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Exact Dx synthetic data · demonstration
Exact Dx · Before you sign · P15 synthetic data · demonstration · printed Fri Nov 13, 2026 04:55 PM

All notes

P15 woman, 75 · inpatient visit Clinician-typed

Open in the chart

Needs a look Creatinine rose by 0.4 mg/dL within 24 hours during this stay (peak 1.6 mg/dL); the note doesn't mention a change in kidney function.

The note unsigned draft · Thu Nov 12, 2026 04:00 PM

Hospital day 2 progress note.
S: Cough improving, afebrile overnight.
O: T 37.2, BP 112/66, SpO2 95% on 2 L.
Right lower lobe crackles.
A/P:
1. Community-acquired pneumonia: continue ceftriaxone and azithromycin, day 2.
2. Deconditioning: physical therapy evaluation.
Edit note

The results

The note is compared with the patient's own measurements, in both directions. Kidney filtering rate (eGFR) is estimated from creatinine, age and sex.

Creatinine change during this stay Needs a look

  • 2026-11-11 15:00 creatinine 1.2 mg/dL (first in this stay)
  • 2026-11-12 15:00 creatinine 1.6 mg/dL (highest)

Threshold: creatinine up by 0.3 mg/dL within 48 hours, or to 1.5 times an earlier value. Urine output is not checked.

Kidney function over time Not assessable

Could not check kidney function: there is no usable creatinine result outside an acute change.

  • 2026-11-11 creatinine 1.2 mg/dL · filtering rate 47.2 (G3a range) (not used)
  • 2026-11-12 creatinine 1.6 mg/dL · filtering rate 33.4 (G3b range) (not used)

Threshold: filtering rate below 60 on two results at least 90 days apart, none of 60 or more between them.

Other measurements checked against published definitions

Each definition is a draft pending clinical and coding review unless marked reviewed. You decide what the note says.

  1. Needs a look Potassium Draft · pending review

    Potassium 5.8 mmol/L on 2026-11-12 15:00 meets the published definition's criteria for the category “'mild' band (5.5 to 5.9 mmol/L)” (ukka2026_hyperkalaemia@1.0). The note doesn't mention this.

    Published bodies disagree on these thresholds; another definition may give a different answer.

    Published definition and source

    Clinical Practice Guidelines: Treatment of Acute Hyperkalaemia in Adults

    ukka2026_hyperkalaemia@1.0
    It is further classified by severity into mild (5.5-5.9 mmol/l), moderate (6.0-6.4 mmol/l) or severe (≥ 6.5 mmol/l).

    UK Kidney Association · edition updated July 2026 · Introduction, document page 9 (PDF page 10) · opened 2026-11-14 · source

    Threshold for this category (ukka2026_hyperkalaemia@1.0): potassium ≥ 5.5 mmol/L and potassium < 6 mmol/L.

    Draft definition: pending clinical and coding review.

Show all (4)

1 more, grouped by what was measured. At most three are shown above at once.

Lactate Needs your clinical judgement
  1. Needs your clinical judgement Lactate Draft · pending review

    Lactate 2.6 mmol/L on 2026-11-11 15:10: the record shows these values; this needs your clinical judgement (sepsis3_septic_shock_lactate@1.0 uses them as one part of a wider clinical picture, category “lactate above 2 mmol/L”).

    Published definition and source

    The Third International Consensus Definitions for Sepsis and Septic Shock (Sepsis-3)

    sepsis3_septic_shock_lactate@1.0
    persisting hypotension requiring vasopressors to maintain MAP ≥65 mm Hg and having a serum lactate level >2 mmol/L (18mg/dL) despite adequate volume resuscitation

    Society of Critical Care Medicine and European Society of Intensive Care Medicine task force (JAMA 2016;315:801-810) · edition 2016 · Box 3 'New Terms and Definitions' · opened 2026-11-14 · source

    Threshold for this category (sepsis3_septic_shock_lactate@1.0): lactate > 2 mmol/L.

    Draft definition: pending clinical and coding review.

Library check LRUN-00015 · library_default_set@1.0 · library-engine 1.0 · replay 7ec5fd4e26dc…

Show the details

Your decision: Creatinine change during this admission

Mode: measurements only (no diagnosis is named). The check runs the same way on clinician-typed and AI-drafted notes (as declared by the source system).

Kidney function (eGFR persistence) · kdigo_ckd_2024@1.1

eGFR: Not assessable: the data cannot decide not assessable

no steady-state creatinine on file. Not assessable: no steady-state creatinine result on file. Lookback: every creatinine result on file before this note. Nothing to review until the data can decide.

Both directions
Both directions Not assessable: the data cannot decide (reason above). Nothing is flagged either way.
  • not met: Urine ACR >= 30 mg/g on two values at least 90 days apart (needed only when eGFR >= 60) (kdigo_ckd_2024@1.1)
    no urine ACR on file
  • met: No condition on record that makes the estimating equation unreliable (maintenance dialysis, kidney transplant, pregnancy, limb amputation or another extreme of muscle mass) (kidney_exclusions@1.0)
    none on record for this encounter date
  • not met: Two eGFR < 60 at least 90 days apart, none >= 60 between (2009 eGFR equation) (kdigo_ckd_2024@1.1)
    not assessable: no steady-state creatinine result on file
  • not met: Two eGFR < 60 at least 90 days apart, none >= 60 between (2021 eGFR equation) (kdigo_ckd_2024@1.1)
    not assessable: no steady-state creatinine result on file
  • met: Values used are steady-state (local convention: values from an admission meeting the creatinine-change criteria are excluded) (kdigo_ckd_2024@1.1)
    excluded L-0033, L-0034
    Rows: L-0033, L-0034

