{"patient_id":"P28","encounter_id":"KE-P28","note_id":"KN-P28-1","signed":false,"origin":"clinician","origin_label":"Clinician-typed","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-00028","replay_hash":"6839b1d6b660e14e4bd20b833ab6e17cb5782e590713868ca8827400b5f172f5","measurement_replay_hash":"5e326bc28800b024843cb6c969d612b31d6c6c62f93deaabd578da9a7a9a9e5d","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-00028","encounter_id":"KE-P28","note_id":"KN-P28-1","config":"library_default_set@1.0","engine":"library-engine 1.0","replay_hash":"6eca4102460907edb86c7f68b204cfbb9fd9f73f0c50259920506e8e853b7927","measurement_replay_hash":"4e3493cc16768629c12e179e3800000fd7f3ec129547dc7ee8e550babc265ad6","surfaced":[],"more":[{"family":"ldl","topic":"LDL cholesterol","direction":"NOT_ASSESSABLE","status":"not_assessable","label":"Not assessable","icon":"∅","lead":"The note says ","quote":"Hyperlipidemia","text":"; it could not be checked against aha2018_severe_hypercholesterolaemia@1.0: there is no LDL cholesterol result in the last 730 days.","sentence":"The note says “Hyperlipidemia”; it could not be checked against aha2018_severe_hypercholesterolaemia@1.0: there is no LDL cholesterol result in the last 730 days.","threshold":"Categories that count (aha2018_severe_hypercholesterolaemia@1.0): LDL 190 mg/dL or more (LDL ≥ 190 mg/dL).","span":[99,113],"note_mentions":true,"lab_ids":[],"definition":"aha2018_severe_hypercholesterolaemia@1.0","version":"1.0","tier":"measured","values":"","alternatives":["Another published definition (atp3_ldl@1.0) cannot decide: there is no usable LDL cholesterol result."],"contested":false,"contested_text":"","reviewed":false,"draft_label":"Draft definition: pending clinical and coding review","source_url":"https://pmc.ncbi.nlm.nih.gov/articles/PMC7403606/","optional_set":null,"cite":{"id":"aha2018_severe_hypercholesterolaemia@1.0","title":"2018 AHA/ACC/AACVPR/AAPA/ABC/ACPM/ADA/AGS/APhA/ASPC/NLA/PCNA Guideline on the Management of Blood Cholesterol","body":"American Heart Association / American College of Cardiology and partner societies","edition":"2018 (Circulation 2019;139:e1082-e1143, author manuscript PMC7403606)","year":2018,"url":"https://pmc.ncbi.nlm.nih.gov/articles/PMC7403606/","locator":"Section 4.2 heading; Top 10 Take-Home Message 4","quote":"Severe Hypercholesterolemia (LDL-C ≥190 mg/dL [≥4.9 mmol/L])","accessed":"2026-11-14"}},{"family":"sodium","topic":"Sodium","direction":"NONE","status":"agrees","label":"Agrees","icon":"✓","lead":"","quote":null,"text":"Sodium 139 mmol/L on 2026-11-11 09:05: in the category “135 mmol/L or above” of ese2014_hyponatraemia@1.0; the note doesn't mention this. Nothing to review.","sentence":"Sodium 139 mmol/L on 2026-11-11 09:05: in the category “135 mmol/L or above” of ese2014_hyponatraemia@1.0; the note doesn't mention this. Nothing to review.","threshold":"Categories that count (ese2014_hyponatraemia@1.0): below 135 mmol/L (sodium < 135 mmol/L).","span":null,"note_mentions":false,"lab_ids":["LM-P28-02"],"definition":"ese2014_hyponatraemia@1.0","version":"1.0","tier":"measured","values":"sodium 139 mmol/L on 2026-11-11 09:05","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"}}],"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 “CKD stage 3a”; results 240 days apart are 60 or above (filtering rate 72.3 on 2026-03-16 and 67.7 on 2026-11-11), so the threshold of below 60 is not met.","quote":"CKD stage 3a","threshold":"Threshold: filtering rate below 60 on two results at least 90 days apart, none of 60 or more between them.","span":[48,60],"note_mentions":true,"lab_ids":["L-0062","L-0064"]}]}