Clinical Practice Guidelines
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Clinical Practice Guidelines, published by HL7 International / Clinical Decision Support. This guide is not an authorized publication; it is the continuous build for version 2.0.0 built by the FHIR (HL7® FHIR® Standard) CI Build. This version is based on the current content of https://github.com/HL7/cqf-recommendations/ and changes regularly. See the Directory of published versions

: CKD Referral Nephrology

Active as of 2026-04-29

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<ActivityDefinition xmlns="http://hl7.org/fhir">
  <id value="cc-cpg-activity-referral-nephrology"/>
  <meta>
    <profile
             value="http://hl7.org/fhir/uv/cpg/StructureDefinition/cpg-computableactivity"/>
  </meta>
  <language value="en"/>
  <text>
    <status value="extensions"/>
    <div xmlns="http://www.w3.org/1999/xhtml">
  <table class="narrative-table">
    <tbody>
<tr>


<th colspan="2" scope="row" class="row-header">Metadata</th>


</tr>



<tr>


<th scope="row" class="row-header">Version</th>



<td class="content-container">2.0.0</td>


</tr>







  
<tr>


<th scope="row" class="row-header">Identifier</th>



<td class="content-container">urn:oid:2.16.840.1.113883.4.642.40.48.11.21</td>


</tr>








<tr>


<th scope="row" class="row-header">Experimental</th>



<td class="content-container">true</td>


</tr>





<tr>


<th scope="row" class="row-header">Jurisdiction</th>



<td class="content-container">
    World


</td>


</tr>








<tr>


<th scope="row" class="row-header">Steward (Publisher)</th>



<td class="content-container">HL7 International / Clinical Decision Support</td>


</tr>



<tr>


<th scope="row" class="row-header">Steward Contact</th>



<td class="content-container">HL7 International / Clinical Decision Support</td>


</tr>







<tr>


<th scope="row" class="row-header">Description</th>



<td class="content-container"><div><p>Referral: Nephrology; History: [add diagnosis, symptom(s)]; Question: [add reason for referral]</p>
</div></td>


</tr>









<tr>


<th scope="row" class="row-header">Resource Kind</th>



<td class="content-container">ServiceRequest</td>


</tr>



<tr>


<th scope="row" class="row-header">Code</th>



<td class="content-container">Referral to nephrologist
</td>


</tr>


<tr>


<th scope="row" class="row-header">Intent</th>



<td class="content-container">Proposal</td>


</tr>



<tr>


<th scope="row" class="row-header">Timing</th>



<td class="content-container">Events: ?? </td>


</tr>










<tr>
  <th colspan="2" scope="row" class="row-header">Generated using version 0.5.4 of the sample-content-ig Liquid templates</th>
</tr>

    </tbody>
  </table>
</div>
  </text>
  <extension
             url="http://hl7.org/fhir/StructureDefinition/cqf-knowledgeCapability">
    <valueCode value="shareable"/>
  </extension>
  <extension
             url="http://hl7.org/fhir/StructureDefinition/cqf-knowledgeCapability">
    <valueCode value="computable"/>
  </extension>
  <extension
             url="http://hl7.org/fhir/StructureDefinition/cqf-knowledgeCapability">
    <valueCode value="publishable"/>
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  <url
       value="http://hl7.org/fhir/uv/cpg/ActivityDefinition/cc-cpg-activity-referral-nephrology"/>
  <identifier>
    <system value="urn:ietf:rfc:3986"/>
    <value value="urn:oid:2.16.840.1.113883.4.642.40.48.11.21"/>
  </identifier>
  <version value="2.0.0"/>
  <name value="ReferralNephrology"/>
  <status value="active"/>
  <experimental value="true"/>
  <date value="2026-04-29T15:06:55+00:00"/>
  <publisher value="HL7 International / Clinical Decision Support"/>
  <contact>
    <name value="HL7 International / Clinical Decision Support"/>
    <telecom>
      <system value="url"/>
      <value value="http://www.hl7.org/Special/committees/dss"/>
    </telecom>
  </contact>
  <description
               value="Referral: Nephrology; History: [add diagnosis, symptom(s)]; Question: [add reason for referral]"/>
  <jurisdiction>
    <coding>
      <system value="http://unstats.un.org/unsd/methods/m49/m49.htm"/>
      <code value="001"/>
      <display value="World"/>
    </coding>
  </jurisdiction>
  <relatedArtifact>
    <type value="justification"/>
    <display
             value="Refer to nephrologist for co-management of treatment plan in cases of:


	Unclear etiology of kidney disease



	Rapid progression of disease (GFR decline greater than 5 mL/minute/1.73 m&amp;sup2;/year)



	Acute kidney injury or abrupt sustained fall in GFR



	GFR less than 30 mL/minute/1.73 m&amp;sup2; (GFR categories G4-G5) to prepare for renal replacement therapy



	Consistent finding of significant albuminuria (albumin/creatinine ratio of 300 mg/g or more)



	Hypertension resistant to treatment with 4 or more antihypertensive agents



	Difficulty in decreasing the level of albuminuria despite institution of ACE inhibitor or angiotensin II receptor blocker therapy



	Persistent electrolyte abnormalities, including hyperkalemia or high serum phosphate



	Recurrent or extensive nephrolithiasis



	Hereditary kidney disease


&amp;nbsp;

Nephrologist involvement is recommended when the cause of chronic kidney disease is not clear


	Renal biopsy may be performed to determine the cause as well as to predict disease progression and response to therapy"/>
    <citation
              value="Chronic Kidney Disease Clinical Overview. ClinicalKey. Source"/>
    <url
         value="http://himss19.ordersetsmanager.com/evidenceviewer/#/7CBBBE9B75E10232E05352E3610A5325/7CBBBE9B75DA0232E05352E3610A5325"/>
    <document>
      <url
           value="http://himss19.ordersetsmanager.com/evidenceviewer/#/7CBBBE9B75E10232E05352E3610A5325/7CBBBE9B75DA0232E05352E3610A5325"/>
    </document>
  </relatedArtifact>
  <kind value="ServiceRequest"/>
  <code>
    <coding>
      <system value="http://snomed.info/sct"/>
      <code value="306286007"/>
      <display value="Referral to nephrologist (procedure)"/>
    </coding>
    <text value="Referral to nephrologist"/>
  </code>
  <intent value="proposal"/>
  <timingTiming>
    <event>
      <extension
                 url="http://hl7.org/fhir/StructureDefinition/cqf-expression">
        <valueExpression>
          <language value="text/cql"/>
          <expression value="Now()"/>
        </valueExpression>
      </extension>
    </event>
  </timingTiming>
  <participant>
    <type value="practitioner"/>
  </participant>
</ActivityDefinition>