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© 2019 Altitude Kidney Health.  All Rights Reserved

Designed by Zach McNamara Creative and Peter Brookens

When to Refer to a Nephrologist?

  • 26 million estimated people in the US have chronic kidney disease (“CKD”)

  • Many more are at risk from diabetes, hypertension, family history of kidney disease, and age > 60 years

  • Kidney disease kills more people than breast or prostate cancer

  • Early referral to nephrology slows or prevents CKD progression. It halves mortality in some studies!

  • Reasons to refer for patient safety, adapted from the National Kidney Foundation:

  • Refer by CKD criteria:

  1. Marker of kidney damage (one or more)

  2. Estimated glomerular filtration rate (eGFR) <60 mL/min 

  3. (mandatory < 30mL/min)

  4. Radiographic or symptomatic abnormality of kidney structure

  5. Dysfunction persisting >3 mos 

  • Refer by CKD risk factors:

  1. Diabetes > 5 years

  2. Hypertension > 5 years or difficult to control

  3. Family history of kidney disease

  4. Age > 60 years (kidney function declines with age)

  5. Frequent usage of NSAIDs or nephrotoxic medications/drugs

  6. History of AKI (acute kidney injury)


Altitude Kidney Health is a nephrology practicefounded in 2018 with a goal to decrease the barriers to kidney care for all residents of the greater Rocky Mountain region. AKH has offices in Denver and Frisco, CO, and is available Monday-Friday for consult via in-person and telehealth video visit—for providers & patients. 

We are happy to co-manage or provide a second opinion. Please reach us using our contact info below or on-demand video consult.

Printable PDF of "When to refer to a nephrologist."

Kidney Sketch | Andrew Brookens | Altitude Kidney Health
Prognosis of CKD by GFR and Albuminuria Categories
  1. Medication errors (toxicity, improper dosing, inadequate monitoring)

  2. Electrolyte disturbances

  3. Diagnostic tests (contrast studies, bowel preps, etc)

  4. Fluid management (hypotension, volume excess, complex heart failure patients) 

  5. Augmenting patient awareness of risks (ie, NSAIDs, supplements)

  6. Vessel preservation (for future dialysis access)

Impact of early primary care CKD detection for patient safety