When to Refer

There are several “absolute” criteria. To us this means that no matter how extensive the workup and treatment are at the primary care office, these conditions will require nephrology intervention at some point:

Absolute Criteria

  • All patients with calculated GFR < 60 and concomitant proteinuria, hematuria and/or pyuria.
  • All patients with GFR < 60 and GFR declining.
  • A patient expected to need dialysis
  • Incidental diagnosis of polycystic kidney disease on CT, US or MRI
  • Unexplained proteinuria quantitated greater than 500 mg/day.
  • Nephrotic syndrome (Heavy proteinuria, edema, hypoalbuminemia, hyperlipidemia, +/- hypertension)
  • Patients with the combination of proteinuria and hematuria or pyuria (even when proteinuria is low-grade). See note below.
  • Patients who have a kidney transplant


Common conditions that generally do not require nephrology consultation:


Solitary simple renal cysts

People with simple kidney cysts have sacs that are filled with fluid within their kidneys.

Controlled hypertension

…in the absence of diabetes and/or abnormal calculated GFR.