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

P07 man, 71 · outpatient visit Clinician-typed

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

COPD follow-up.
S: Stable dyspnea on exertion, no exacerbations since spring.
O: SpO2 94% on room air. Scattered wheeze.
A/P:
1. COPD: continue inhaled maintenance therapy; pulmonary rehab referral.
2. Tobacco use: counselled; nicotine patch offered.

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 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

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

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)
Row	Collected	Creatinine	Age	2021	Range	2009	Used
`L-0014`	2026-05-14 09:00	2.6	71	25.6	G4	23.7	yes
`L-0015`	2026-11-10 10:00	2.8	71	23.4	G4	21.7	yes

P07 man, 71 · outpatient visit ✎ Clinician-typed