in general referral to a nephrologist is indicated if significant proteinuria (protein:creatinine ratio> 100 mg/mmol)
however proteinuria > 50 mg/mmol may be significant if other features of renal disease are present (e.g. impairment of renal function, coexistent microscopic haematuria, hypertension, features indicating an underlying systemic disease) (1)
other guidance suggests referral for protein:creatinine ratio >100 mg/mmol, or >45 mg/mmol if co-existing microscopic haematuria or estimated GFR <60mL/min (2)
prot/creat ratio at levels <= 45mg/mmol then manage as Chronic Kidney Disease (CKD), according to stage
if referring a patient for nephrology review then consider initiating other investigations such as renal tract ultrasonography, immunology (serum and urine protein electrophoresis, antinuclear antibodies, antineutrophil cytoplasmic antibodies, complements), and hepatitis B and C serology
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