What are the indications for consulting a nephrologist (kidney specialist)?

From the Guidelines

Nephrology consultation is crucial for patients with advanced kidney disease, particularly those with an eGFR <30 mL/min/1.73 m2, as it has been shown to reduce cost, improve quality of care, and delay dialysis 1. When considering referral to a nephrologist, several key factors come into play, including:

• Uncertainty about the etiology of kidney disease
• Difficult management issues, such as anemia, secondary hyperparathyroidism, significant increases in albuminuria despite good blood pressure control, metabolic bone disease, resistant hypertension, or electrolyte disturbances
• Advanced kidney disease requiring discussion of renal replacement therapy for end-stage renal disease (ESRD) Key benefits of early nephrology referral include:
• Reduced cost
• Improved quality of care
• Delayed dialysis
• Better management of complications
• Preparation for renal replacement therapy if needed As noted in the study published in Diabetes Care in 2022 1, consultation with a nephrologist when stage 4 CKD develops has been found to have numerous benefits, highlighting the importance of timely referral. Nephrologists provide specialized expertise in:
• Kidney biopsy interpretation
• Complex medication adjustments for kidney function
• Coordinating multidisciplinary care for patients with kidney disease By prioritizing nephrology consultation for patients with advanced kidney disease or complex management issues, healthcare providers can improve patient outcomes and reduce the risk of progression to end-stage kidney disease.

From the Research

Reasons to Consult Nephrology

• Patients with chronic kidney disease should be referred to a nephrologist, as well as those with other nephrological conditions 2
• Referral criteria include:
  • Serum creatinine or estimated glomerular filtration rate 2
  • Proteinuria 2, 3
  • Blood pressure 2
  • Electrolytes 2
  • Hematuria 2, 3
• Nephritic syndrome, characterized by hematuria, proteinuria, hypertension, and acute kidney injury, is a condition that requires consultation with a nephrologist 3
• Acute kidney injury in patients with nephrotic syndrome due to primary glomerulopathies is a serious condition that requires prompt recognition and timely initiation of appropriate treatment 4
• Other conditions that may require consultation with a nephrologist include:
  • Infection-related glomerulonephritis
  • IgA nephropathy
  • Lupus nephritis
  • Membranoproliferative glomerulonephritis
  • Antineutrophil cytoplasmic antibody-associated vasculitis 3