Exact Dx · Before you sign · P17 synthetic data · demonstration · printed Fri Nov 13, 2026 04:55 PM

P17 man, 63 · outpatient visit Clinician-typed

Agrees The note says CKD 3b and two results 110 days apart agree (G3b range, filtering rate 44.7 on 2026-07-25 and 41.8 on 2026-11-12).

The note unsigned draft · Thu Nov 12, 2026 12:00 PM

Diabetes follow-up.
S: Checking glucose twice daily, fasting 110-140.
O: BP 128/76. Foot exam normal.
A/P:
1. DM2: A1c 7.4, continue metformin at the current dose, add SGLT2 inhibitor.
2. CKD 3b: as above, labs in 3 months.

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

2026-07-25 creatinine 1.7 mg/dL · filtering rate 44.7 (G3b range)
2026-11-12 creatinine 1.8 mg/dL · filtering rate 41.8 (G3b 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 (3)

2 more, grouped by what was measured. At most three are shown above at once.

Glucose and HbA1c Agrees 2

Agrees Glucose and HbA1c Draft · pending review

The note says Diabetes, and HbA1c 7.4 % on 2026-11-12 10:05 meets the published definition's criteria for the category “two results at or above the diagnostic thresholds” (ada2026_diabetes@1.0).

Show in the note Show the results

Published definition and source

2. Diagnosis and Classification of Diabetes: Standards of Care in Diabetes—2026
ada2026_diabetes@1.0

Table 2.1: A1C ≥6.5% (≥48 mmol/mol); FPG ≥126 mg/dL (≥7.0 mmol/L); 2-h PG ≥200 mg/dL (≥11.1 mmol/L) during OGTT; random plasma glucose ≥200 mg/dL (≥11.1 mmol/L) with classic symptoms of hyperglycemia or hyperglycemic crisis. In the absence of unequivocal hyperglycemia, diagnosis requires two abnormal results from different tests ... or the same test at two different time points.

American Diabetes Association Professional Practice Committee · edition 2026 (Diabetes Care 2026;49 Suppl 1:S27-S49, doi:10.2337/dc26-S002) · Table 2.1 Criteria for the diagnosis of diabetes in nonpregnant individuals · opened 2026-11-14 · source

Threshold for this category (ada2026_diabetes@1.0): number of qualifying results ≥ 2.

Draft definition: pending clinical and coding review.
Agrees Glucose and HbA1c (intermediate range) Draft · pending review

HbA1c 7.4 % on 2026-11-12 10:05: in the category “a result in the higher (diagnostic) range” of ada2026_prediabetes@1.0; the note doesn't mention this. Nothing to review.

Published bodies disagree on these thresholds; another definition may give a different answer.

The note does not mention this. Show the results

Published definition and source

2. Diagnosis and Classification of Diabetes: Standards of Care in Diabetes—2026
ada2026_prediabetes@1.0

A1C 5.7–6.4% (39–47 mmol/mol); FPG 100 mg/dL (5.6 mmol/L) to 125 mg/dL (6.9 mmol/L) (IFG); 2-h PG during 75-g OGTT 140 mg/dL (7.8 mmol/L) to 199 mg/dL (11.0 mmol/L) (IGT)

American Diabetes Association Professional Practice Committee · edition 2026 (Diabetes Care 2026;49 Suppl 1:S27-S49) · Table 2.2 Criteria defining prediabetes in nonpregnant individuals · opened 2026-11-14 · source

Categories that count (ada2026_prediabetes@1.0): intermediate range (HbA1c 5.7 to 6.4%, fasting glucose 100 to 125 mg/dL, or 2-hour glucose 140 to 199 mg/dL) (HbA1c ≥ 5.7 % and HbA1c < 6.5 % or fasting glucose ≥ 100 mg/dL and fasting glucose < 126 mg/dL or 2-hour glucose ≥ 140 mg/dL and 2-hour glucose < 200 mg/dL).

Draft definition: pending clinical and coding review.

Library check LRUN-00017 · library_default_set@1.0 · library-engine 1.0 · replay cdedba8ce66a…

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: Note and criteria agree criteria met under 2 of 2 eGFR equations (2021 race-free, 2009)

eGFR 41.8 on 2026-11-12 (lab row L-0040) and eGFR 44.7 on 2026-07-25 (lab row L-0039), 110 days apart, no value >= 60 between. KDIGO persistence: met. Persistent GFR category G3b (the range both values meet). Note: the kidney-function statement (quoted below) agrees with the persistent GFR category.

From the draft note: CKD 3b

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; criteria met

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)
1.8 / 1.7 = 1.06x
Rows: L-0039, L-0040
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-0039 (42.0, 2026-07-25) and L-0040 (39.2, 2026-11-12), 110 days apart; persistent category G3b (the range both values meet)
Rows: L-0039, L-0040
met: Two eGFR < 60 at least 90 days apart, none >= 60 between (2021 eGFR equation) (kdigo_ckd_2024@1.1)
pair L-0039 (44.7, 2026-07-25) and L-0040 (41.8, 2026-11-12), 110 days apart; persistent category G3b (the range both values meet)
Rows: L-0039, L-0040
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-00017 · seed · Fri Nov 13, 2026 04:55 PM · audit entry #1605

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 3b (characters 188-194)
Encounter list: DM2
Encounter list: CKD 3b

Provenance

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

Results side

measurement replay hash 7236f131e027960cd383bece1b5e3098b2592eb76b569b92174b2a3722dc46f6 (computed from structured values only)

Replay hash

4ce48c4bb76170bbcd875e0be51caad2bcda136011e963b89a36294d1dfde989

Decisions

none yet

Revisions

KN-P17-1

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-0039`	2026-07-25 09:00	1.7	63	44.7	G3b	42.0	yes
`L-0040`	2026-11-12 10:00	1.8	63	41.8	G3b	39.2	yes

P17 man, 63 · outpatient visit ✎ Clinician-typed