{"patient_id":"P14","encounter_id":"KE-P14","note_id":"KN-P14-1","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":"kidney","family":"aki"},{"source":"library","family":"sodium"}],"model":{"off":false,"failed":false,"degraded":false},"run_id":"RUN-00014","replay_hash":"e85c2205b031110ba21c997553d043efc5123d40586c10b2442f77014b999bb6","measurement_replay_hash":"6f9b2f2464bf1445af2e241a5a6bd0ce17dd36f9e9f433c01ef4c61cd0fd524c","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-00014","encounter_id":"KE-P14","note_id":"KN-P14-1","config":"library_default_set@1.0","engine":"library-engine 1.0","replay_hash":"930e4d37f3107cb6711b78056346c7e1d617342c7018640920966702a8e6c90d","measurement_replay_hash":"4cbc25ac0771de4e6cdfe2724f490e0869b7e6ef2615595c6aefd18156fcaedc","surfaced":[{"family":"sodium","topic":"Sodium","direction":"UNDER","status":"needs_look","label":"Needs a look","icon":"●","lead":"","quote":null,"text":"Sodium 131 mmol/L on 2026-11-11 06:00 meets the published definition's criteria for the category “below 135 mmol/L” (ese2014_hyponatraemia@1.0). The note doesn't mention this.","sentence":"Sodium 131 mmol/L on 2026-11-11 06:00 meets the published definition's criteria for the category “below 135 mmol/L” (ese2014_hyponatraemia@1.0). The note doesn't mention this.","threshold":"Threshold for this category (ese2014_hyponatraemia@1.0): sodium < 135 mmol/L.","span":null,"note_mentions":false,"lab_ids":["LM-P14-03"],"definition":"ese2014_hyponatraemia@1.0","version":"1.0","tier":"measured","values":"sodium 131 mmol/L on 2026-11-11 06:00","alternatives":[],"contested":false,"contested_text":"","reviewed":false,"draft_label":"Draft definition: pending clinical and coding review","source_url":"https://academic.oup.com/ndt/article/29/suppl_2/i1/1908883","optional_set":null,"cite":{"id":"ese2014_hyponatraemia@1.0","title":"Clinical practice guideline on diagnosis and treatment of hyponatraemia","body":"European Society of Intensive Care Medicine, European Society of Endocrinology and European Renal Association – European Dialysis and Transplant Association (ERBP)","edition":"2014 (Nephrol Dial Transplant 2014;29 Suppl 2:i1-i39; also Eur J Endocrinol 2014;170:G1-G47)","year":2014,"url":"https://academic.oup.com/ndt/article/29/suppl_2/i1/1908883","locator":"Abstract","quote":"Hyponatraemia, defined as a serum sodium concentration <135 mmol/l","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 270 days apart are 60 or above (filtering rate 96.4 on 2026-01-14 and 73.1 on 2026-10-11) 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-0028","L-0030"]},{"family":"aki","topic":"Creatinine change during this stay","status":"agrees","label":"Agrees","sentence":"The note says “AKI” and creatinine supports it: it rose by 0.7 mg/dL within 22 hours (peak 2.3 mg/dL).","quote":"AKI","threshold":"Threshold: creatinine up by 0.3 mg/dL within 48 hours, or to 1.5 times an earlier value. Urine output is not checked.","span":[187,190],"note_mentions":true,"lab_ids":["L-0031","L-0032","L-0028"]}]}