When should I consider referring a patient with AKI to secondary care, and what criteria should guide this decision?

Refer immediately to secondary care or a nephrologist if the patient has evidence of severe complications such as hyperkalaemia (serum potassium of 6.5 mmol/L or more), metabolic acidosis, symptoms or complications of uraemia (e.g., pericarditis or encephalopathy), fluid overload, or pulmonary oedema ³.

Refer for renal replacement therapy immediately if the patient does not respond to medical management and has hyperkalaemia, metabolic acidosis, uraemic symptoms, or fluid overload ³.

Consider referral to secondary care or a nephrologist within 24 hours if the patient has stage 3 AKI, an uncertain diagnosis, no response to treatment, or complications such as vasculitis, glomerulonephritis, or myeloma, or if they have a renal transplant or CKD stage 4 or 5 ².

Refer immediately if there is suspected urological obstruction such as pyonephrosis, obstructed solitary kidney, or bilateral upper urinary tract obstruction ³.