{"patient_id":"P09","encounter_id":"KE-P09","note_id":"KN-P09-1","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-00009","replay_hash":"1b1921695ee7c7fc26f99962bd161dbe9a2e805e9e6757d2c452a9b2bf1dc941","measurement_replay_hash":"43106afbb820cb9463e7f0e7cb6e588816f31225e72748f3d6e2e22d5c68b7fc","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-00009","encounter_id":"KE-P09","note_id":"KN-P09-1","config":"library_default_set@1.0","engine":"library-engine 1.0","replay_hash":"37038d41350228d92420be2d568da1cb7386985a90ad61436c235eb814a4518a","measurement_replay_hash":"52e0404a2c8cc3d1dee3690cd10c8dd9793a6c7de336d0694738219d3d49716f","surfaced":[],"more":[{"family":"blood_pressure","topic":"Blood pressure readings","direction":"NOT_ASSESSABLE","status":"not_assessable","label":"Not assessable","icon":"∅","lead":"The note says ","quote":"hypertension","text":"; it could not be checked against nhlbi_bp_categories@1.0: only one blood pressure result meets the threshold; the definition needs results on at least two separate dates.","sentence":"The note says “hypertension”; it could not be checked against nhlbi_bp_categories@1.0: only one blood pressure result meets the threshold; the definition needs results on at least two separate dates.","threshold":"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).","span":[52,64],"note_mentions":true,"lab_ids":["LM-P09-02","LM-P09-01"],"definition":"nhlbi_bp_categories@1.0","version":"1.0","tier":"measured","values":"blood pressure 146/90 mmHg on 2026-11-11 14:05","alternatives":["Another published definition (esc2024_office_bp@1.0) gives the category “office 140/90 or higher”."],"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.nhlbi.nih.gov/health/high-blood-pressure/diagnosis","optional_set":null,"cite":{"id":"nhlbi_bp_categories@1.0","title":"High Blood Pressure — Diagnosis","body":"National Heart, Lung, and Blood Institute (U.S. National Institutes of Health)","edition":"page last updated June 26, 2025","year":2025,"url":"https://www.nhlbi.nih.gov/health/high-blood-pressure/diagnosis","locator":"Blood pressure categories table","quote":"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","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":"not_assessable","label":"Not assessable","sentence":"Could not check kidney function yet: only one result is below 60 (filtering rate 53.6 on 2026-11-11); a repeat at least 90 days later is needed.","quote":null,"threshold":"Threshold: filtering rate below 60 on two results at least 90 days apart, none of 60 or more between them.","span":[149,154],"note_mentions":true,"lab_ids":["L-0018"]}]}