{
  "description": "Ultrasound, Renal; History: [add diagnosis, symptom(s)]; Question: [add reason for exam]",
  "_filename": "example/ActivityDefinition-cc-cpg-activity-ultrasound-renal.json",
  "package_name": "hl7.fhir.uv.cpg",
  "date": "2019-08-05T12:02:55-04:00",
  "publisher": "Elsevier Inc",
  "jurisdiction": [ {
    "coding": [ {
      "code": "001",
      "system": "http://unstats.un.org/unsd/methods/m49/m49.htm",
      "display": "World"
    } ]
  } ],
  "name": "UltrasoundRenalHistory",
  "type": null,
  "experimental": "true",
  "participant": [ {
    "type": "practitioner"
  } ],
  "resourceType": "ActivityDefinition",
  "title": "Ultrasound, Renal; History: [add diagnosis, symptom(s)]; Question: [add reason for exam]",
  "package_version": "0.1.0",
  "timingTiming": {
    "_event": [ {
      "extension": [ {
        "url": "http://hl7.org/fhir/StructureDefinition/cqf-expression",
        "valueExpression": {
          "language": "text/cql",
          "expression": "Now()"
        }
      } ]
    } ]
  },
  "status": "active",
  "id": "fda2a507-55e1-479e-afb1-afb52315c14f",
  "kind": "ServiceRequest",
  "url": "http://hl7.org/fhir/uv/cpg/ActivityDefinition/cc-cpg-activity-ultrasound-renal",
  "code": {
    "text": "Ultrasound of bilateral kidneys",
    "coding": [ {
      "code": "13301000087109",
      "system": "http://snomed.info/sct",
      "display": "Ultrasonography of bilateral kidneys (procedure)"
    } ]
  },
  "version": "0.1.0",
  "relatedArtifact": [ {
    "url": "http://himss19.ordersetsmanager.com/evidenceviewer/#/7CBBBE9B75E10232E05352E3610A5325/7CBBBE9B75D50232E05352E3610A5325",
    "type": "justification",
    "display": "
Renal ultrasonography
\n\n
\n\t
Perform ultrasonography to detect structural abnormalities when routine evaluation and urinalysis are inconclusive or to distinguish between acute and chronic kidney disease
\n
\n\n
\n\t
Small hyperechoic kidneys, cysts, or lesions are irregularities associated with chronic kidney disease
\n
\n\n
\n\t
Ultrasonography will also detect presence of stones, cysts, or masses that can affect renal function
\n
\n\n
\n\t
Diagnosis of chronic kidney disease requires abnormalities persisting beyond 3 months
\n
\n\n
 
\n\n
Differential Diagnosis
\n\n
\n\t
Renal artery stenosis\n\t
\n\t\t
Narrowing of the renal arteries resulting in loss of kidney function and blood pressure alteration
\n\t\t
Both renal artery stenosis and chronic kidney disease present with hypertension and reduced GFR
\n\t\t
Although also a cause of chronic kidney disease, renal artery stenosis (usually from atherosclerosis) is present before the development of kidney disease
\n\t\t
Renal bruit is indicative of renal artery stenosis
\n\t\t
Duplex ultrasonography can identify blockage in the renal artery and high velocity flow rate, indicative of renal artery stenosis
\n\t
\n\t
\n
\n\n
\n\t
Neoplasm\n\t
\n\t\t
Neoplasm of the kidney is a tumor growth in the renal cells
\n\t\t
Both diseases present with RBCs in urine
\n\t\t
Neoplasia can be differentiated by detecting tumor mass on kidney
\n\t\t
Contrast-enhanced CT scanning or ultrasonography can identify renal neoplasias, which can then be further evaluated with MRI
\n\t
\n\t
\n
",
    "citation": "Chronic Kidney Disease Clinical Overview. ClinicalKey. Source"
  } ]
}