Telemedicine has significant potential to extend nephrology consultation to rural and isolated communities. We describe a telenephrology clinic which has delivered ongoing consultative care from a nephrologist based at the National Institutes of Health in Bethesda Maryland to the Zuni Comprehensive Health Center in western New Mexico. Over the past nine years the clinic has conducted 1870 patient visits managing patients using a collaborative approach engaging a nurse case manager, nephrologist, primary clinicians, pharmacists, and community health nurses. A significant proportion of the care provided is directed towards patients with advanced kidney disease (eGFR< 30ml/min/1.73m2). While there are unique aspects to the Indian Health Service and to the Zuni community which is served by this clinic, it does serve as a demonstration that nephrologic consultative care can be delivered effectively and efficiently to rural high risk communities using a collaborative and integrated model of care.