Pathways and Stages Kidney disease pathway hematuria pathway diabetes pathway non-diabetic MRP CKD stages referral sheet go to the start of the kidney pathway
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MRP Kidney Disease Referral Pathway

N.B. See Proteinuria Conversion Table

N.B. When the ACR is ≥ 30 mg/mmol, it underestimates total proteinuria which is better estimated by PCR.

eGFR units: ml/min/1.73 m2

Risk Factors:

  • Diabetes Mellitus
  • Hypertension
  • Cardiovascular Disease
  • Family history of kidney disease
  • Urinary tract abnormalities including reduced renal mass
  • High risk ethnic groups e.g. First Nations
  • Known systemic auto immune disorders such as SLE
  • Excessive use of known toxins such as analgesics (NSAIDs), lithium and others
  • ⇒ NEXT

Screening for at risk individuals (annual):

  • History and physical examination with blood pressure assessment
  • eGFR from serum creatinine
  • Urinalysis, and spot urine for albumin/creatinine (ACR) or protein/creatinine ratio (PCR).
  • ⇒ If abnormal eGFR OR ACR or PCR > 50 mg/mmol OR hematuria, order Renal Ultrasound and CBC, serum urea, electrolytes – Na, K, Cl, HCO3, calcium, phosphorous, glucose, albumin. If over 40 y/o obtain serum and urine protein electrophoresis.

If Diabetic review Diabetic Management Guidelines (PDF) or d

If Non-Diabetic review Non-Diabetic Management Guidelines (PDF) or

  • ⇒ If eGFR < 15
  • ⇒ If eGFR 15-59.9
  • ⇒ Non diabetic: ACR or PCR < 300 mg/mmol
  • ⇒ Non-Diabetic: ACR or PCR ≥ 300 mg/mmol
  • ⇒ If Hematuria (>2 rbc’s on 2 specimens)

If patient with life-threatening uremic symptoms such as severe hyperkalemia or acidosis, pulmonary edema, encephalopathy, pericarditis.

  • ⇒ YES
  • ⇒ NO

Refer to Nephrology, URGENT. Repeat eGFR and serum electrolytes at least Q 1-4 weeks until seen by nephrology.

Refer to Nephrology EMERGENT. Page nephrologist or/and send patient to ER

Repeat eGFR from serum creatinine, urea, electrolytes – Na, K, Cl, HCO3, ACR or PCR at least once within 2 weeks.

  • ⇒ NEXT

If eGFR declines by ≥ 20% in 1-30 days

  • ⇒ YES
  • ⇒ NO

Refer to Nephrology, URGENT. Repeat eGFR and serum electrolytes at least Q 1-4 weeks until seen by nephrology.

For eGFR ≥ 60 repeat blood and urine tests every 6-12 mos.

For eGFR 30-59 repeat blood and urine tests every 3-6 mos.

For eGFR 15-29 repeat blood and urine tests every 1-3 mos.

Repeat U/A, ACR or PCR, eGFR from serum creatinine, urea, electrolytes – Na, K, Cl, HCO3, calcium, phosphorous, albumin, CBC

  • ⇒ NEXT

Refer to Nephrology ELECTIVE, if eGFR decreases ≥ 10%/yr OR eGFR < 30 OR ACR or PCR ≥ 200 mg/mmol in a non-Diabetic patient.

Also see the Non-Diabetic CKD Management Guidelines, to be used Concomitantly with the Kidney Disease Referral Pathway

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Go to the Non-Diabetic CKD Management Guidelines