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This page contains information for general practitioners on how to refer patients aged 16 years and over Nephrology services to Mater Hospital Brisbane.
The Mater Nephrology service comprises of nephrologists and a dedicated Clinical Nurse Consultant with access to allied health specialists to provide a comprehensive, individualised approach to patient care. Weekly multidisciplinary team meetings are held to discuss complex cases and develop individualised care plans.
In addition to inpatient beds and outpatient clinics the Nephrology service also offers in centre and satellite haemodialysis services at the Brisbane Dialysis Clinic (South Brisbane) and Brookwater Dialysis Clinic (Brookwater). Please note that the Nephrology service does not accept patients requiring peritoneal dialysis or home dialysis.
Specialised young adult options are also available for patients aged 16-25 years old who have undergone transplants in paediatric health services, through the Mater Young Adult Health Centre Brisbane (MYAHCB) . This clinic offers a number of clinical services and programs that have been specifically developed with young people in mind.
The Mater Nephrology service is also an academic unit involved in clinical research and teaching of medical students from the University of Queensland.
How to send a referral
Please call your local nephrology service if there is any doubt regarding the urgency of referral for an unwell patient.
Acute decline in Kidney function:
Chronic Kidney Disease:
Cystic kidney Disease
Glomerulonephritis
Haematuria:
Hypertension
If suspected pregnancy induced hypertension or pre-eclampsia refer patient to emergency department of a facility that offers obstetric services where possible
Nephrolithiais- recurrent
Protienuria
Other
For this referral to progress we require Essential information General Referral Information Presence of comorbid conditions such as hypertension, diabetes or vascular disease List of medicines BP records (if available) FBC Serial ELFTs including urea, craetinine and eGFR results Urine midstream M/C/S (including testing for red cell morphology and casts preferable) Urinalysis including albumin creatinine ratio (ACR) and protein creatinine ratio (PCR)(Ideally early morning sample, but a random sample is acceptable) Ultrasound (kidney, ureters and bladder) and any other available relevant imaging results Additional referral information (useful for processing the referral) Timeline of symptoms Presence or absence of oedema Other supportive tests If macroalbumiuria present, include ANCA, ANA, ENA and anti DNA Abs, C3/C4 and Hepatitis B/C serology If myeloma suspected, include paraprotein testing e.g. FLC, SEPP, BJP Other useful information for management (not an exhaustive list) Refer to local Health pathways or local guidelines Consider withholding ACE- Inhibitor, ARB, diuretics, NSAIDS, metformin, sulphonylureas, SGLT2 inhibitors Consider dose adjustment of medication Clinician resources KHA-CARI – Acute kidney injury Patient resources Kidney Health Australia – Acute kidney injury Categorisation Available appointments are provided to our patients based on clinical priority. A process of categorisation ensures safety and equity of access.
For this referral to progress we require
Essential information
Additional referral information (useful for processing the referral)
Other useful information for management (not an exhaustive list)
Clinician resources
Patient resources
Categorisation
Available appointments are provided to our patients based on clinical priority. A process of categorisation ensures safety and equity of access.
Category 1 – urgent
Clinically recommended timeframe for initial appointment is 30 days
Category 2 - Priority
Clinically recommended timeframe for initial appointment is 90 days
Category 3 - Routine
Clinically recommended timeframe for initial appointment is 365 days
Abrupt and significant decline in kidney function that does not require referral to emergency but where specialists review is required, for example:
No category 2 criteria
No category 3 criteria
For this referral to progress we require Essential information General Referral Information Presence of comorbid conditions such as hypertension, diabetes or vascular disease List of medicines Recent BP results FBC & ELFTs Serial urea, craetinine and eGFR results demonstrating abnormal eGFR over at least 3 months Urine midstream M/C/S (including testing for red cell morphology and casts preferable) Urinalysis including albumin creatinine ratio (ACR) and protein creatinine ratio (PCR)(Ideally early morning sample, but a random sample is acceptable) Ultrasound (kidney, ureters and bladder) and any other available relevant imaging results Additional referral information (useful for processing the referral) Timeline of the symptoms Ethnicity (with Aboriginal and Torres Strait Islander population at risk) Family history of kidney disease Kidney biopsy report (if available) Iron studies (essential if referring for anaemia) Other supportive investigative tests indicated including : If haematuria or macroalbuminuria present, include ANCA, ANA, ENA, and anti DNA Abs, C3/C4 and Hepatitis B/C serology If myeloma suspected, include paraprotein testing (especially if proteinuria) eg FLC, SEPP, BJP PTH B12, Folate Other useful information for management (not an exhaustive list) Refer to Healthpathways or local guidelines At the level of nephrotic range proteinuria, albumin accounts for 60-7-% of total urinary protein. Within the CPC, ACR >300mg/mmol OR PCR > 3000g/mol has been used for simplicity and ease of application.
