What are the referral criteria for a patient with significant proteinuria to a nephrologist?

Referral criteria for a patient with significant proteinuria to a nephrologist include:

• Adults with an albumin:creatinine ratio (ACR) of 70 mg/mmol or more, unless the proteinuria is known to be caused by diabetes and already appropriately treated.
• Adults with an ACR of more than 30 mg/mmol (ACR category A3) together with haematuria.
• Adults with a sustained decrease in estimated glomerular filtration rate (eGFR) of 25% or more and a change in eGFR category within 12 months.
• Adults with a sustained decrease in eGFR of 15 ml/min/1.73 m2 or more per year.
• Adults with hypertension that remains poorly controlled despite the use of at least 4 antihypertensive medicines at therapeutic doses.
• Adults with known or suspected rare or genetic causes of chronic kidney disease (CKD).
• Adults with suspected renal artery stenosis.

For children and young people, referral is indicated if they have an ACR of 3 mg/mmol or more confirmed on a repeat early morning urine sample, haematuria, any decrease in eGFR, hypertension, known or suspected rare or genetic causes of CKD, suspected renal artery stenosis, or renal outflow obstruction.

These criteria are based on the NICE guideline NG203 on chronic kidney disease: assessment and management ¹.