Creatinine change during this admission · kdigo_aki_2012@1.1

Creatinine change: Labs meet the criteria; nothing documented

Starting value (KDIGO does not define one; pick to compare) Lowest value in the 365 days before admission Most recent outpatient value 7-365 days before admission Median of values in the 365 days before admission Back-calculated from eGFR 75 (2021 equation, age and sex at admission)
Starting value
not available
KDIGO stage at admission
0
KDIGO stage at peak
1
Same chart, four starting values
Starting valuemg/dLStage at admissionStage at peak
Lowest value in the 365 days before admission (selected) — 01
Most recent outpatient value 7-365 days before admission — 01
Median of values in the 365 days before admission — 01
Back-calculated from eGFR 75 (2021 equation, age and sex at admission) 0.816 01

Creatinine 1.2 mg/dL at admission (lab row L-0033), peak 1.6 mg/dL (lab row L-0034). KDIGO creatinine criterion met: criteria met under 0 of 4 baselines at admission; 4 of 4 at peak. Urine-output criterion not evaluated (no structured source). Note: no statement about an acute kidney change found.

Both directions
What the labs show that the note doesn't say Criteria met; no statement in the note
What the note says that the labs don't support No statement in the note
  • met: Creatinine rise >= 0.3 mg/dL within 48 hours (kdigo_aki_2012@1.1)
    L-0033 -> L-0034: +0.4 mg/dL in 24.0 h
    Rows: L-0033, L-0034
  • met: No condition on record that makes the creatinine-change criteria unreliable (maintenance dialysis, kidney transplant, pregnancy) (kidney_exclusions@1.0)
    none on record for this encounter date
  • not met: A creatinine value before admission is available (needed before a statement can be called not supported) (kdigo_aki_2012@1.1)
    none in the 365 days before admission
  • met: Creatinine >= 1.5x baseline (back-calculated from egfr 75 (2021 equation, age and sex at admission)) (kdigo_aki_2012@1.1)
    baseline 0.816 mg/dL; admission stage 0, peak stage 1 (never used alone)
    Rows: L-0033, L-0034
  • met: Creatinine >= 1.5x baseline (most recent outpatient value 7-365 days before admission) (kdigo_aki_2012@1.1)
    baseline not available; peak stage 1 from the 48-hour rise only
    Rows: L-0033, L-0034
  • met: Creatinine >= 1.5x baseline (lowest value in the 365 days before admission) (kdigo_aki_2012@1.1)
    baseline not available; peak stage 1 from the 48-hour rise only
    Rows: L-0033, L-0034
  • met: Creatinine >= 1.5x baseline (median of values in the 365 days before admission) (kdigo_aki_2012@1.1)
    baseline not available; peak stage 1 from the 48-hour rise only
    Rows: L-0033, L-0034
  • not met: Reverse comparison: admission or peak creatinine >= 1.5x the lowest value in the following 7 days (kdigo_aki_2012@1.1)
    L-0033 1.2 mg/dL vs L-0034 1.6 mg/dL: 0.75x
    Rows: L-0033, L-0034

Try one creatinine value

One value is never a confirmed stage: the persistence rule needs a repeat at least 90 days later.

The record of this check

Run
RUN-00015 · seed · Fri Nov 13, 2026 04:55 PM · audit entry #1597
Engine
kidney-engine 2.0
Rule versions
  • ckd_epi_2009@1.0 · Levey et al., Ann Intern Med 2009;150:604-12 (2009 eGFR equation, drift check)
  • ckd_epi_2021@1.0 · Inker et al., N Engl J Med 2021;385:1737-49 (2021 race-free eGFR equation)
  • kdigo_aki_2012@1.1 · KDIGO 2012 guideline, Kidney Int Suppl 2012;2:1-138 (Rec 2.1.1-2.1.2, Table 2)
  • kdigo_ckd_2024@1.1 · KDIGO 2024 guideline, Kidney Int 2024;105(4S):S117-S314 (G/A categories, >3 months)
  • kidney_compare@1.1 · Two-sided comparison (this tool); ICD-10-CM guideline I.A.19; ACDIS/AHIMA compliant query practice, 2026 update
  • kidney_exclusions@1.0 · KDIGO 2024 guideline, limitations of creatinine-based eGFR (muscle mass, pregnancy, kidney replacement); local list
  • lab_units@1.1 · KDIGO 2012 and 2024 guidelines, unit conversion (creatinine 1 mg/dL = 88.4 umol/L; ACR 1 mg/mmol = 8.84 mg/g)
Note reading
word list + model, agreement required · model: ok · kidney function: silent · creatinine change: silent
Agreed statements
none
Provenance
Clinician-typed, as declared by the source system (context only: never an input to the rules)
Results side
measurement replay hash e845f978a01abc2bfafe23417cd94af52b8a66ab5883e3458b625301b5690a4f (computed from structured values only)
Replay hash
8f35978ee48431945b7216c52e6074cb8bc84623f683ae610db23438b907c588
Decisions
none yet
Revisions
KN-P15-1
Every creatinine row on file, with the filtering rate by the 2021 equation (and the 2009 equation as a drift check)
RowCollectedCreatinineAge 2021Range2009Used
L-00332026-11-11 15:001.2 7547.2G3a44.2 no: collected during an admission in which the creatinine-change criteria are met (not steady state)
L-00342026-11-12 15:001.6 7533.4G3b31.2 no: collected during an admission in which the creatinine-change criteria are met (not steady state)