{"patient_id":"P24","encounter_id":"KE-P24","note_id":"KN-P24-1","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-00024","replay_hash":"71cfe343504388231e5c4c24a19ca7da6a7e8c77e029b97f1ea77ca8eec3394e","measurement_replay_hash":"bd50e5d79c73abdf5a68497b33e8a1544e6a83a63c83be7407f132e9bab883e2","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-00024","encounter_id":"KE-P24","note_id":"KN-P24-1","config":"library_default_set@1.0","engine":"library-engine 1.0","replay_hash":"c675658fbd7853580a06bd562fd80ad074a4ddc4809a4f341eacf702b2ac50dc","measurement_replay_hash":"12a2a8a081c90ba19474d031d8f3739799d59480c4eee602fa71aa4f5157a8df","surfaced":[],"more":[{"family":"diabetes","topic":"Glucose and HbA1c","direction":"NOT_ASSESSABLE","status":"not_assessable","label":"Not assessable","icon":"∅","lead":"The note says ","quote":"diabetes","text":"; it could not be checked against ada2026_diabetes@1.0: HbA1c or glucose values outside the range do not show that a stated condition is absent (for example under treatment).","sentence":"The note says “diabetes”; it could not be checked against ada2026_diabetes@1.0: HbA1c or glucose values outside the range do not show that a stated condition is absent (for example under treatment).","threshold":"Categories that count (ada2026_diabetes@1.0): two results at or above the diagnostic thresholds (number of qualifying results ≥ 2); random glucose 200 mg/dL or more with typical symptoms (random glucose ≥ 200 mg/dL and a recorded clinical item); one result at or above a diagnostic threshold (number of qualifying results ≥ 1).","span":[174,182],"note_mentions":true,"lab_ids":["LM-P24-01"],"definition":"ada2026_diabetes@1.0","version":"1.0","tier":"measured","values":"HbA1c 6.1 % on 2026-11-01 09:00","alternatives":[],"contested":false,"contested_text":"","reviewed":false,"draft_label":"Draft definition: pending clinical and coding review","source_url":"https://pmc.ncbi.nlm.nih.gov/articles/PMC12690183/","optional_set":null,"cite":{"id":"ada2026_diabetes@1.0","title":"2. Diagnosis and Classification of Diabetes: Standards of Care in Diabetes—2026","body":"American Diabetes Association Professional Practice Committee","edition":"2026 (Diabetes Care 2026;49 Suppl 1:S27-S49, doi:10.2337/dc26-S002)","year":2026,"url":"https://pmc.ncbi.nlm.nih.gov/articles/PMC12690183/","locator":"Table 2.1 Criteria for the diagnosis of diabetes in nonpregnant individuals","quote":"Table 2.1: A1C ≥6.5% (≥48 mmol/mol); FPG ≥126 mg/dL (≥7.0 mmol/L); 2-h PG ≥200 mg/dL (≥11.1 mmol/L) during OGTT; random plasma glucose ≥200 mg/dL (≥11.1 mmol/L) with classic symptoms of hyperglycemia or hyperglycemic crisis. In the absence of unequivocal hyperglycemia, diagnosis requires two abnormal results from different tests ... or the same test at two different time points.","accessed":"2026-11-14"}},{"family":"prediabetes","topic":"Glucose and HbA1c (intermediate range)","direction":"NONE","status":"agrees","label":"Agrees","icon":"✓","lead":"","quote":null,"text":"HbA1c 6.1 % on 2026-11-01 09:00: the note states a related topic, so nothing is raised here (ada2026_prediabetes@1.0). Nothing to review.","sentence":"HbA1c 6.1 % on 2026-11-01 09:00: the note states a related topic, so nothing is raised here (ada2026_prediabetes@1.0). Nothing to review.","threshold":"Threshold for this category (ada2026_prediabetes@1.0): HbA1c ≥ 5.7 % and HbA1c < 6.5 % or fasting glucose ≥ 100 mg/dL and fasting glucose < 126 mg/dL or 2-hour glucose ≥ 140 mg/dL and 2-hour glucose < 200 mg/dL.","span":null,"note_mentions":false,"lab_ids":["LM-P24-01"],"definition":"ada2026_prediabetes@1.0","version":"1.0","tier":"measured","values":"HbA1c 6.1 % on 2026-11-01 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://pmc.ncbi.nlm.nih.gov/articles/PMC12690183/","optional_set":null,"cite":{"id":"ada2026_prediabetes@1.0","title":"2. Diagnosis and Classification of Diabetes: Standards of Care in Diabetes—2026","body":"American Diabetes Association Professional Practice Committee","edition":"2026 (Diabetes Care 2026;49 Suppl 1:S27-S49)","year":2026,"url":"https://pmc.ncbi.nlm.nih.gov/articles/PMC12690183/","locator":"Table 2.2 Criteria defining prediabetes in nonpregnant individuals","quote":"A1C 5.7–6.4% (39–47 mmol/mol); FPG 100 mg/dL (5.6 mmol/L) to 125 mg/dL (6.9 mmol/L) (IFG); 2-h PG during 75-g OGTT 140 mg/dL (7.8 mmol/L) to 199 mg/dL (11.0 mmol/L) (IGT)","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: limb amputation is on record, and the filtering-rate equation is not reliable then.","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-0053","L-0054"]}]}