4 Specialist services

Referrals to renal services

4.1 To minimise risk from COVID‑19, delay referral if the clinical need is not urgent, for example, if the patient has mild to moderate proteinuria and a stable GFR (including patients with suspected inherited kidney disease).

4.2 Continue to refer patients for urgent outpatient appointments if there is a clinical need, for example, if the patient has:

  • accelerated progression of CKD, defined as:

    • a sustained decrease in GFR of 25% or more and a change in GFR category within 12 months or

    • a sustained decrease in GFR of 15 ml/min/1.73 m2 per year

  • nephrotic syndrome or very severe proteinuria (urinary ACR more than 300 mg/mmol)

  • a new diagnosis of GFR category G5 (GFR less than 15ml/min/1.73m2).

4.3 Contact the renal team by telephone or virtually if there is uncertainty about the need for an urgent outpatient referral.

Renal ultrasound

4.4 To minimise risk from COVID‑19, delay referral for renal ultrasound if the result is unlikely to change management immediately, for example, if the patient has:

  • a family history of polycystic kidney disease and needs renal ultrasound to exclude this disease

  • a GFR less than 30 ml/min/1.73 m2 (GFR category G4 or G5) that has been stable for at least 6 months

  • been identified by a nephrologist as having a possible need for a non‑urgent renal biopsy.

4.5 Continue to refer patients for renal ultrasound if the result might immediately change management, for example, if the patient has:

  • accelerated progression of CKD (see recommendation 4.2)

  • visible or persistent invisible haematuria

  • symptoms of urinary tract obstruction

  • been identified by a nephrologist as needing an urgent renal biopsy.

Hospital admission

4.6 When deciding whether to refer a patient with CKD and COVID‑19 for hospital admission, discuss with the admitting clinician and take into account:

  • the patient's preferences

  • the severity of the CKD and any comorbidities

  • whether the patient is taking immunosuppressants

  • the benefits and risks of admission

  • the care that can be offered in hospital compared with that at home.