{"patient_id":"P02","encounter_id":"KE-P02","note_id":"KN-P02-1","signed":false,"origin":"clinician","origin_label":"Clinician-typed","origin_note":"as declared by the source system","needs_look":0,"needs_look_kidney":0,"surfaced":[{"source":"kidney","family":"kidney"}],"model":{"off":false,"failed":false,"degraded":false},"run_id":"RUN-00002","replay_hash":"db562dc94f6ddcdc38a2a014ee5062caafe29ac11bd25c032253cce20eb2ad77","measurement_replay_hash":"44499c0ae4deeb0cd546f407b4ac6607b330987bfc2bdd0c36c30013b73c4ff1","engine":"kidney-engine 2.0","rules":[{"rule":"ckd_epi_2009@1.0","source":"Levey et al., Ann Intern Med 2009;150:604-12 (2009 eGFR equation, drift check)","url":"https://www.acpjournals.org/doi/10.7326/0003-4819-150-9-200905050-00006"},{"rule":"ckd_epi_2021@1.0","source":"Inker et al., N Engl J Med 2021;385:1737-49 (2021 race-free eGFR equation)","url":"https://www.kidney.org/ckd-epi-creatinine-equation-2021"},{"rule":"kdigo_aki_2012@1.1","source":"KDIGO 2012 guideline, Kidney Int Suppl 2012;2:1-138 (Rec 2.1.1-2.1.2, Table 2)","url":"https://kdigo.org/guidelines/acute-kidney-injury/"},{"rule":"kdigo_ckd_2024@1.1","source":"KDIGO 2024 guideline, Kidney Int 2024;105(4S):S117-S314 (G/A categories, >3 months)","url":"https://kdigo.org/guidelines/ckd-evaluation-and-management/"},{"rule":"kidney_compare@1.1","source":"Two-sided comparison (this tool); ICD-10-CM guideline I.A.19; ACDIS/AHIMA compliant query practice, 2026 update","url":"https://www.cms.gov/medicare/coding-billing/icd-10-codes"},{"rule":"kidney_exclusions@1.0","source":"KDIGO 2024 guideline, limitations of creatinine-based eGFR (muscle mass, pregnancy, kidney replacement); local list","url":"https://kdigo.org/guidelines/ckd-evaluation-and-management/"},{"rule":"lab_units@1.1","source":"KDIGO 2012 and 2024 guidelines, unit conversion (creatinine 1 mg/dL = 88.4 umol/L; ACR 1 mg/mmol = 8.84 mg/g)","url":"https://kdigo.org/guidelines/ckd-evaluation-and-management/"}],"last_replay":null,"library":{"run_id":"LRUN-00002","encounter_id":"KE-P02","note_id":"KN-P02-1","config":"library_default_set@1.0","engine":"library-engine 1.0","replay_hash":"823d08e0e0d974b0e32bafb22e2d03484b6ac9910d08506bda515147259bc713","measurement_replay_hash":"c5a1dcbce21a74761c2244eaae71388d2d5a903de76dd06f2cfdb1c3b1b43a70","surfaced":[],"more":[{"family":"haemoglobin","topic":"Haemoglobin","direction":"NOT_ASSESSABLE","status":"not_assessable","label":"Not assessable","icon":"∅","lead":"","quote":null,"text":"Haemoglobin: could not check against who2024_anaemia@1.0: pregnancy status and pregnancy trimester are not recorded. Results: haemoglobin 128 g/L on 2026-11-12 11:00.","sentence":"Haemoglobin: could not check against who2024_anaemia@1.0: pregnancy status and pregnancy trimester are not recorded. Results: haemoglobin 128 g/L on 2026-11-12 11:00.","threshold":"Categories that count (who2024_anaemia@1.0): 'severe' band (haemoglobin < 70 g/L); 'moderate' band (haemoglobin ≥ 70 g/L and haemoglobin < 100 g/L); 'mild' band (haemoglobin ≥ 100 g/L and haemoglobin < 110 g/L).","span":null,"note_mentions":false,"lab_ids":["LM-P02-04"],"definition":"who2024_anaemia@1.0","version":"1.0","tier":"measured","values":"haemoglobin 128 g/L on 2026-11-12 11:00","alternatives":[],"contested":true,"contested_text":"Published bodies disagree on these thresholds; another definition may give a different answer.","reviewed":false,"draft_label":"Draft definition: pending clinical and coding review","source_url":"https://iris.who.int/server/api/core/bitstreams/f9f74397-1440-478d-a63c-26f29a01552f/content","optional_set":null,"cite":{"id":"who2024_anaemia@1.0","title":"Guideline