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Nephrology – public patients 

Purpose

This page contains information for general practitioners on how to refer patients aged 16 years and over Nephrology services to Mater Hospital Brisbane.

Service

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 Refer

If referral for care is indicated please list all of the General Referral Information and reason for request, and essential information as indicated below.

To refer, please fill in the Mater Adult Referral Form, available to download and embed into most major Practice Management software applications.

Referrals can be sent by:

 

Secure messaging  Medical Objects:   HM4101000R8
  HealthLink EDI:    materref   
Fax    07 3163 8548

 

 

 

 

 

Emergency

If any of the following are present or suspected, phone 000 to arrange immediate transfer to the emergency department or seek emergency medical advice if in a remote region:

 

View lists of conditions:

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:

  • Any acute kidney injury or significant decline in kidney function where the treating doctor believes the patient requires urgent hospital care (especially of the abrupt increase in the serum craetinine by > 50% of the baseline)
  • Oliguria/anuria
  • Severe acute electrolyte disturbance such as:
    • Hyperkalemia with Potassium (K+) >6.5mmol/L OR >6.0mmol/L with ECG Changes;
    • Hypokalemia with potassium <2.5 mmol/L OR <3.0mmol/L with symptoms
    • Severe metabolic Acidosis (HCO3 < 15mmol/L)
  • Kidney transplant recipients with an acute decline in kidney functions (e.g. > 20% increase in serum craetinine)
  • Suspected glomerulonephritis (proteinuria and haematuria) associated with acute kidney injury
  • Rapidly declining eGFR

Chronic Kidney Disease:

  • Severe acute electrolyte disturbance such as:
    • Hyperkalemia with Potassium (K+) >6.5mmol/L OR >6.0mmol/L with ECG Changes;
    • Hypokalemia with potassium <2.5 mmol/L OR <3.0mmol/L with symptoms
    • Severe metabolic Acidosis (HCO3 < 15mmol/L)
  • Severe hypertension especially when accompanied with decline kidney function
  • Patient with severe uraemic symptoms and signs
  • Evidence of acute fluid overload or heart failure in a patient with known CKD
  • Kidney transplant recipients with acute intercurrent illness
  • Peritoneal or haemodialysis patient with acute issues or problems with dialysis access (e.g. vascular access issues or peritoneal dialysis catheter issues)
  • Peritoneal dialysis patients with suspected peritonitis (abdominal pain, cloudy dialysis fluid)

Cystic kidney Disease

  • Significant cyst haemorrhage, suspected septicaemia related to cyst infection, suspected rupture of berry aneurysm

Glomerulonephritis

  • Suspected Glomerulonephritis (proteinuria and haematuria) with acutely declining kidney function or patient systemically unwell

Haematuria:

  •  Severe macroscopic haematuria

Hypertension

  • Hypertensive emergency (for example BP >220/140)
  • Severe hypertension with systolic BP > 180mmHg with any of the concerning features:
    • headache
    • confusion
    • blurred vision
    • retinal haemorrhage
    • reduced level of consciousness
    • seizures
    • proteinuria
    • papilloedema
    • signs of heart failure
    • chest pain

If suspected pregnancy induced hypertension or pre-eclampsia refer patient to emergency department of a facility that offers obstetric services where possible

Nephrolithiais- recurrent

  • Suspected urolithiasis/nephrolithiasis with infection or severe pain
  • Suspected urinary retention/obstruction (eg anuria, oliguria)

Protienuria

  • Nephrotic syndrome (proteinuria >3.5 grams/24 hours OR urine ACR >300mg/mmol or PCR 300g/mol) with concerning features
    • significant peripheral oedema
    • signs of pulmonary oedema
    • severe hypertension
    • signs of DVT/PE
    • infection
    • acute kidney injury

Other

  • Kidney transplant patients with significant intercurrent illness (eg diarrhoea and vomiting)

 

Scope of Service

Conditions out of scope

The following conditions are not routinely managed at Mater Hospital Brisbane:

View lists of conditions:

  • Peritoneal Dialysis
  • Home Dialysis
  • Chronic Kidney disease with
  • Stable eGFR > 30ml/min/1.73m2
  • Urine ACR < 30mg/mmol (with no haematuria)
  • Controlled blood pressure
  • Clear cause of CKD

 

 

Conditions in scope

Acute decline in Kidney function

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

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

  • Increase in Serum creatinine by > 50% of baseline within the last 4 weeks
  • Increase in serum creatinine by >26.5µmol/L in last 7 days

 

No category 2 criteria

No category 3 criteria

 

Chronic kidney disease

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 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)

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;

  • Stable eGFR > 30 mL/min/1.73 m2
  • Urine ACR < 30 mg/mmol (with no haematuria)
  • Controlled blood pressure

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.

  • Refer to Health pathways 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.

 

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

Stage 5 CKD (eGFR < 15) that does not require referral to emergency

Stage 4 CKD (eGFR 15-29) with any of the following:

  • severe complications (eg renal bone disease, acidosis, hyperkalaemia)
  • symptoms of CKD (eg fatigue, restless legs, itch, weight loss, severe anaemia, mild uremic symptoms)
  • Rapid detoriation
  • multiple contributing comorbities

Known CKD with severe anaemia (Hb < 80g/L) 

 

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

Persitant nephrotic range prootenuria*(urine ACR>300mg/mmol OR PCR > 300g/mol)

 

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

 

Cystic kidney disease

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)

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

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

Multicystic kidney disease associated with severe symptoms or complications (example- pain, haemorrhage, recurrent infection)

 

 

Multicystic kidney disease

  • associated with mild to moderate symptoms or complications
  • in a female patient that is contemplating pregnancy

Asymptomatic Multicystic kidney disease

 

 


 

Glomerulonephritis

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
  • 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

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

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 

No category 3 criteria

 

Haematuria (Nephrology)

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.

 

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

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

 

Hypertension (Nephrology)

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.

 

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

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:

  • headache
  • confusion
  • blurred vision
  • retinal haemorrhage
  • reduced level of consciousness
  • seizures
  • proteinuria
  • papilloedema
  • signs of heart failure
  • chest pain

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

 

Nephrolithiasis- recurrent

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
  • Urinary metabolic Screen
  • Stone analysis
  • Record of any previous 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

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

No Category 1 criteria

 

No Category 2 criteria

Recurrent nephrolithiasis with any of the following

  • urinary metabolic assessment is needed
  • tubular dysfunction is evident
  • systemic disease with associated stone formation is evident

 

Proteinuria

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 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)
  • 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

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

Nephrotic range proteinuria * (urine ACR >300mg/mmol or PCR >300g/mol) with out concerning features

Proteinuria (Urine ACR 30-300mg/mmol or PCR 60-300g/mol) with a declining eGFR but without concerning features:

  • Significant peripheral oedema
  • Signs of pulmonary oedema
  • Severe hypertension
  • Signs of DVT/PE
  • Infection
  • Acute Kidney Injury

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 25-300mg/mmol for men or urine ACR 35-300mg/mmol for women or PCR 60-300g/mol) with stable eGFR

Asymptomatic microalbuminuria (urine ACR <25mg/mmol for men or < 35mk/mmol for women or PCR < 60g/mol) with other evidence of kidney disease (eg haematuria)

 

Our Specialists 

 

Dr Richard Bear

Nephrologists

Dr Michael Burke

Nephrologists

Dr Andrea Viecelli

Nephrologists

 
Bulk Billed Clinics 

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.

Contact Us 

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 

 Current Waiting Time for Appointments 

We provide up to date data on how long patients are waiting for their first appointment by specialty here.

Referral Guideline Development

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: 01 May 2019

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