Exact Dx · Before you sign · P11 synthetic data · demonstration · printed Fri Nov 13, 2026 04:55 PM

P11 man, 77 · outpatient visit Clinician-typed

Needs a look The note says CKD 3; two results 130 days apart are in the G4 range (filtering rate 25.8 on 2026-07-04 and 23.5 on 2026-11-11), not the stage written.

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

Follow-up.
S: Mild ankle swelling in the evenings.
O: BP 136/80. Trace edema.
A/P:
1. CKD 3: continue current care, nephrology follow-up as scheduled.
2. Benign prostatic hyperplasia: continue tamsulosin.

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

2026-07-04 creatinine 2.5 mg/dL · filtering rate 25.8 (G4 range)
2026-11-11 creatinine 2.7 mg/dL · filtering rate 23.5 (G4 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: Stage in the note differs from the computed category criteria met under 2 of 2 eGFR equations (2021 race-free, 2009)

eGFR 23.5 on 2026-11-11 (lab row L-0023) and eGFR 25.8 on 2026-07-04 (lab row L-0022), 130 days apart, no value >= 60 between. KDIGO persistence: met. Persistent GFR category G4 (the range both values meet). Note: the stage in the kidney-function statement (quoted below) differs from the persistent GFR category.

From the draft note: CKD 3

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; its stage is missing or differs from the computed category

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)
2.7 / 2.5 = 1.08x
Rows: L-0022, L-0023
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-0022 (23.9, 2026-07-04) and L-0023 (21.8, 2026-11-11), 130 days apart; persistent category G4 (the range both values meet)
Rows: L-0022, L-0023
met: Two eGFR < 60 at least 90 days apart, none >= 60 between (2021 eGFR equation) (kdigo_ckd_2024@1.1)
pair L-0022 (25.8, 2026-07-04) and L-0023 (23.5, 2026-11-11), 130 days apart; persistent category G4 (the range both values meet)
Rows: L-0022, L-0023
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-00011 · seed · Fri Nov 13, 2026 04:55 PM · audit entry #1581

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 3 (characters 86-91)

Provenance

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

Results side

measurement replay hash 40308920a45d47bbb5d95182450f5894900f719e4a13ee45e75e881380c27f8f (computed from structured values only)

Replay hash

9168691df703aa722a661a5834f9a07b0f935276cccc45956d4aef1d1eaf53b0

Decisions

none yet

Revisions

KN-P11-1

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-0022`	2026-07-04 09:00	2.5	77	25.8	G4	23.9	yes
`L-0023`	2026-11-11 08:00	2.7	77	23.5	G4	21.8	yes

P11 man, 77 · outpatient visit ✎ Clinician-typed