Pathways and Stages Kidney disease pathway hematuria pathway diabetes pathway non-diabetic MRP CKD stages referral sheet
    Disclaimer: The information and data in this document ("Information") is based on scientific evidence current as of the date issued and is subject to change without notice. The Information should not be construed as dictating an exclusive course of treatment or procedure to be followed. Any person consulting or applying the Information is expected to use independent medical judgment and expertise in the context of individual clinical circumstances. Winnipeg Regional Health Authority and the Manitoba Renal Program make no representation or guarantees of any kind whatsoever regarding the content or use or application of the Information and specifically disclaim any responsibility for its application or use in any way.

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:

  • ⇒ NEXT

Screening for at risk individuals (annual):

  • ⇒ 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.

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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