{
  "engine": {
    "id": "cpe-003",
    "code": "CPE-003",
    "name": "Chronic Kidney Disease Pattern Engine",
    "version": "1.2.0",
    "url": "https://biod.ai/tools/kidney",
    "status": "Specification v1.2.0, validation release. Reviewed by Dr. Vinicius Amaral, D.O. Not for clinical production use."
  },
  "notice": "Clinical decision support for licensed clinicians. Synthetic-data demonstration. Not FDA cleared. Physician adjudication required.",
  "rules": [
    {
      "id": "DQ-001",
      "name": "Adult-only validated pathway",
      "group": "Eligibility",
      "status": "active",
      "classification": "Priority 1",
      "summary": "Adult-only validated pathway. Evaluates age years below 18.",
      "sections": [
        {
          "heading": "Condition",
          "items": [
            "Any of:",
            "  age years < 18",
            "  age years missing"
          ]
        },
        {
          "heading": "What it reports",
          "items": [
            "Analysis status: excluded or data insufficient",
            "Message: CPE-003 v1.1 is validated for adults only; route to pediatric kidney pathway or request age."
          ]
        }
      ],
      "evidence": [
        "R3",
        "R1"
      ],
      "url": "https://biod.ai/tools/kidney/rules/dq-001"
    },
    {
      "id": "DQ-002",
      "name": "Route special populations out of general CKD diagnostic pathway",
      "group": "Eligibility",
      "status": "active",
      "classification": "Priority 2",
      "summary": "Route special populations out of general CKD diagnostic pathway. Evaluates dialysis status is true.",
      "sections": [
        {
          "heading": "Condition",
          "items": [
            "Any of:",
            "  dialysis status == true",
            "  kidney transplant history == true",
            "  pregnancy status == pregnant"
          ]
        },
        {
          "heading": "What it reports",
          "items": [
            "Analysis status: special population route",
            "Message: Specialized pathway required; do not apply general CPE-003 classification without clinician review."
          ]
        }
      ],
      "evidence": [
        "R1"
      ],
      "url": "https://biod.ai/tools/kidney/rules/dq-002"
    },
    {
      "id": "DQ-003",
      "name": "Input units and specimen quality required",
      "group": "Data quality",
      "status": "active",
      "classification": "Priority 3",
      "summary": "Input units and specimen quality required. Evaluates creatinine unit not normalized when creatinine used.",
      "sections": [
        {
          "heading": "Condition",
          "items": [
            "Any of:",
            "  creatinine unit not normalized when creatinine used",
            "  UACR unit not normalized when UACR used",
            "  potassium critical and specimen hemolysis status unknown"
          ]
        },
        {
          "heading": "What it reports",
          "items": [
            "Analysis status: data quality warning",
            "Normalize units before staging",
            "Expose assay/specimen uncertainty",
            "For elevated potassium, assess sample hemolysis without delaying urgent review when clinically indicated"
          ]
        }
      ],
      "evidence": [
        "R1",
        "R3"
      ],
      "url": "https://biod.ai/tools/kidney/rules/dq-003"
    },
    {
      "id": "DQ-004",
      "name": "eGFR calculation assay provenance",
      "group": "Data quality",
      "status": "active",
      "classification": "Priority 4",
      "summary": "eGFR calculation assay provenance. Evaluates serum creatinine mg dl present.",
      "sections": [
        {
          "heading": "Condition",
          "items": [
            "All of:",
            "  serum creatinine mg dl present",
            "  creatinine assay idms traceable != true"
          ]
        },
        {
          "heading": "What it reports",
          "items": [
            "Warning: eGFR computed with unknown/non-confirmed standardized assay; interpret with assay provenance visible."
          ]
        }
      ],
      "evidence": [
        "R3",
        "R4"
      ],
      "url": "https://biod.ai/tools/kidney/rules/dq-004"
    },
    {
      "id": "SAFE-AKI-001",
      "name": "Possible acute kidney injury based on creatinine trajectory",
      "group": "Global safety gates",
      "status": "active",
      "classification": "Priority 10",
      "summary": "Possible acute kidney injury based on creatinine trajectory. Evaluates delta serum creatinine mg dl at or above 0.3 within 48 hours.",
      "sections": [
        {
          "heading": "Condition",
          "items": [
            "Any of:",
            "  delta serum creatinine mg dl >= 0.3 within 48 hours",
            "  serum creatinine current >= 1.5 * baseline serum creatinine within 7 days"
          ]
        },
        {
          "heading": "What it reports",
          "items": [
            "Analysis status: acute process possible",
            "Alert level: urgent",
            "Message: Possible AKI or AKI on CKD. Urgent clinician review required; current value must not be used alone to finalize chronic CKD staging."
