Exact Dx · Before you sign · P20 synthetic data · demonstration · printed Fri Nov 13, 2026 04:55 PM

P20 man, 80 · outpatient visit AI-drafted

Needs a look Two kidney results 140 days apart are in the G3b range (filtering rate 35.2 on 2026-06-25 and 33.1 on 2026-11-12); the note doesn't mention kidney function.

The note unsigned draft · Thu Nov 12, 2026 10:00 AM

Chief complaint: follow-up of blood pressure and memory concerns.
History of present illness: The patient is accompanied by his son. He reports taking his medications with a weekly pill box. His son notes occasional forgetfulness with names.
Exam: Alert and oriented. Blood pressure 134/76.
Assessment and plan: 1. Mild memory concerns. Cognitive screening today; will review at the next visit. 2. Blood pressure at goal. Continue the current regimen. 3. Fall prevention discussed; home safety handout given.

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

2026-06-25 creatinine 1.9 mg/dL · filtering rate 35.2 (G3b range)
2026-11-12 creatinine 2.0 mg/dL · filtering rate 33.1 (G3b 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: Labs meet the criteria; nothing documented criteria met under 2 of 2 eGFR equations (2021 race-free, 2009)

eGFR 33.1 on 2026-11-12 (lab row L-0046) and eGFR 35.2 on 2026-06-25 (lab row L-0045), 140 days apart, no value >= 60 between. KDIGO persistence: met. Persistent GFR category G3b (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)
2.0 / 1.9 = 1.05x
Rows: L-0045, L-0046
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-0045 (32.6, 2026-06-25) and L-0046 (30.6, 2026-11-12), 140 days apart; persistent category G3b (the range both values meet)
Rows: L-0045, L-0046
met: Two eGFR < 60 at least 90 days apart, none >= 60 between (2021 eGFR equation) (kdigo_ckd_2024@1.1)
pair L-0045 (35.2, 2026-06-25) and L-0046 (33.1, 2026-11-12), 140 days apart; persistent category G3b (the range both values meet)
Rows: L-0045, L-0046
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-00020 · seed · Fri Nov 13, 2026 04:55 PM · audit entry #1617

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 54348d96bf360c190995a3538a3ca6cebd5a1523d00f09f6d3481991d29c80da (computed from structured values only)

Replay hash

cf92beddcf388050882e39f648daff3c13b4464f3bfdf312da6702fe00814f05

Decisions

none yet

Revisions

KN-P20-1

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-0045`	2026-06-25 09:00	1.9	80	35.2	G3b	32.6	yes
`L-0046`	2026-11-12 08:30	2.0	80	33.1	G3b	30.6	yes

P20 man, 80 · outpatient visit ◆ AI-drafted