Can the Nephrologist Order Creatinine and Urine Albumin Labs?
Yes, you should place the orders for serum creatinine and urine albumin-to-creatinine ratio yourself now, rather than waiting for the nephrologist to order them. As the referring primary care physician managing CKD stage 3a with diabetes, you are responsible for ensuring complete baseline laboratory data—including current eGFR and albuminuria status—are available at the time of nephrology consultation 1.
Why You Should Order These Labs Before Nephrology Referral
Both eGFR and UACR are required to stage CKD, guide treatment decisions, and stratify cardiovascular and progression risk—the nephrologist cannot provide optimal recommendations without knowing the patient's albuminuria category 1.
KDIGO guidelines explicitly recommend measuring both eGFR (from serum creatinine) and UACR at baseline for all patients with CKD, as these two parameters provide independent prognostic information for CKD progression, cardiovascular events, and mortality 1, 2.
The American Diabetes Association recommends annual screening with both eGFR and UACR in all patients with diabetes, and your patient's prior A1c of 7.7% with CKD stage 3a places them at high risk for diabetic kidney disease 1.
Delaying these labs until the nephrology visit wastes time and may require the patient to return for additional testing before the nephrologist can formulate a treatment plan—this is inefficient and delays initiation of potentially renoprotective therapies such as SGLT2 inhibitors or intensified RAAS blockade 1, 3.
What to Order Now
Serum creatinine to calculate current eGFR using the CKD-EPI equation 1.
Urine albumin-to-creatinine ratio (UACR) on a random spot urine sample (preferably first morning void to minimize variability) 1.
Complete metabolic panel including potassium, bicarbonate, calcium, and phosphate to screen for CKD complications such as hyperkalemia, metabolic acidosis, and mineral-bone disorder 1, 3.
Hemoglobin to assess for anemia of CKD 3.
Common Pitfalls to Avoid
Do not assume the nephrologist will order "everything"—nephrology consultants expect referring physicians to provide baseline eGFR and albuminuria data, as these are standard primary care screening tests for patients with diabetes and CKD 1.
Do not rely on serum creatinine alone without calculating eGFR—KDIGO guidelines emphasize that eGFR (not creatinine) should be used for CKD staging and clinical decision-making 1.
Do not skip UACR testing—even if the patient has stable eGFR, the presence and degree of albuminuria independently predicts cardiovascular events, CKD progression, and mortality, and determines whether ACE inhibitor/ARB therapy is indicated 1.
Avoid ordering a 24-hour urine collection for routine CKD evaluation—spot UACR is the preferred method for screening and monitoring, as 24-hour collections are cumbersome, frequently incomplete, and add little clinical value in this setting 1.
Why This Approach is Standard Practice
Primary care physicians are responsible for initial CKD diagnosis, staging, and baseline laboratory evaluation before nephrology referral—this is explicitly stated in KDIGO and American Diabetes Association guidelines 1.
Nephrology referral is indicated for eGFR <30 mL/min/1.73 m², rapidly declining eGFR, or uncertainty about etiology—but the referring physician must provide baseline eGFR and UACR data to facilitate appropriate triage and management 1, 3.
Your patient's eGFR of 48 mL/min/1.73 m² (stage 3a) does not yet meet the threshold for mandatory nephrology referral (eGFR <30), but co-management is appropriate given diabetes, prior hyperkalemia, and suboptimal glycemic control 1, 3.