Associates of Kentuckiana, PSC provides care for all aspects of the prevention and
treatment of kidney disease. As a referring physician, you may wonder
when is the right time to refer a patient to a Nephrologist. Any time
you would like our help, input or advice in regard to your patient's
some general guidelines to help you in making that decision as well as
some helpful presentations by
Dr. Danny Woo.
There are several “absolute”
criteria. To us this means that no matter how extensive the
workup and treatment are at the primary care office, these conditions
will require nephrology intervention at some point:
with calculated GFR < 60 and concomitant proteinuria, hematuria and/or
with GFR < 30
All patients with GFR < 60 and declining.
Diabetics with proteinuria.
diagnosis of polycystic kidney disease on CT, US or MRI.
proteinuria quantitated greater than 500 mg/day.
syndrome (Heavy proteinuria, edema, hypoalbuminemia, and hyperlipidemia)
the combination of proteinuria and hematuria or pyuria (even when
proteinuria is low-grade). See note below.
have a kidney transplant.
expected to need dialysis.
are several conditions for which you may desire
having us consult, at your discretion:
of blood pressure in a previously stable patient.
- In a person under the age of 35
- In a person on 3 or more antihypertensive medications
- In a person with any degree of kidney disease
proteinuria (1+ or 2+)
mellitus with difficult to control hypertension and/or proteinuria.
See Note below
Patients with a
history of nephrectomy and/or a solitary kidney who have any degree of
abnormalities such as hyponatremia, hypercalcemia, acid base
disturbances, and hyperkalemia, among others.
with any degree of kidney disease.
Low bone density
or bone pain in patients with GFR < 60 cc/min - often related to metabolic bone
Finally, there are some
common conditions that generally do not
require nephrology consultation:
Note: patients with newly discovered
proteinuria with hematuria may have underlying acute nephritis, which
requires rapid work-up and treatment. Nephrology consultation should
occur urgently even when creatinine/GFR appear normal.