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Exact Dx synthetic data · demonstration
Exact Dx · Before you sign · P04 synthetic data · demonstration · printed Fri Nov 13, 2026 04:55 PM

All notes

P04 woman, 61 · outpatient visit Clinician-typed

Open in the chart

Agrees Kidney results 220 days apart are 60 or above (filtering rate 72.7 on 2026-04-04 and 77.9 on 2026-11-10) and the note doesn't mention kidney function.

The note unsigned draft · Tue Nov 10, 2026 03:00 PM

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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.

Kidney function over time Agrees

  • 2026-04-04 creatinine 0.9 mg/dL · filtering rate 72.7 (G2 range)
  • 2026-11-10 creatinine 0.85 mg/dL · filtering rate 77.9 (G2 range)

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 Bone density T-score Draft · pending review

    The note says Osteopenia; T-score -2.7 on 2026-10-11 09:00 meets the published definition's criteria for the category “T-score -2.5 or lower band” (who1994_osteoporosis@1.0), not the category written.

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

    Published definition and source

    Assessment of fracture risk and its application to screening for postmenopausal osteoporosis: report of a WHO Study Group (WHO Technical Report Series 843)

    who1994_osteoporosis@1.0
    Normal. A value for BMD or BMC within 1 SD of the young adult reference mean. Low bone mass (osteopenia). ... more than 1 SD below the young adult mean but less than 2.5 SD below this value. Osteoporosis. ... 2.5 SD or more below the young adult mean.

    World Health Organization · edition 1994 · Section 2.1 Definitions, printed pages 5-6 (PDF pages 11-12) · opened 2026-11-14 · source

    Threshold for this category (who1994_osteoporosis@1.0): T-score ≤ -2.5 SD.

    Draft definition: pending clinical and coding review.

Library check LRUN-00004 · library_default_set@1.0 · library-engine 1.0 · replay c5f6663f69e1…

Show the details

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: Nothing to review criteria met under 0 of 2 eGFR equations (2021 race-free, 2009)

eGFR 77.9 on 2026-11-10 (lab row L-0009); eGFR 72.7 on 2026-04-04 (lab row L-0008). KDIGO persistence: not met (two values of 60 or more 220 days apart, none below 60 after them). Note: no kidney-function statement found. Nothing to review.

Both directions
What the labs show that the note doesn't say Criteria not met; nothing unstated
What the note says that the labs don't support No statement in the note
  • 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: Latest creatinine below 1.5x the lowest value in the previous 365 days (otherwise: possible acute change; repeat needed) (kdigo_ckd_2024@1.1)
    0.85 / 0.9 = 0.94x
    Rows: L-0008, L-0009
  • 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 met: two values of 60 or more 220 days apart, none below 60 after them
    Rows: L-0008, L-0009
  • not met: Two eGFR < 60 at least 90 days apart, none >= 60 between (2021 eGFR equation) (kdigo_ckd_2024@1.1)
    not met: two values of 60 or more 220 days apart, none below 60 after them
    Rows: L-0008, L-0009
  • met: Values used are steady-state (local convention: values from an admission meeting the creatinine-change criteria are excluded) (kdigo_ckd_2024@1.1)
    no values excluded

Creatinine change during this admission · kdigo_aki_2012@1.1

Creatinine change: Does not apply to this visit

Not assessed: outpatient visit: the creatinine-change check runs on inpatient encounters only.

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-00004 · seed · Fri Nov 13, 2026 04:55 PM · audit entry #1553
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 7e22c749048fc129618232532e8e075c88892ebef5a21b917b0dfca8b5899f63 (computed from structured values only)
Replay hash
091c426b3502d74b12cc57c338af67db51734a092a9cbcead69fed69460417c9
Decisions
none yet
Revisions
KN-P04-1
Every creatinine row on file, with the filtering rate by the 2021 equation (and the 2009 equation as a drift check)
RowCollectedCreatinineAge 2021Range2009Used
L-00082026-04-04 09:000.9 6172.7G269.0 yes
L-00092026-11-10 13:000.85 6177.9G273.9 yes