Exact Dx · Before you sign · P12 synthetic data · demonstration · printed Fri Nov 13, 2026 04:55 PM

P12 woman, 81 · outpatient visit Clinician-typed

Needs a look The note says CKD; it gives no stage. two results 200 days apart are in the G4 range (filtering rate 28.9 on 2026-04-24 and 27.1 on 2026-11-10), not the stage written.

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

Follow-up.
S: Lives with daughter, independent in daily activities.
O: BP 130/72.
A/P:
1. CKD, follow with labs.
2. Atrial fibrillation: rate controlled, continue apixaban.

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

2026-04-24 creatinine 1.75 mg/dL · filtering rate 28.9 (G4 range)
2026-11-10 creatinine 1.85 mg/dL · filtering rate 27.1 (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 27.1 on 2026-11-10 (lab row L-0025) and eGFR 28.9 on 2026-04-24 (lab row L-0024), 200 days apart, no value >= 60 between. KDIGO persistence: met. Persistent GFR category G4 (the range both values meet). Note: the kidney-function statement (quoted below) gives no stage.

From the draft note: CKD

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)
1.85 / 1.75 = 1.06x
Rows: L-0024, L-0025
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-0024 (26.8, 2026-04-24) and L-0025 (25.1, 2026-11-10), 200 days apart; persistent category G4 (the range both values meet)
Rows: L-0024, L-0025
met: Two eGFR < 60 at least 90 days apart, none >= 60 between (2021 eGFR equation) (kdigo_ckd_2024@1.1)
pair L-0024 (28.9, 2026-04-24) and L-0025 (27.1, 2026-11-10), 200 days apart; persistent category G4 (the range both values meet)
Rows: L-0024, L-0025
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-00012 · seed · Fri Nov 13, 2026 04:55 PM · audit entry #1585

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 (characters 90-93)

Provenance

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

Results side

measurement replay hash fdeb3c4b749888ddd91586bf394c27839c353b64ba09085d1175d03cc81dd98e (computed from structured values only)

Replay hash

65201fc8caf865354c733f5887acf02dfe7c48b0617df84757ce1d669f33578c

Decisions

none yet

Revisions

KN-P12-1

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-0024`	2026-04-24 09:00	1.75	81	28.9	G4	26.8	yes
`L-0025`	2026-11-10 09:00	1.85	81	27.1	G4	25.1	yes

P12 woman, 81 · outpatient visit ✎ Clinician-typed