{"patient_id":"P34","encounter_id":"KE-P34","note_id":"KN-P34-1","signed":false,"ignored_instructions":[],"origin":"clinician","origin_label":"Clinician-typed","origin_note":"as declared by the source system","needs_look":1,"extended":{"on":false,"front":[],"library":[],"banner":"Extended capabilities: published criteria cited by title and restated in our own words, no text reproduced; a licence or permission is needed before commercial use.","title":"Extended capabilities","n":0,"n_hidden":0},"check_current":true,"needs_look_kidney":1,"surfaced":[{"source":"front","family":"kidney"}],"model":{"off":false,"failed":false,"degraded":false},"run_id":"RUN-00046","replay_hash":"3da85b8944e67efa996a394385020047e783551dc190d4ed1391f1f82783fded","measurement_replay_hash":"db0608dcbc2368708310fa55f6ff749b5d96f569d4c03dc5e819b422e3bfac51","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-00046","encounter_id":"KE-P34","note_id":"KN-P34-1","config":"library_default_set@1.1","engine":"library-engine 1.1","replay_hash":"f415d9cbb1b74d25152dcff557c6404866acf94ccdc9178e9149c034acde2551","measurement_replay_hash":"dbf9b3e29352152c81e1da8d8ad7dd2926a14914f2a31a179e81628af28c7ef5","surfaced":[],"more":[],"extended":[],"extended_on":false,"n_hidden_extended":0,"n_extended_needs":0,"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 filtering rate (eGFR) over time","status":"needs_look","label":"Needs a look","sentence":"The note says “CKD”; the note does not give a stage. Two results 110 days apart are in the G3b range (filtering rate 38.4 on 2026-07-25 and 37.0 on 2026-11-12).","quote":"CKD","threshold":"Threshold: filtering rate below 60 on two results at least 90 days apart, none of 60 or more between them.","span":[156,159],"note_mentions":true,"lab_ids":["L-0078","L-0080"]}],"front":{"run_id":"FRUN-00046","cards":[{"family":"kidney","topic":"Kidney filtering rate (eGFR) over time","status":"needs_look","label":"Needs a look","sentence":"The note says “CKD”; the note does not give a stage. Two results 110 days apart are in the G3b range (filtering rate 38.4 on 2026-07-25 and 37.0 on 2026-11-12).","quote":"CKD","threshold":"Threshold: filtering rate below 60 on two results at least 90 days apart, none of 60 or more between them. Albumin-to-creatinine category: A1 below 30, A2 30-299, A3 300 mg/g or above.","span":[156,159],"note_mentions":true,"lab_ids":["L-0078","L-0080"],"direction":"SPECIFICITY_GAP","definition":"front_kidney_stage_wording@1.0","reviewed":false,"evidence":[{"text":"Filtering rate 38.4 on 2026-07-25 (G3b range) and 37.0 on 2026-11-12 (G3b range)","quote":null,"by":null,"item":"L-0078"},{"text":"Urine albumin-to-creatinine ratio 165 mg/g on 2026-11-12: A2 range","quote":null,"by":null,"item":"L-0081"},{"text":"Urine albumin-to-creatinine ratio 140 mg/g on 2026-07-25: A2 range","quote":null,"by":null,"item":"L-0079"},{"text":"Albuminuria on two tests at least 90 days apart: yes","quote":null,"by":null,"item":null}],"acuity":[],"options":[{"key":"G1","kind":"wording","requires":"filtering rate 90 or above with a kidney damage marker (for example albuminuria on two tests at least 90 days apart)","shows":"filtering rate 38.4 on 2026-07-25 and 37.0 on 2026-11-12 (G3b range)","status":"not_met","status_label":"not met","wording":"Chronic kidney disease stage 1"},{"key":"G2","kind":"wording","requires":"filtering rate 60-89 with a kidney damage marker (for example albuminuria on two tests at least 90 days apart)","shows":"filtering rate 38.4 on 2026-07-25 and 37.0 on 2026-11-12 (G3b range)","status":"not_met","status_label":"not met","wording":"Chronic kidney disease stage 2"},{"key":"G3a","kind":"wording","requires":"filtering rate 45-59 on two results at least 90 days apart","shows":"filtering rate 38.4 on 2026-07-25 and 37.0 on 2026-11-12 (G3b range)","status":"not_met","status_label":"not met","wording":"Chronic kidney disease stage 3a"},{"key":"G3b","kind":"wording","requires":"filtering rate 30-44 on two results at least 90 days apart","shows":"filtering rate 38.4 on 2026-07-25 and 37.0 on 2026-11-12 (G3b range)","status":"met","status_label":"met","wording":"Chronic kidney disease stage 3b"},{"key":"G4","kind":"wording","requires":"filtering rate 15-29 on two results at least 90 days apart","shows":"filtering rate 38.4 on 2026-07-25 and 37.0 on 2026-11-12 (G3b range)","status":"not_met","status_label":"not met","wording":"Chronic kidney disease stage 4"},{"key":"G5","kind":"wording","requires":"filtering rate below 15 on two results at least 90 days apart","shows":"filtering rate 38.4 on 2026-07-25 and 37.0 on 2026-11-12 (G3b range)","status":"not_met","status_label":"not met","wording":"Chronic kidney disease stage 5"},{"key":"other","kind":"fixed","wording":"Other (I will write it)"},{"key":"unable","kind":"fixed","wording":"Clinically unable to determine"},{"key":"not_supported","kind":"fixed","wording":"Not clinically supported (I will revise the note myself)"}],"chosen":null}],"dismissed":0}}