Early Referral

Why is early referral of your patients important?
By consulting with a Nephrologist, earlier rather than later, you can benefit from their specific strategies to improve the overall care of YOUR patients. Your nephrologist partner can provide specific recommendations that YOU can implement to more effectively delay the progression of kidney disease in your patients.

A referral should be made to a nephrologist if any of the following conditions exist in your patient:

  • Elevated Serum Creatinine – Even a mildly elevated serum creatinine is a very strong indicator of chronic kidney disease (CKD). The 1993 NIH Consensus Statement on Morbidity and Mortality of Dialysis recommended that referral of a patient to a nephrologist should occur at a serum creatinine of 1.5 mg/dL in women and 2 mg/dL in men. (reference: Ann Intern Med 121:62,1994)
  • Estimated GFR (eGFR) < 59 – Timely referral to a nephrologist can also be determined by calculating the glomerular filtration rate (GFR). Click HERE to access a GFR Calculator for Adults (patients 18-70).

NOTE: THE FORMULA USED TO CALCULATE EGFRS IN ALL CALCULATORS IS ONLY VALID FOR AMBULATORY PATIENTS BETWEEN THE AGES OF 18 – 70 YEARS OF AGE

  • Irrespective of Serum Creatinine or eGFR levels, patients should be referred to a nephrologist if they have any of the following:
    • Abnormal urinary sediment in patients with diseases associated with a high incidence of kidney disease, such as diabetes mellitus and hypertension, including:
      • Protein
      • Hemoglobin
      • RBCs
      • WBCs
      • casts
    • Primary kidney disease(s)
      • Polycystic Kidney Disease
      • Glomerulonephritis
      • Interstitial nephritis
      • Kidney stones
    • Systemic disease(s) (which may affect the kidneys)
      • Collagen vascular diseases (SLE, scleroderma)
      • Arteriosclerosis
      • Cardiovascular disease (congestive heart failure, coronary artery disease)

GFR is considered by medical professionals to be the best measure of kidney function
Early diagnosis and intervention are critical to patient well-being and longevity when living with Chronic Kidney Disease. The National Kidney Foundation and the American Diabetes Association have determined that GFR is the best overall index of the level of kidney function and allows a physician to properly stage a patient with Chronic Kidney Disease.

StageDescriptionGFRSymptomsTreatment/Next Steps
Stage 1Kidney damage with normal or elevated GFR. Kidneys are minimally damaged and still clean the blood normally.More than 90 mL/minUsually noneDiagnosis and treatment of CKD. Treatment of accompanying conditions. Reducing risk of CKD/slowing its progression.
Stage 2Kidney damage with some decrease in GFR. Kidneys are not functioning normally.60 to 89 mL/minUsually noneEstimating and slowing progression.
Stage 3 (moderate)Moderate decrease in GFR. Kidneys are damaged and are half way to failure.30 to 59 mL/minUsually noneEvaluating and treating complications and slowing progression.
Stage 4 (severe)Severe decrease in GFR. Kidneys are near failure.15 to 29 mL/minThere may be swelling and nausea.Preparation for dialysis and/or transplant.
Stage 5Kidney failure – dialysis required.Less than 15 mL/minThere may be swelling, nausea or shortness of breath.Dialysis is necessary. Kidney transplant possible.