NEPHROLOGY CLEARANCE REQUEST 2026

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  1. Click ‘Get Form’ to open the NEPHROLOGY CLEARANCE REQUEST in the editor.
  2. Begin by entering the date at the top of the form. This is essential for record-keeping and scheduling purposes.
  3. Fill in your name as the referring physician, ensuring clarity for communication.
  4. Provide details about the patient, including their name and date of birth, which are crucial for identification.
  5. Indicate whether the patient is scheduled for surgery and specify the type of anesthetic required by checking the appropriate boxes.
  6. Document the length of the procedure in hours and minutes to assist in planning.
  7. Clearly state any necessary information regarding nephrology clearance, including risk stratification recommendations.
  8. Select one of the risk assessment options provided and list any recommendations if applicable.
  9. Sign and date the form at the bottom, ensuring all contact information is accurate for follow-up.
  10. Finally, fax the completed form to Community Surgery Center Northwest using the provided number.

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Whether kidney disease is acute or chronic, drug clearance decreases, and the volume of distribution may remain the same or increase. Although in CKD, these changes progress relatively slowly, they are dynamic in AKI, and recovery is possible depending on the etiology and treatments.
Renal clearance is defined as the volume of blood from which a substance is removed by the kidneys per unit time, calculated using the formula C = U x V/P, where U and P are the and plasma concentrations of the substance, and V is the flow rate.
Renal clearance is characterized as the composite of three processes glomerular filtration, tubular secretion, and tubular reabsorption (Equation (1)) [1]. While filtration and secretion add substances to the urinary ultrafiltrate, reabsorption removes compounds from the ultrafiltrate.
The creatinine clearance test is a test that checks your how well your kidneys are working. It allows your healthcare provider to see how much creatinine is in a sample of your pee () and blood. The results of this test can lead to a diagnosis of kidney disease. Creatinine is a waste product of creatine.
Renal clearance is the rate at which certain substances are removed from the plasma by the kidneys. It helps to measure how well the kidneys are filtering waste products from the blood.

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