 criteria 
  • stage 3a or 3b CKD with progressive deterioration in eGFR despite treatment— deterioration in eGFR > 15 mL/min/1.73m2 or > 25% over 12 months
  • CKD with resistant hypertension despite at least three antihypertensive agents including at least one diuretic
  • chronic anaemic (Hb 80-100g/L) with CKD stage 3a or 3b where other causes have been exlcuded
  • persistent sub-nephrotic range macroalbuminuria - urine ACR 30-300mg/mmol or PCR 60-300g/mol
  • CKD with uncontrolled hypertension that are not achieving blood pressure target
  • CKD without clear diagnosis
  • CKD of any stage for preconception counselling

Category 3 (appointment clinically indicated within 365 days)

  • nil

Essential referral information

Completion required before first appointment to ensure patients are ready for care. Please indicate in the referral if the patient is unable to access mandatory tests or investigations as they incur a cost or are unavailable locally.

Ideally, pathology should be repeated one week prior to scheduled appointment with Nephrologist. Please intstrust your patient to do this and provide the necessary pathology forms (repeat electrolytes, urea and creatinine (EUC) and complete blood examination (CBE) at a minimum).

Clinical features

  • reason for referral
  • current medications and six month medication history relevant to renal disease
  • past medical history: cardiovascular disease, diabetes mellitus, hypertension (include historical blood pressure readings), medical comorbidities, family history, previous medical reactions and allergies

Investigations and correspondence

  • all recent and relevant past kidney function tests:
    • electrolytes, urea and creatinine (EUC)
    • complete blood examination (CBE)
    • liver function tests (LFT)
    • urine microscopy, culture and sensititivies (MCS)
    • urine albumin/creatine ratio (ACR) - ideally first void early morning but a random sample is acceptable
    • imaging - ultrasound of kidneys, ureters and bladder
    • serial urea, creatinine and estimated glomerular filtration rate (eGFR) results demonstrating abnormal eGFR over at least three months
    • iron studies, vitamin B12 and folate - essential if referring for anaemia
  • copies of other relevant letters should accompany the referral

Additional information to assist triage categorisation

  • C-reactive protein (CRP) optional

Reason for request

  • to establish a diagnosis
  • for treatment or intervention
  • for advice and management
  • for specialist to take over management
  • for a specified test/investigation the General Practitioner cannot order
  • for other reason (e.g. rapidly accelerating disease progression)
  • transfer of care from another tertiary service
  • clinical judgement indicates a referral for specialist review is necessary.

Patient demographic details

  • 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

Clinical modifiers

  • 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

Other relevant information

  • 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.
  • Relevant social history, including identifying if you feel your patient is from a vulnerable population, under guardianship/out-of-home care arrangements and/or requires a third party to receive correspondence on their behalf.
  • Triage of a specialist outpatient referral is based on clinical decision making to allocate an appropriate urgency categorisation.
  • Where appropriate and where available, the referral may be streamed to an associated public allied health and/or nursing service. Access to some specific services may include initial assessment and management by associated public allied health and/or nursing, which may either facilitate or negate the need to see the public medical specialist.
  • A change in patient circumstance (such as condition deteriorating or pregnancy) may affect the urgency categorisation and should be communicated as soon as possible.
  • All new referrals will be triaged by a consultant and appointment times scheduled according to clinical urgency.