Refer immediately to secondary care or a nephrologist if the patient has evidence of severe complications such as hyperkalaemia (serum potassium of 6.5 mmol/L or more), metabolic acidosis, symptoms or complications of uraemia (e.g., pericarditis or encephalopathy), fluid overload, or pulmonary oedema NICE NG148.
Refer for renal replacement therapy immediately if the patient does not respond to medical management and has hyperkalaemia, metabolic acidosis, uraemic symptoms, or fluid overload NICE NG148.
Consider referral to secondary care or a nephrologist within 24 hours if the patient has stage 3 AKI, an uncertain diagnosis, no response to treatment, or complications such as vasculitis, glomerulonephritis, or myeloma, or if they have a renal transplant or CKD stage 4 or 5 NICE CKS.
Refer immediately if there is suspected urological obstruction such as pyonephrosis, obstructed solitary kidney, or bilateral upper urinary tract obstruction NICE NG148.