At the level of nephrotic range proteinuria, albumin accounts for 60-7-% of total urinary protein. Within the CPC, ACR >300mg/mmol OR PCR > 3000g/mol has been used for simplicity and ease of application.
Before waiting 3 months to refer, it is important to establish that there is no evidence of acute kidney injury.
In absence of other referral indicators, referral is not necessary if;
The decision to refer or not must always be individualised, and particularly in younger individuals the indication for referral may be less stringent. Discuss management issue with a specialists by letter, email, telephone in case where it may not be necessary for the person with CKD to be seen by specialists.
Categorisation Available appointments are provided to our patients based on clinical priority. A process of categorisation ensures safety and equity of access.
Stage 5 CKD (eGFR < 15) that does not require referral to emergency
Stage 4 CKD (eGFR 15-29) with any of the following:
Known CKD with severe anaemia (Hb < 80g/L)
Persitant nephrotic range proteinuria*(urine ACR>220mg/mmol OR PCR > 350g/mol)
NB: eGFR units: mL/min/1.73m2
Stage 4 CKD (eGFR 15-29) that do not meet Category 1 criteria
Stage 3a or b CKD with progressive deterioration in eGFR (eGFR > 15mL/min/1.73m2 OR 25% over 12 months) despite treatment
CKD with resistant hypertension despite at least three antihypertensive agents including at least one diuretic
Chronic anaemia (Hb 80-100g/L) with CKD Stage 3a or b where other causes have been excluded
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 disgnosis
For this referral to progress we require Essential information General referral information Presence of comorbid conditions such as hypertension, diabetes or vascular disease Family History of kidney disease List of medicines FBC / ELFT results Urine midstream M/C/S (including testing for red cell morphology and casts preferable) Urine albumin creatinine ratio (ACR) and protein creatinine ratio (PCR) (ideally early morning sample but a random sample is acceptable Ultrasound (kidney, ureters and bladder) and any other available relevant imaging results Recent BP results Additional referral information (useful for processing the referral Serial imaging results Other useful information for management (not an exhaustive list) Refer to Healthpathways or local guidelines Main disorder in this category Cystic kidney disease Autosomal dominant polycystic kidney disease (ADPKD) Autosomal recessive polycystic kidney disease Nephronophthisis (juvenile and adult) Autosomal dominant tubulointerstitial kidney disease (medullary cystic kidney disease) Medullary sponge kidney Associated with multiple malformation syndrome Tuberous sclerosis complex, Lowe's syndrome, Von Hippel-Lindau Disease Acquired cystic kidney disease Note that Complex cysts (Bosniak type 2 or above) should be referred to urology (where available) Refer to Health pathways or local guidelines Patient resources Kidney Health Australia - Polycystic Kidney Disease Polycystic Kidney Disease Australia Categorisation Available appointments are provided to our patients based on clinical priority. A process of categorisation ensures safety and equity of access.
Additional referral information (useful for processing the referral
Main disorder in this category
Note that Complex cysts (Bosniak type 2 or above) should be referred to urology (where available)
Multicystic kidney disease associated with severe symptoms or complications (example- pain, haemorrhage, recurrent infection)
Multicystic kidney disease
Asymptomatic Multicystic kidney disease
For this referral to progress we require Essential information General Referral Information Presence of comorbid conditions such as SLE or other autoimmune condition, hypertension, diabetes or vascular disease List of medicines or allergies FBC / ELFT results Serial urea, creatinine & eGFR results Urine midstream M/C/S (including testing for red cell morphology and casts preferable) Urine albumin creatinine ratio (ACR) and protein creatinine ratio (PCR) (ideally early morning sample but a random sample is acceptable Recent BP results Additional referral information (useful for processing the referral) Timeline of Symptoms Ethnicity (with Aboriginal and Torres Strait Islander population at risk) Family history of kidney disease Examination findings including oedema, rash, recent throat infection Ultrasound (kidney, ureters and bladder) and any other available relevant imaging results Other supportive investigative tests if indicating including: ANCA, ANA, ENA and anti DNA Abs (if suspected or confirmed autoimmune condition that may impact on kidney function) Hepatitis B/C serology especially if proteinuria Paraprotein testing eh FLC, SEPP, BJP if myeloma suspected Complement C3/C4 Anti GBM antibodies Anti-streptococcal antibodies Kidney biopsy report (if previously performed) Other useful information for management (not an exhaustive list) Refer to Healthpathways or local guidelines Please call your nephrologists if any doubt of urgency of acute referral as direct ward admission may be considered Please consider multi system involvement especially possibility of pulmonary haemorrhage Clinician resources KDIGO Clinical Practice Guideline for Glomerulonephritis Patient resources Kidney Health Australia Nephritis fact sheet Lupus nephritis fact sheet IgA nephritis fact sheet Categorisation Available appointments are provided to our patients based on clinical priority. A process of categorisation ensures safety and equity of access.
