The nephrological community recommends referral to specialist kidney care services for people with CKD in the following circumstances:
- AKI or abrupt sustained fall in GFR;
- GFR <30 ml/min/1.73 m2 (GFR categories G4-G5);
- a consistent finding of significant albuminuria (ACR ≥300 mg/g [≥30 mg/mmol] or AER ≥300 mg/24 hours, approximately equivalent to PCR ≥500 mg/g [≥50 mg/mmol] or PER ≥500 mg/24 hours);
- urinary red cell casts, RBC 420 per high power field sustained and not readily explained;
- CKD and hypertension refractory to treatment with 4 or more antihypertensive agents;
- persistent abnormalities of serum potassium;
- recurrent or extensive nephrolithiasis;
- hereditary kidney disease.1