{"patient_id":"P25","encounter_id":"KE-P25","note_id":"KN-P25-1","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"},{"source":"kidney","family":"aki"}],"model":{"off":false,"failed":false,"degraded":false},"run_id":"RUN-00025","replay_hash":"1c2451784d1489a4c46052fc5e0d5658af5d37d4ce418d6867a1fa56a426c340","measurement_replay_hash":"55e20c1109dc3be1b4490215dc8049d735acdee7335821e5fad0832abdfcc81b","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-00025","encounter_id":"KE-P25","note_id":"KN-P25-1","config":"library_default_set@1.0","engine":"library-engine 1.0","replay_hash":"b7f0381668907c1bfc31a0fc0b71f12d240ce24ff6736eb20f17198b94aa07a3","measurement_replay_hash":"caf192ec3c4667f74a37f2911a1eb7824cc5dfc51190720d384ae74edcb86aa0","surfaced":[],"more":[],"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: there are not two results at least 90 days apart.","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-0055","L-0056"]},{"family":"aki","topic":"Creatinine change during this stay","status":"not_assessable","label":"Not assessable","sentence":"Could not check the creatinine change: there is no result from before this stay, and creatinine did not rise or fall enough during it.","quote":null,"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":[117,120],"note_mentions":true,"lab_ids":["L-0055","L-0056"]}]}