What are the key indications for referring a patient with glomerulonephritis to a nephrologist?

Key indications for referring a patient with glomerulonephritis to a nephrologist include:

• A urinary albumin:creatinine ratio (ACR) of 70 mg/mmol or more, unless proteinuria is known to be associated with diabetes mellitus and is managed appropriately.
• An ACR of more than 30 mg/mmol together with persistent haematuria (after excluding urinary tract infection).
• A sustained decrease in estimated glomerular filtration rate (eGFR) of 25% or more within 12 months accompanied by a change in CKD category, or a sustained decrease in eGFR of 15 mL/min/1.73 m2 or more per year.
• Hypertension that remains poorly controlled despite the use of at least four antihypertensive drugs at therapeutic doses.
• Known or suspected rare or genetic causes of chronic kidney disease (CKD), such as polycystic kidney disease.
• Suspected renal artery stenosis.
• Diagnostic uncertainty regarding the cause or progression of kidney disease.

Referral urgency depends on clinical judgement, but these criteria warrant specialist nephrology assessment to guide diagnosis, management, and potential renal replacement therapy planning.

Additionally, if glomerulonephritis presents as part of acute kidney injury with no clear cause, inadequate response to treatment, or complications, immediate nephrology referral is advised.

These recommendations are based on NICE guidelines for chronic kidney disease assessment and management and acute kidney injury management.

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