Acute Glomerulonephritis (proteinuria and haematuria)
NB: Please call your local nephrologists if any doubt of urgency of acute referral as direct ward admission may be considered.
Previous diagnosed chronic glomerulonephritis patient requiring ongoing specialists follow up
For this referral to progress we require Essential information General Referral Information Presence of comorbid conditions such as hypertension, diabetes or vascular disease List of medicines Presence or absence of pain FBC / ELFT results Serial urea, creatinine and eGFR results Urine midstream M/C/S (including testing for red cell morphology and casts preferable) Urine albumin creatinine ratio (ACR) and protein creatinine ratio (PCR) (ideally early morning sample but a random sample is acceptable Ultrasound (kidney, ureters and bladder) and any other available relevant imaging results Recent BP result Additional referral information (useful for processing the referral) Urologic Malignancy Test results (eg urine cytology (x3) results) Other useful information for management (not an exhaustive list) Refer to Healthpathways or local guidelines Refer to Haematuria flowchart for guidance in determining whether to refer to urology or nephrology Exclusion of lower tract source of haematuria for those at risk of urological malignancy is important Categorisation Available appointments are provided to our patients based on clinical priority. A process of categorisation ensures safety and equity of access.
Microscopic haematuria with rapid decline in kidney function (>25% decline in eGFR in 6-12 weeks) and urological cause is eliminated
Persistent Microscopic haematuria wit coexisting proteinuria and stable or slow progressing decline in kidney function (<25% decline in eGFR in 6-12 weeks)
Previously diagnosed chronic glomerulonephritis who require ongoing specialists follow up.
Asymptomatic persistant microscopic haematuria where urological cause is eliminated
For this referral to progress we require Essential information General Referral Information Presence of comorbid conditions such as hypertension, diabetes or vascular disease List of medicines including details of all treatments offered and efficacy FBC / ELFT and eGFR resultsresults Urine midstream M/C/S (including testing for red cell morphology and casts preferable) Urine albumin creatinine ratio (ACR) and protein creatinine ratio (PCR) (ideally early morning sample but a random sample is acceptable Ultrasound (kidney, ureters and bladder) and any other available relevant imaging results History of BP measurements including 24-hour measurements or home measurements if available Renal duplex report (only where renal artery stenosis is suspected) Additional referral information (useful for processing the referral) History of smoking, alcohol or drug use (including recreational drugs) Ethnicity (with Aboriginal and Torres Strait Islander population at risk) ECG and echocardiogram results Any investigations relevant to co-morbidities or where results exclude other secondary causes eg sleep study, endocrine tests Other useful information for management (not an exhaustive list) Refer to Healthpathways or local guidelines Categorisation Available appointments are provided to our patients based on clinical priority. A process of categorisation ensures safety and equity of access.
