Exact Dx · Before you sign · P27 synthetic data · demonstration · printed Fri Nov 13, 2026 04:55 PM

P27 man, 71 · outpatient visit AI-drafted

Needs a look The note says Chronic kidney disease stage 4; two results 118 days apart are in the G3a range (filtering rate 51.5 on 2026-07-17 and 47.6 on 2026-11-12), not the stage written.

The note unsigned draft · Thu Nov 12, 2026 11:00 AM

Chief complaint: follow-up of blood pressure and kidney function.
History of present illness: The patient reports feeling well and walking daily. He takes his medications as prescribed.
Exam: Blood pressure 136/80. No edema.
Assessment and plan: 1. Chronic kidney disease stage 4. Continue current management and recheck labs. 2. Hypertension, controlled. Continue lisinopril.

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

2026-07-17 creatinine 1.45 mg/dL · filtering rate 51.5 (G3a range)
2026-11-12 creatinine 1.55 mg/dL · filtering rate 47.6 (G3a 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.

Blood pressure Not assessable

Not assessable Blood pressure readings Draft · pending review

The note says Hypertension; it could not be checked against nhlbi_bp_categories@1.0: there is no blood pressure result in the last 365 days.

Another published definition (esc2024_office_bp@1.0) cannot decide: there is no usable blood pressure result.

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

Show in the note

Published definition and source

High Blood Pressure — Diagnosis
nhlbi_bp_categories@1.0

Normal: Less than 120 systolic AND Less than 80 diastolic; Elevated: 120 to 129 AND Less than 80; Stage 1: 130 to 139 OR 80 to 89; Stage 2: 140 or higher OR 90 or higher; Hypertensive Crisis: Higher than 180 OR Higher than 120

National Heart, Lung, and Blood Institute (U.S. National Institutes of Health) · edition page last updated June 26, 2025 · Blood pressure categories table · opened 2026-11-14 · source

Categories that count (nhlbi_bp_categories@1.0): range above 180 systolic or above 120 diastolic (systolic > 180 mmHg or diastolic > 120 mmHg); stage 2 range (140 or more systolic, or 90 or more diastolic) (systolic ≥ 140 mmHg or diastolic ≥ 90 mmHg); stage 1 range (130 to 139 systolic, or 80 to 89 diastolic) (systolic ≥ 130 mmHg and systolic < 140 mmHg or diastolic ≥ 80 mmHg and diastolic < 90 mmHg); elevated range (120 to 129 systolic and below 80 diastolic) (systolic ≥ 120 mmHg and systolic < 130 mmHg and diastolic < 80 mmHg).

Draft definition: pending clinical and coding review.

Library check LRUN-00027 · library_default_set@1.0 · library-engine 1.0 · replay 31c95a0242a5…

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 47.6 on 2026-11-12 (lab row L-0061) and eGFR 51.5 on 2026-07-17 (lab row L-0060), 118 days apart, no value >= 60 between. KDIGO persistence: met. Persistent GFR category G3a (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: Chronic kidney disease stage 4

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)
1.55 / 1.45 = 1.07x
Rows: L-0060, L-0061
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-0060 (48.1, 2026-07-17) and L-0061 (44.4, 2026-11-12), 118 days apart; persistent category G3a (the range both values meet)
Rows: L-0060, L-0061
met: Two eGFR < 60 at least 90 days apart, none >= 60 between (2021 eGFR equation) (kdigo_ckd_2024@1.1)
pair L-0060 (51.5, 2026-07-17) and L-0061 (47.6, 2026-11-12), 118 days apart; persistent category G3a (the range both values meet)
Rows: L-0060, L-0061
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-00027 · seed · Fri Nov 13, 2026 04:55 PM · audit entry #1645

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

Chronic kidney disease stage 4 (characters 249-279)

Provenance

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

Results side

measurement replay hash 4099549adba16ece7cf7a09a3f31a7a9fb253591e9d35ad20238a97fa1b35b5c (computed from structured values only)

Replay hash

2328b0338ac8fa8ba87b8c17c6f22380eebb93bb60e5ccd7fdfd2853094c1976

Decisions

none yet

Revisions

KN-P27-1

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-0060`	2026-07-17 09:00	1.45	71	51.5	G3a	48.1	yes
`L-0061`	2026-11-12 09:00	1.55	71	47.6	G3a	44.4	yes

P27 man, 71 · outpatient visit ◆ AI-drafted