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Exact Dx synthetic data · demonstration
Exact Dx · Before you sign · P07 synthetic data · demonstration · printed Fri Nov 13, 2026 04:55 PM

All notes

P07 man, 71 · outpatient visit Clinician-typed

Open in the chart

Needs a look Two kidney results 180 days apart are in the G4 range (filtering rate 25.6 on 2026-05-14 and 23.4 on 2026-11-10); the note doesn't mention kidney function.

The note unsigned draft · Tue Nov 10, 2026 12:00 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 Needs a look

  • 2026-05-14 creatinine 2.6 mg/dL · filtering rate 25.6 (G4 range)
  • 2026-11-10 creatinine 2.8 mg/dL · filtering rate 23.4 (G4 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.

Nothing else needs a look.

Show all (2)

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

Lung function and oxygen Needs your clinical judgement

  1. Needs your clinical judgement Lung function after bronchodilator Draft · pending review

    The note says COPD. FEV1/FVC 0.58 on 2026-09-11 10:00; FEV1 % predicted 62 % on 2026-09-11 10:00: the record shows these values; this needs your clinical judgement (gold2026_copd_airflow@1.0 uses them as one part of a wider clinical picture, category “FEV1/FVC below 0.7 with FEV1 50 to below 80% predicted (grade 2)”).

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

    Show in the note Show the results

    Published definition and source

    Global Strategy for Prevention, Diagnosis and Management of COPD: 2026 Report — Pocket Guide

    gold2026_copd_airflow@1.0
    In patients with COPD (FEV1/FVC < 0.7): GOLD 1: Mild FEV1 ≥ 80% predicted; GOLD 2: Moderate 50% ≤ FEV1 < 80% predicted; GOLD 3: Severe 30% ≤ FEV1 < 50% predicted; GOLD 4: Very Severe FEV1 < 30% predicted

    Global Initiative for Chronic Obstructive Lung Disease (GOLD) · edition 2026 (pocket guide v1.1, 20 Nov 2025) · Figure 2.10 (PDF page 20); key points (PDF page 11) · opened 2026-11-14 · source

    Threshold for this category (gold2026_copd_airflow@1.0): FEV1/FVC < 0.7 and FEV1 % predicted ≥ 50 % and FEV1 % predicted < 80 %.

    Draft definition: pending clinical and coding review.

Library check LRUN-00007 · library_default_set@1.0 · library-engine 1.0 · replay 7e6a5c327d65…

Show the details

Your decision: Kidney function (eGFR persistence)

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: Labs meet the criteria; nothing documented criteria met under 2 of 2 eGFR equations (2021 race-free, 2009)

eGFR 23.4 on 2026-11-10 (lab row L-0015) and eGFR 25.6 on 2026-05-14 (lab row L-0014), 180 days apart, no value >= 60 between. KDIGO persistence: met. Persistent GFR category G4 (the range both values meet). Note: no kidney-function statement 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
  • 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)
    2.8 / 2.6 = 1.08x
    Rows: L-0014, L-0015
  • 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
  • met: Two eGFR < 60 at least 90 days apart, none >= 60 between (2009 eGFR equation) (kdigo_ckd_2024@1.1)
    pair L-0014 (23.7, 2026-05-14) and L-0015 (21.7, 2026-11-10), 180 days apart; persistent category G4 (the range both values meet)
    Rows: L-0014, L-0015
  • met: Two eGFR < 60 at least 90 days apart, none >= 60 between (2021 eGFR equation) (kdigo_ckd_2024@1.1)
    pair L-0014 (25.6, 2026-05-14) and L-0015 (23.4, 2026-11-10), 180 days apart; persistent category G4 (the range both values meet)
    Rows: L-0014, L-0015
  • 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-00007 · seed · Fri Nov 13, 2026 04:55 PM · audit entry #1565
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 2a1570191b34227399b66a35ba23883a8f2e609e47f04c44568e3238e1748f5b (computed from structured values only)
Replay hash
42508c0c3a9b5ca250e1a520ff0bfb3b26802c369d802987b1397627d5984e81
Decisions
none yet
Revisions
KN-P07-1
Every creatinine row on file, with the filtering rate by the 2021 equation (and the 2009 equation as a drift check)
RowCollectedCreatinineAge 2021Range2009Used
L-00142026-05-14 09:002.6 7125.6G423.7 yes
L-00152026-11-10 10:002.8 7123.4G421.7 yes