When Should You Refer A Patient to Peninsula Kidney Associates?

These conditions require nephrology intervention in a timely fashion:

  • Patients with eGFR < 60 and concomitant proteinuria, hematuria and/or pyuria
  • Patients with eGFR < 60 and his/her GFR has been declining
  • Patients with advanced CKD who will need extensive education for possible kidney transplant and different dialysis modalities
  • Incidental diagnosis of polycystic kidney disease on imaging studies such as ultrasound, CT or MRI
  • Unexplained proteinuria, quantitated greater than 500 mg/day
  • Nephrotic syndrome (with heavy proteinuria, edema, hypoalbuminemia, hyperlipidemia) +/- hypertension
  • Patients with the combination of proteinuria and hematuria or pyuria, even when proteinuria is low-grade.
  • Unexplained hematuria. Patients with newly discovered hematuria +/- proteinuria may have underlying acute glomerulonephritis, which requires rapid work-up and treatment, even when creatinine/eGFR appear normal.
  • Patients who have a kidney transplant
  • Worsening blood pressure control in a previously stable patient
  • Resistant hypertension in a patient under the age of 35, in a patient on 3 or more antihypertensive medications, or in a patient with any degree of kidney disease
  • Recurrent kidney stones
  • Diabetes mellitus with proteinuria and/or difficult-to-control hypertension
  • Patients with a history of nephrectomy and/or a solitary kidney who have any degree of renal insufficiency
  • Recurrent electrolyte abnormalities such as hyponatremia, hypercalcemia, hyper/hypokalemia, hypomagnesemia, and acid base disturbances, among others
  • Refractory edema
  • Pregnant women with any degree of kidney disease
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There are some common conditions that generally do not require nephrology consultation:

  • Solitary simple renal cysts
  • Controlled hypertension in the absence of diabetes and/or abnormal eGFR