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Pilar Lindqvist: Chronic kidney disease
ENC-00073 · 87F · Hospital Medicine · admitted Mon Nov 09, 2026 04:43 PM · discharged Thu Nov 12, 2026 04:38 PM · attending Dr. Rosalind Quillan · resident Dr. Keira Upfield
Criteria support Chronic kidney disease stage 3b (N18.32); no corresponding diagnosis is documented.
Documented vs supported
- Documented
- not documented
- Criteria support
- Chronic kidney disease stage 3b · N18.32 Chronic kidney disease, stage 3b
- Outcome
- Two eGFR values >=90 days apart, both below 60; staging value 42.1 (G3b)
- Rule
- Chronic kidney disease stage (eGFR, CKD-EPI 2021) v2026.11-1
- Published source
- KDIGO 2024 Clinical Practice Guideline for the Evaluation and Management of Chronic Kidney Disease (2024), Chapter 1, Table 1 (definition: abnormality for a minimum of 3 months) and Table 2 (GFR categories) · source (checked 2026-11-14)
Effect if the clinician agrees (illustrative)
- Change
- add N18.32
- Secondary-diagnosis level
- — → non-CC
- MS-DRG (illustrative)
- 194 Simple pneumonia and pleurisy with CC → 194 Simple pneumonia and pleurisy with CC
- Relative weight
- 0.8059 → 0.8059 (+0.0000)
- Codes before
- J18.9, E46, N17.9, D62, K21.9, I10
- Codes after
- J18.9, E46, N17.9, D62, K21.9, I10, N18.32
All open gaps on this encounter together: MS-DRG 194 → 194 (RW +0.0000). The grouping does not change; the record becomes accurate.
CC/MCC status, CC exclusions (subset) and relative weights from the public CMS FY2026 IPPS final rule tables (5, 6I, 6J, 6K). This is not a grouper and not a payment estimate. Queries never mention any of this.
Severity documentation index change SIMULATED
0.0 points
SIMULATED: Illustrative severity weights (MCC = 1.0, CC = 0.5, non-CC = 0) summed over secondary diagnoses; not a validated risk-adjustment model and not a measured effect.
Evidence
Structured values are read by code from the cited rows. Note facts are shown only when the model's quote was found verbatim in the note.
| Input | Value | Source |
|---|---|---|
| Number of pre-admission eGFR values within 2 years (inpatient values during acute illness are not used) | 2 |
creatinine 1.24 -> eGFR 42
creatinine 1.4 -> eGFR 36
|
| Days between the earliest and latest pre-admission eGFR values | 215 |
creatinine 1.24 mg/dL -> eGFR 42 (CKD-EPI 2021)
creatinine 1.4 mg/dL -> eGFR 36 (CKD-EPI 2021)
|
| Earliest pre-admission eGFR (mL/min/1.73 m2, CKD-EPI 2021) | 42.1 |
creatinine 1.24 mg/dL -> eGFR 42 (CKD-EPI 2021)
|
| Latest pre-admission eGFR (mL/min/1.73 m2, CKD-EPI 2021) | 36.4 |
creatinine 1.4 mg/dL -> eGFR 36 (CKD-EPI 2021)
|
Rule trace (inputs, thresholds, outcome)
| Step | Expression | Inputs and thresholds read | Result |
|---|---|---|---|
| derived: chronic | egfr_n >= 2 and egfr_span_days >= t.chronic_days |
egfr_n=2, egfr_span_days=215, t.chronic_days=90 | true |
| derived: staging_egfr | max(egfr_early, egfr_late) |
egfr_early=42.1, egfr_late=36.4 | 42.1 |
| derived: both_below_60 | egfr_early < t.g2 and egfr_late < t.g2 |
egfr_early=42.1, egfr_late=36.4, t.g2=60 | true |
| derived: category | case(staging_egfr >= t.g2, 'G1-G2', staging_egfr >= t.g3a, 'G3a', staging_egfr >= t.g3b, 'G3b', staging_egfr >= t.g4, 'G4', 'G5') |
staging_egfr=42.1, t.g2=60, t.g3a=45, t.g3b=30, t.g4=15 | G3b |
| outcome: duration_not_shown | not chronic |
chronic=True | false |
| outcome: straddles_60 | not both_below_60 and min(egfr_early, egfr_late) < t.g2 |
both_below_60=True, egfr_early=42.1, egfr_late=36.4, t.g2=60 | false |
| outcome: g1_g2 | staging_egfr >= t.g2 |
staging_egfr=42.1, t.g2=60 | false |
| outcome: g3a | category == 'G3a' |
category=G3b | false |
| outcome: g3b | category == 'G3b' |
category=G3b | true |
Documentation query
Title and question drafted by model clockworks-mock (audit entry #2114); clinical indicators and answer options assembled by code from the rule and the record.
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DOCUMENTATION QUERY (draft) Title: Clarification request: chronic kidney documentation Encounter: ENC-00073 Patient: Pilar Lindqvist To: Dr. Rosalind Quillan Clinical indicators from the health record: - creatinine 1.24 -> eGFR 42 (2025-12-16 09:15) [lab LAB-002492] - creatinine 1.4 -> eGFR 36 (2026-07-19 10:05) [lab LAB-002493] Question: Based on your clinical judgement and the indicators above, can the chronic kidney condition be further specified, including stage if known? Response options (select one or write your own): ( ) Chronic kidney disease stage 3a (eGFR 45-59) ( ) Chronic kidney disease stage 3b (eGFR 30-44) ( ) Chronic kidney disease stage 4 (eGFR 15-29) ( ) Other (please specify): ____________ ( ) Unable to determine Please respond based on your independent clinical judgement. Any response, including "unable to determine", is acceptable. This query and your response are kept as part of the health record.
Other findings on this encounter
- Acute kidney injury · Clinical validation gap Documented “AKI” (N17.9) but the criteria are not met: KDIGO creatinine and urine-output criteria not met.
- Malnutrition · Specificity gap Documented “malnutrition” (E46); criteria support the more specific Moderate (non-severe) protein-calorie malnutrition (acute illness context) (E44.0).
History
| Seq | When (UTC) | Actor | Action | Entities | Decision / reason | Model / hashes |
|---|---|---|---|---|---|---|
| 2114 | 2026-11-14T20:57:24 | system:llm system |
llm.call |
ENC-00073, ENC-00073.ckd | — | clockworks-mock mock-1/exactdx.draft_query@1 prompt 23057ac6e924 output bf34b17a9932 entry f6f82af7c3f0 |
| 1288 | 2026-11-14T19:24:29 | system:llm system |
llm.call |
ENC-00073, ENC-00073.ckd | — | clockworks-mock mock-1/exactdx.draft_query@1 prompt 23057ac6e924 output bf34b17a9932 entry 1526996f1c35 |
| 546 | 2026-11-14T18:29:04 | system:llm system |
llm.call |
ENC-00073, ENC-00073.ckd | — | clockworks-mock mock-1/exactdx.draft_query@1 prompt 23057ac6e924 output bf34b17a9932 entry 809d6bb4cdcb |