What criteria should I use to refer a patient with ADPKD for specialist nephrology assessment?

Refer a patient with autosomal dominant polycystic kidney disease (ADPKD) for specialist nephrology assessment if they have a known or suspected rare or genetic cause of chronic kidney disease (CKD), such as polycystic kidney disease. This is a direct referral criterion regardless of other factors. Additionally, consider referral if the patient has any of the following: a 5-year risk of needing renal replacement therapy greater than 5% (measured by the 4-variable Kidney Failure Risk Equation), an albumin-to-creatinine ratio (ACR) of 70 mg/mmol or more unless caused by diabetes and already treated, an ACR over 30 mg/mmol with haematuria, a sustained decrease in estimated glomerular filtration rate (eGFR) of 25% or more with a change in eGFR category within 12 months, a sustained decrease in eGFR of 15 ml/min/1.73 m2 or more per year, hypertension that remains poorly controlled despite at least four antihypertensive drugs at therapeutic doses, or suspected renal artery stenosis. Diagnostic uncertainty or suspected complications of CKD also warrant referral. These criteria ensure timely specialist assessment and management of ADPKD to prevent progression and complications ¹,²,³.