Severe hypertension (>180/110 but below 220/140) that persists after trail of oral medication as described by the Heart Foundation Hypertension Guide but without any of the concerning features:
If suspected pregnancy induced hypertension or pre-eclampsia refer patient to the emergency department of a facility that offers obstetrics service where possible
Suspected or confirmed artery stenosis
Patient with resistant hypertension despite on three or more hypertensive medicines including diuretic in the context of CKD
Patients with uncontrolled hypertension and CKD
Hypertension without clear diagnosis especially in young patients
For this referral to progress we require Essential information General Referral Information Detailed history of nephrolithiasis episodes Urine microscopy for evaluation of urinary sediment and urine albumin creatinine ratio FBC, ELFT, urea, creatinine, eGFR, calcium, Mg and PO4 results Ultrasound (kidney, ureters and bladder) or CT results Additional referral information (useful for processing the referral) Family History of chronic kidney disease and /or calculi Stone analysis Record of any previous urinalysis and urinary biochemistry (if available) Record of any previous calculus biochemistry (if available) BP Other useful information for management (not an exhaustive list) Refer to Health pathways or local guidelines Generally, patients with systemic illness, renal tubular dysfunction or metabolic involvement would require referral to nephrology rather than urology where possible
Generally, patients with systemic illness, renal tubular dysfunction or metabolic involvement would require referral to nephrology rather than urology where possible
No Category 1 criteria
No Category 2 criteria
Recurrent nephrolithiasis with any of the following
For this referral to progress we require Essential information General Referral Information Presence of comorbid conditions such as hypertension, diabetes, vascular disease or known CKD. Current medications, medication history and allergies Examination of the findings including BP, peripheral oedema, signs of pulmonary oedema FBC, ELFT, urea, creatinine & eGFR results (also include previous kidney related pathology results to use as a baseline) Urine midstream M/C/S (including testing for red cell morphology and casts preferable) Urine albumin creatinine ratio (ACR) or urine protein creatinine ratio (PCR) (ideally early morning sample but a random sample is acceptable) Timeline of the symptoms Additional referral information (useful for processing the referral) Fasting Lipid results HbA1c results (for the patients with diabetes) Ethnicity (with Aboriginal and Torres Strait Islander population at risk) Ultrasound (kidney, ureters and bladder) results Other useful information for management (not an exhaustive list) * At the level of nephrotic range proteinuria, albumin accounts for 60-7-% of total urinary protein. Within the CPC CPC, ACR > 300mg/mmol OR PCR >300g/mol has been used for simplicity and ease of application. Quantifying proteinuria (Source- Tasmanian Health 2018) Urine ACR (random or first morning) is generally a sufficient screen for albuminuria/microalbuminuria in diabetic and non-diabetic populations and is a useful test in most renal clinic referrals (first morning specimens increase specificity - but not necessary)Additional protein creatinine ration testing can assist with diagnostic evaluation 24 hour quatification: Where urine ACR is significantly elevated (>100 mg/mmol) consideration can be given to 24 - hour urine protein collections (not generally required in most low-level albuminuria but is more likely to be helpful in those with suspected nephrotic syndrome) Low level albuminuria/proteinuria can occure transiently during fever, cardiac failure, after strenuous exercise (usually no more than trace on dipstick) Haematuria and proteinuria present together is strongly suggestive of glomerular source for haematuria As per KHA guidelines, persistent significant albuminuria (ACR>30mg/mmol) should be referred Referral is not necessary for a urine ACR < 30mg/mmol with no haematuria Refer to Healthpathways or local guidelines Clinician resources Proteinuria Consensus Statement, 2012 Patient resources Kidney Health Australia – Albuminuria fact sheet Categorisation Available appointments are provided to our patients based on clinical priority. A process of categorisation ensures safety and equity of access.
* At the level of nephrotic range proteinuria, albumin accounts for 60-7-% of total urinary protein. Within the CPC CPC, ACR > 300mg/mmol OR PCR >300g/mol has been used for simplicity and ease of application.
Quantifying proteinuria (Source- Tasmanian Health 2018)
As per KHA guidelines, persistent significant albuminuria (ACR>30mg/mmol) should be referred
Nephrotic range proteinuria * (urine ACR >220mg/mmol or PCR >350g/mol) with out concerning features
Proteinuria (Urine ACR 30-220mg/mmol or PCR 60-350g/mol) with a declining eGFR but without concerning features:
Please call your local nephrologist if any doubt of urgency of acute referral as direct ward admission may be considered
Sub-nephrotic macroalbuminuria (urine ACR 25-220mg/mmol for men or urine ACR 35-350mg/mmol for women or PCR 60-350g/mol) with stable eGFR
Asymptomatic microalbuminuria (urine ACR <25mg/mmol for men or < 35mk/mmol for women or PCR < 50g/mol) with other evidence of kidney disease (eg haematuria)
Mater Health offers patients the opportunity to attend bulk billed clinics. To provide your patient with the opportunity to attend a bulk billed clinic, please provide a named referral to one of the specialists listed above.
If you would like to discuss a referral, including clinical criteria, or update the status of a current patient please contact our priority GP phone line on 07 3163 2200
We provide up to date data on how long patients are waiting for their first appointment by specialty here.
These Mater Referral Guidelines align with standardised best practice tools for referral to publicly funded specialist outpatient services developed in Queensland through the Clinical Prioritisation Criteria project.
Content last reviewed: 13 December 2023
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