Understanding the Importance of Early Referral to Renal Units

Early referral to a renal unit is crucial for ensuring effective management and preparation for renal replacement therapy. Medical professionals generally recommend that patients should be referred when their serum creatinine levels approach 150–200 µmol/L or when their estimated glomerular filtration rate (eGFR) falls below 45 mL/min/1.73 m². This proactive approach allows for both physical and psychological preparation, essential elements in managing chronic kidney disease.

There are specific clinical indicators that necessitate a referral to a nephrologist. Increasing proteinuria in the absence of diabetic retinopathy can indicate non-diabetic renal damage, warranting further evaluation. Additionally, symptoms such as uncontrolled hypertension, rapid declines in renal function, and nephritic syndrome are critical signs. Unexplained anemia and abnormalities in bone chemistry—such as serum calcium, phosphate, and parathyroid hormone levels—are also red flags that should prompt referral.

For patients with diabetes, annual screening for kidney disease is recommended. This includes assessments of serum creatinine and eGFR, as well as urine dipstick tests to evaluate proteinuria. A urine sample may also be analyzed for microalbuminuria and the protein-to-creatinine ratio. If abnormalities are detected, prompt action can help delay progression to more severe kidney dysfunction.

Renal replacement therapy options include hemodialysis, continuous ambulatory peritoneal dialysis, and renal transplantation. For those under 60 years old, renal transplantation is often deemed the best choice, as the five-year survival rates post-transplantation have improved significantly, matching those of patients without diabetes.

Anemia is another concern for patients with renal disease, often stemming from a deficiency in erythropoietin, a hormone produced by the kidneys that stimulates red blood cell production. In such cases, specific hormone replacement may be required.

Moreover, complications like neuropathy can affect a significant percentage of patients with type 2 diabetes, leading to serious outcomes such as foot ulcers and amputations. Timely referral and intervention are essential to mitigate these risks and improve quality of life for patients facing these challenges.