{"patient_id":"P27","encounter_id":"KE-P27","note_id":"KN-P27-1","signed":false,"origin":"ai_scribe","origin_label":"AI-drafted","origin_note":"as declared by the source system","needs_look":1,"needs_look_kidney":1,"surfaced":[{"source":"kidney","family":"kidney"}],"model":{"off":false,"failed":false,"degraded":false},"run_id":"RUN-00027","replay_hash":"2328b0338ac8fa8ba87b8c17c6f22380eebb93bb60e5ccd7fdfd2853094c1976","measurement_replay_hash":"4099549adba16ece7cf7a09a3f31a7a9fb253591e9d35ad20238a97fa1b35b5c","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-00027","encounter_id":"KE-P27","note_id":"KN-P27-1","config":"library_default_set@1.0","engine":"library-engine 1.0","replay_hash":"31c95a0242a502ea25b6626fb12ec50a09849dd5113c326195b80a49ef6d1423","measurement_replay_hash":"a820a45fd2e03e0ad5f612fd0848c53148e47f89408f3f837e7f81089cd32999","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: there is no blood pressure result in the last 365 days.","sentence":"The note says “Hypertension”; it could not be checked against nhlbi_bp_categories@1.0: there is no blood pressure result in the last 365 days.","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":[330,342],"note_mentions":true,"lab_ids":[],"definition":"nhlbi_bp_categories@1.0","version":"1.0","tier":"measured","values":"","alternatives":["Another published definition (esc2024_office_bp@1.0) cannot decide: there is no usable blood pressure result."],"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":2,"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":"needs_look","label":"Needs a look","sentence":"The note says “Chronic kidney disease stage 4”; two results 118 days apart are in the G3a range (filtering rate 51.5 on 2026-07-17 and 47.6 on 2026-11-12), not the stage written.","quote":"Chronic kidney disease stage 4","threshold":"Threshold: filtering rate below 60 on two results at least 90 days apart, none of 60 or more between them.","span":[249,279],"note_mentions":true,"lab_ids":["L-0060","L-0061"]}]}