Exact Dx · Before you sign · P20 synthetic data · demonstration · printed Fri Nov 13, 2026 04:55 PM

P20 man, 80 · outpatient visit AI-drafted

Needs a look Two kidney results 140 days apart are in the G3b range (filtering rate 35.2 on 2026-06-25 and 33.1 on 2026-11-12); the note doesn't mention kidney function.

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

2026-06-25 creatinine 1.9 mg/dL · filtering rate 35.2 (G3b range)
2026-11-12 creatinine 2.0 mg/dL · filtering rate 33.1 (G3b range)

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

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

eGFR 33.1 on 2026-11-12 (lab row L-0046) and eGFR 35.2 on 2026-06-25 (lab row L-0045), 140 days apart, no value >= 60 between. KDIGO persistence: met. Persistent GFR category G3b (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)
2.0 / 1.9 = 1.05x
Rows: L-0045, L-0046
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-0045 (32.6, 2026-06-25) and L-0046 (30.6, 2026-11-12), 140 days apart; persistent category G3b (the range both values meet)
Rows: L-0045, L-0046
met: Two eGFR < 60 at least 90 days apart, none >= 60 between (2021 eGFR equation) (kdigo_ckd_2024@1.1)
pair L-0045 (35.2, 2026-06-25) and L-0046 (33.1, 2026-11-12), 140 days apart; persistent category G3b (the range both values meet)
Rows: L-0045, L-0046
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-00020 · seed · Fri Nov 13, 2026 04:55 PM · audit entry #1617

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

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

Results side

measurement replay hash 54348d96bf360c190995a3538a3ca6cebd5a1523d00f09f6d3481991d29c80da (computed from structured values only)

Replay hash

cf92beddcf388050882e39f648daff3c13b4464f3bfdf312da6702fe00814f05

Decisions

none yet

Revisions

KN-P20-1

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-0045`	2026-06-25 09:00	1.9	80	35.2	G3b	32.6	yes
`L-0046`	2026-11-12 08:30	2.0	80	33.1	G3b	30.6	yes

P20 man, 80 · outpatient visit ◆ AI-drafted