XV. Referral Plan patients with a Referral to a nephrologist is generally recommended for cute kidney failure "persistent estimated glomerular filtration rate less than 30 mL/min/1.73 m2, progressive decline of kidney function, ratio of urine protein to creatinine greater than 100 mg/mmol (about 900 mg/24 h) or urine albumin to creatinine ratio greater than 60 mg/mmol (about 500 mg/24 h), inability to achieve treatment targets, or rapid changes in kidney function." (Levin, 2008)

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