Exact Dx · Before you sign · P18 synthetic data · demonstration · printed Fri Nov 13, 2026 04:55 PM

P18 woman, 67 · outpatient visit Clinician-typed

Agrees The note says CKD 3a and two results 150 days apart agree (G3a range, filtering rate 55.1 on 2026-06-14 and 52.2 on 2026-11-11).

The note unsigned draft · Wed Nov 11, 2026 11:00 AM

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

2026-06-14 creatinine 1.1 mg/dL · filtering rate 55.1 (G3a range)
2026-11-11 creatinine 1.15 mg/dL · filtering rate 52.2 (G3a 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.

Blood pressure Agrees

Agrees Blood pressure readings Draft · pending review

The note says Hypertension, and blood pressure 130/78 mmHg on 2026-11-11 09:05 meets the published definition's criteria for the category “stage 1 range (130 to 139 systolic, or 80 to 89 diastolic)” (nhlbi_bp_categories@1.0).

Another published definition (esc2024_office_bp@1.0) gives the category “office 120 to 139 systolic or 70 to 89 diastolic”.

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

Show in the note Show the results

Published definition and source

High Blood Pressure — Diagnosis
nhlbi_bp_categories@1.0

Normal: Less than 120 systolic AND Less than 80 diastolic; Elevated: 120 to 129 AND Less than 80; Stage 1: 130 to 139 OR 80 to 89; Stage 2: 140 or higher OR 90 or higher; Hypertensive Crisis: Higher than 180 OR Higher than 120

National Heart, Lung, and Blood Institute (U.S. National Institutes of Health) · edition page last updated June 26, 2025 · Blood pressure categories table · opened 2026-11-14 · source

Threshold for this category (nhlbi_bp_categories@1.0): systolic ≥ 130 mmHg and systolic < 140 mmHg or diastolic ≥ 80 mmHg and diastolic < 90 mmHg.

Draft definition: pending clinical and coding review.

Library check LRUN-00018 · library_default_set@1.0 · library-engine 1.0 · replay 77ac6e56e5db…

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: Note and criteria agree criteria met under 2 of 2 eGFR equations (2021 race-free, 2009)

eGFR 52.2 on 2026-11-11 (lab row L-0042) and eGFR 55.1 on 2026-06-14 (lab row L-0041), 150 days apart, no value >= 60 between. KDIGO persistence: met. Persistent GFR category G3a (the range both values meet). Note: the kidney-function statement (quoted below) agrees with the persistent GFR category.

From the draft note: CKD 3a

Both directions
What the labs show that the note doesn't say	Criteria met; the note has a statement
What the note says that the labs don't support	Statement present; criteria met

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)
1.15 / 1.1 = 1.05x
Rows: L-0041, L-0042
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-0041 (51.9, 2026-06-14) and L-0042 (49.2, 2026-11-11), 150 days apart; persistent category G3a (the range both values meet)
Rows: L-0041, L-0042
met: Two eGFR < 60 at least 90 days apart, none >= 60 between (2021 eGFR equation) (kdigo_ckd_2024@1.1)
pair L-0041 (55.1, 2026-06-14) and L-0042 (52.2, 2026-11-11), 150 days apart; persistent category G3a (the range both values meet)
Rows: L-0041, L-0042
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-00018 · seed · Fri Nov 13, 2026 04:55 PM · audit entry #1609

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: stated · creatinine change: silent

Agreed statements

CKD 3a (characters 110-116)
Encounter list: HTN
Encounter list: CKD 3a

Provenance

Clinician-typed, as declared by the source system (context only: never an input to the rules)

Results side

measurement replay hash 0b6fe0066acf45f4e8a1d678b977bf5a2323c14a3f5ab203e37b210b9ba32a5b (computed from structured values only)

Replay hash

dd5ac0b99a464b32f51ca744cf3f5f6d61bcf7ae51efc2172215b79e11b2d68e

Decisions

none yet

Revisions

KN-P18-1

Every creatinine row on file, with the filtering rate by the 2021 equation (and the 2009 equation as a drift check)
Row	Collected	Creatinine	Age	2021	Range	2009	Used
`L-0041`	2026-06-14 09:00	1.1	67	55.1	G3a	51.9	yes
`L-0042`	2026-11-11 09:00	1.15	67	52.2	G3a	49.2	yes

P18 woman, 67 · outpatient visit ✎ Clinician-typed