on haemoglobin cutoffs to define anaemia in individuals and populations","body":"World Health Organization","edition":"2024","year":2024,"url":"https://iris.who.int/server/api/core/bitstreams/f9f74397-1440-478d-a63c-26f29a01552f/content","locator":"Executive summary: Table 2 (PDF page 12), Table 3 (PDF page 13), Table 4 (PDF page 14), Table 5 (PDF page 15)","quote":"Table 3: Adults, 15–65 years, nonpregnant women: No anaemia ≥120; Mild 110–119; Moderate 80–109; Severe <80. Adults, 15–65, years men: ≥130; 110–129; 80–109; <80 (g/L)","accessed":"2026-11-14"}},{"family":"bmi","topic":"Body-mass index","direction":"NONE","status":"agrees","label":"Agrees","icon":"✓","lead":"","quote":null,"text":"Body-mass index 24 kg/m2 on 2026-11-12 11:05: in the category “18.5 to below 25 band” of cdc_adult_bmi@1.0; the note doesn't mention this. Nothing to review.","sentence":"Body-mass index 24 kg/m2 on 2026-11-12 11:05: in the category “18.5 to below 25 band” of cdc_adult_bmi@1.0; the note doesn't mention this. Nothing to review.","threshold":"Categories that count (cdc_adult_bmi@1.0): 40 or more band (class 3) (body-mass index ≥ 40 kg/m2); 35 to below 40 band (class 2) (body-mass index ≥ 35 kg/m2 and body-mass index < 40 kg/m2); 30 to below 35 band (class 1) (body-mass index ≥ 30 kg/m2 and body-mass index < 35 kg/m2); 25 to below 30 band (body-mass index ≥ 25 kg/m2 and body-mass index < 30 kg/m2); below 18.5 band (body-mass index < 18.5 kg/m2).","span":null,"note_mentions":false,"lab_ids":["LM-P02-01"],"definition":"cdc_adult_bmi@1.0","version":"1.0","tier":"measured","values":"body-mass index 24 kg/m2 on 2026-11-12 11:05","alternatives":["Another published definition (who_adult_bmi@1.0) gives the category “below 25”."],"contested":true,"contested_text":"Published bodies disagree on these thresholds; another definition may give a different answer.","reviewed":false,"draft_label":"Draft definition: pending clinical and coding review","source_url":"https://www.cdc.gov/bmi/adult-calculator/bmi-categories.html","optional_set":null,"cite":{"id":"cdc_adult_bmi@1.0","title":"Adult BMI Categories","body":"Centers for Disease Control and Prevention","edition":"page dated March 19, 2024","year":2024,"url":"https://www.cdc.gov/bmi/adult-calculator/bmi-categories.html","locator":"Adult BMI categories table","quote":"Underweight: Less than 18.5; Healthy Weight: 18.5 to less than 25; Overweight: 25 to less than 30; Obesity: 30 or greater; Class 1 Obesity: 30 to less than 35; Class 2 Obesity: 35 to less than 40; Class 3 Obesity (Severe Obesity): 40 or greater","accessed":"2026-11-14"}}],"n_needs":0,"limit":3,"dismissed":0,"ctcae_on":false,"draft_label":"Draft definition: pending clinical and coding review","dismiss_reasons":{"addressed_elsewhere":"Already addressed elsewhere in the record","not_representative":"Values not representative (for example acute illness or a lab error)","not_relevant":"Not relevant to this visit","definition_not_applicable":"The definition does not apply to this patient","other":"Other (explain)"}},"findings":[{"family":"kidney","topic":"Kidney function over time","status":"agrees","label":"Agrees","sentence":"Kidney results 180 days apart are 60 or above (filtering rate 87.5 on 2026-05-16 and 87.5 on 2026-11-12) and the note doesn't mention kidney function.","quote":null,"threshold":"Threshold: filtering rate below 60 on two results at least 90 days apart, none of 60 or more between them.","span":null,"note_mentions":false,"lab_ids":["L-0003","L-0005"]}]}