          ]
        },
        {
          "heading": "Safety note",
          "items": [
            "Runs before CKD confirmation"
          ]
        }
      ],
      "evidence": [
        "R7"
      ],
      "url": "https://biod.ai/tools/kidney/rules/safe-aki-001"
    },
    {
      "id": "SAFE-AKI-002",
      "name": "Possible AKI based on urine output when available",
      "group": "Global safety gates",
      "status": "active",
      "classification": "Priority 11",
      "summary": "Possible AKI based on urine output when available. Evaluates urine output ml kg h available.",
      "sections": [
        {
          "heading": "Condition",
          "items": [
            "All of:",
            "  urine output ml kg h available",
            "  urine output ml kg h < 0.5 for >= 6 hours"
          ]
        },
        {
          "heading": "What it reports",
          "items": [
            "Analysis status: acute process possible",
            "Alert level: urgent",
            "Message: Urine output meets an AKI safety trigger; immediate clinician evaluation required."
          ]
        },
        {
          "heading": "Safety note",
          "items": [
            "Runs before CKD confirmation"
          ]
        }
      ],
      "evidence": [
        "R7"
      ],
      "url": "https://biod.ai/tools/kidney/rules/safe-aki-002"
    },
    {
      "id": "SAFE-K-001",
      "name": "Severe hyperkalemia independent of CKD classification",
      "group": "Global safety gates",
      "status": "active",
      "classification": "Priority 12",
      "summary": "Severe hyperkalemia independent of CKD classification. Evaluates potassium mmol l at or above 6.0.",
      "sections": [
        {
          "heading": "Condition",
          "items": [
            "All of:",
            "  potassium mmol l >= 6.0"
          ]
        },
        {
          "heading": "What it reports",
          "items": [
            "Analysis status: urgent red flag",
            "Alert level: urgent or critical per local lab",
            "Message: Severe potassium elevation detected. Assess symptoms, ECG and specimen validity urgently according to local critical value protocol."
          ]
        },
        {
          "heading": "Safety note",
          "items": [
            "Do not restrict this rule to known CKD",
            "Local critical-value policy supersedes display threshold"
          ]
        }
      ],
      "evidence": [
        "R1"
      ],
      "url": "https://biod.ai/tools/kidney/rules/safe-k-001"
    },
    {
      "id": "SAFE-GN-001",
      "name": "Active glomerular disease red flag",
      "group": "Global safety gates",
      "status": "active",
      "classification": "Priority 13",
      "summary": "Active glomerular disease red flag. Evaluates rbc casts is present.",
      "sections": [
        {
          "heading": "Condition",
          "items": [
            "Any of:",
            "  rbc casts == present",
            "  dysmorphic rbc == present AND (uacr mg g >= 300 OR upcr mg g >= 500)",
            "  persistent hematuria == true AND rapid kidney function decline == true"
          ]
        },
        {
          "heading": "What it reports",
          "items": [
            "Analysis status: urgent red flag",
            "Etiology pattern: possible active glomerular disease",
            "Message: Active glomerular disease pattern detected; urgent nephrology evaluation indicated."
          ]
        }
      ],
      "evidence": [
        "R1"
      ],
      "url": "https://biod.ai/tools/kidney/rules/safe-gn-001"
    },
    {
      "id": "SAFE-OBS-001",
      "name": "Possible obstructive uropathy",
      "group": "Global safety gates",
      "status": "active",
      "classification": "Priority 14",
      "summary": "Possible obstructive uropathy. Evaluates kidney function abnormality is true.",
      "sections": [
        {
          "heading": "Condition",
          "items": [
            "All of:",
            "  kidney function abnormality == true",
            "  Any of:",
            "    hydronephrosis == present",
            "    urinary retention == present",
            "    bladder outlet obstruction == suspected"
          ]
        },
        {
          "heading": "What it reports",
          "items": [
            "Analysis status: urgent red flag",
            "Etiology pattern: possible obstructive uropathy",
            "Message: Potential reversible obstructive kidney process; prompt clinician-directed imaging/urologic evaluation required."
