Exact Dx · Before you sign · P03 synthetic data · demonstration · printed Fri Nov 13, 2026 04:55 PM

P03 man, 47 · outpatient visit AI-drafted

Agrees Kidney results 150 days apart are 60 or above (filtering rate 93.4 on 2026-06-14 and 106.0 on 2026-11-11) and the note doesn't mention kidney function.

The note unsigned draft · Wed Nov 11, 2026 10:00 AM

Chief complaint: low back pain for two weeks.
History of present illness: The patient reports low back pain that started after lifting boxes. He denies leg weakness, numbness or bowel or bladder changes.
Exam: Paraspinal tenderness on the right. Straight-leg raise negative.
Assessment and plan: Mechanical low back pain. Recommend heat, stretching and a short course of acetaminophen. Return if symptoms worsen.

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.

Kidney function over time Agrees

2026-06-14 creatinine 1.0 mg/dL · filtering rate 93.4 (G1 range)
2026-11-11 creatinine 0.9 mg/dL · filtering rate 106.0 (G1 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: Nothing to review criteria met under 0 of 2 eGFR equations (2021 race-free, 2009)

eGFR 106.0 on 2026-11-11 (lab row L-0007); eGFR 93.4 on 2026-06-14 (lab row L-0006). KDIGO persistence: not met (two values of 60 or more 150 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)
0.9 / 1.0 = 0.9x
Rows: L-0006, L-0007
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 150 days apart, none below 60 after them
Rows: L-0006, L-0007
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 150 days apart, none below 60 after them
Rows: L-0006, L-0007
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-00003 · seed · Fri Nov 13, 2026 04:55 PM · audit entry #1549

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 8fb5bf8e16702fe565a4c3db4447a33f2ded2d40ad2151fc3970d53c7e6cd33b (computed from structured values only)

Replay hash

7dfb44e75e39b0aac42bd8e010924c0c2e605f5146fa528b073232067e88f6f0

Decisions

none yet

Revisions

KN-P03-1

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-0006`	2026-06-14 09:00	1.0	47	93.4	G1	89.2	yes
`L-0007`	2026-11-11 08:15	0.9	47	106.0	G1	101.4	yes

P03 man, 47 · outpatient visit ◆ AI-drafted