{"patient_id":"P04","encounter_id":"KE-P04","note_id":"KN-P04-1","signed":false,"origin":"clinician","origin_label":"Clinician-typed","origin_note":"as declared by the source system","needs_look":1,"needs_look_kidney":0,"surfaced":[{"source":"kidney","family":"kidney"},{"source":"library","family":"bone_density"}],"model":{"off":false,"failed":false,"degraded":false},"run_id":"RUN-00004","replay_hash":"091c426b3502d74b12cc57c338af67db51734a092a9cbcead69fed69460417c9","measurement_replay_hash":"7e22c749048fc129618232532e8e075c88892ebef5a21b917b0dfca8b5899f63","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-00004","encounter_id":"KE-P04","note_id":"KN-P04-1","config":"library_default_set@1.0","engine":"library-engine 1.0","replay_hash":"c5f6663f69e18f0843410d7abafb71d2b5fa838f5717daccc532630b44e832ee","measurement_replay_hash":"5befb80dac8ad0d88abd2c71cc44fe1c681608212901029fa197d843a42a57c3","surfaced":[{"family":"bone_density","topic":"Bone density T-score","direction":"SPECIFICITY_GAP","status":"needs_look","label":"Needs a look","icon":"●","lead":"The note says ","quote":"Osteopenia","text":"; T-score -2.7 on 2026-10-11 09:00 meets the published definition's criteria for the category “T-score -2.5 or lower band” (who1994_osteoporosis@1.0), not the category written.","sentence":"The note says “Osteopenia”; T-score -2.7 on 2026-10-11 09:00 meets the published definition's criteria for the category “T-score -2.5 or lower band” (who1994_osteoporosis@1.0), not the category written.","threshold":"Threshold for this category (who1994_osteoporosis@1.0): T-score ≤ -2.5 SD.","span":[110,120],"note_mentions":true,"lab_ids":["LM-P04-01"],"definition":"who1994_osteoporosis@1.0","version":"1.0","tier":"measured","values":"T-score -2.7 on 2026-10-11 09:00","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/7b6bd052-ba92-4ebc-9fb5-3264e99dcb14/content","optional_set":null,"cite":{"id":"who1994_osteoporosis@1.0","title":"Assessment of fracture risk and its application to screening for postmenopausal osteoporosis: report of a WHO Study Group (WHO Technical Report Series 843)","body":"World Health Organization","edition":"1994","year":1994,"url":"https://iris.who.int/server/api/core/bitstreams/7b6bd052-ba92-4ebc-9fb5-3264e99dcb14/content","locator":"Section 2.1 Definitions, printed pages 5-6 (PDF pages 11-12)","quote":"Normal. A value for BMD or BMC within 1 SD of the young adult reference mean. Low bone mass (osteopenia). ... more than 1 SD below the young adult mean but less than 2.5 SD below this value. Osteoporosis. ... 2.5 SD or more below the young adult mean.","accessed":"2026-11-14"}}],"more":[],"n_needs":1,"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 220 days apart are 60 or above (filtering rate 72.7 on 2026-04-04 and 77.9 on 2026-11-10) 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-0008","L-0009"]}]}