          ]
        }
      ],
      "evidence": [
        "R1"
      ],
      "url": "https://biod.ai/tools/kidney/rules/safe-obs-001"
    },
    {
      "id": "DET-001",
      "name": "Kidney abnormality detected",
      "group": "Abnormality detection",
      "status": "active",
      "classification": "Priority 20",
      "summary": "Kidney abnormality detected. Evaluates eGFR selected below 60.",
      "sections": [
        {
          "heading": "Condition",
          "items": [
            "Any of:",
            "  eGFR selected < 60",
            "  uacr mg g >= 30",
            "  persistent hematuria == true",
            "  urine sediment abnormality == true",
            "  structural kidney abnormality == true",
            "  kidney transplant history == true",
            "  tubular disorder marker == true"
          ]
        },
        {
          "heading": "What it reports",
          "items": [
            "Analysis status: kidney abnormality detected",
            "Message: Kidney abnormality detected; determine chronicity and evaluate acute causes before confirming CKD."
          ]
        }
      ],
      "evidence": [
        "R1"
      ],
      "url": "https://biod.ai/tools/kidney/rules/det-001"
    },
    {
      "id": "CHR-001",
      "name": "CKD chronicity confirmed through longitudinal evidence",
      "group": "Chronicity",
      "status": "active",
      "classification": "Priority 30",
      "summary": "CKD chronicity confirmed through longitudinal evidence. Evaluates kidney abnormality detected is true.",
      "sections": [
        {
          "heading": "Condition",
          "items": [
            "All of:",
            "  kidney abnormality detected == true",
            "  evidence duration at least 3 calendar months == true"
          ]
        },
        {
          "heading": "What it reports",
          "items": [
            "Chronicity status: confirmed",
            "Analysis status: ckd_confirmed_eligible_for_CGA"
          ]
        }
      ],
      "evidence": [
        "R1"
      ],
      "url": "https://biod.ai/tools/kidney/rules/chr-001"
    },
    {
      "id": "CHR-002",
      "name": "CKD chronicity may be supported by non-laboratory evidence",
      "group": "Chronicity",
      "status": "active",
      "classification": "Priority 31",
      "summary": "CKD chronicity may be supported by non-laboratory evidence. Evaluates prior documented ckd is true.",
      "sections": [
        {
          "heading": "Condition",
          "items": [
            "Any of:",
            "  prior documented ckd == true",
            "  chronic structural imaging finding == true",
            "  kidney histopathology consistent with chronicity == true"
          ]
        },
        {
          "heading": "What it reports",
          "items": [
            "Chronicity status: confirmed by external evidence",
            "Message: Cronicity supported by documented history/imaging/pathology; physician adjudication required for final classification."
          ]
        }
      ],
      "evidence": [
        "R1"
      ],
      "url": "https://biod.ai/tools/kidney/rules/chr-002"
    },
    {
      "id": "CHR-003",
      "name": "Single abnormal result does not confirm CKD",
      "group": "Chronicity",
      "status": "active",
      "classification": "Priority 32",
      "summary": "Single abnormal result does not confirm CKD. Evaluates kidney abnormality detected is true.",
      "sections": [
        {
          "heading": "Condition",
          "items": [
            "All of:",
            "  kidney abnormality detected == true",
            "  chronicity evidence == absent",
            "  acute process possible != true"
          ]
        },
        {
          "heading": "What it reports",
          "items": [
            "Chronicity status: unconfirmed",
            "Analysis status: kidney abnormality unconfirmed",
            "Message: Single abnormal result; CKD is not confirmed. Repeat/confirm as clinically appropriate and assess acute/transient causes."
          ]
        }
      ],
      "evidence": [
        "R1"
      ],
      "url": "https://biod.ai/tools/kidney/rules/chr-003"
    },
    {
      "id": "ACR-001",
      "name": "Confirm abnormal random ACR using first morning void",
      "group": "Albuminuria",
      "status": "active",
      "classification": "Priority 40",
      "summary": "Confirm abnormal random ACR using first morning void. Evaluates uacr mg g at or above 30.",
      "sections": [
        {
          "heading": "Condition",
          "items": [
            "All of:",
            "  uacr mg g >= 30",
            "  urine collection type == random untimed",
            "  confirmatory first morning void absent == true"
          ]
        },
        {
          "heading": "What it reports",
          "items": [
            "Albuminuria status: abnormal unconfirmed specimen",
            "Action: Obtain subsequent first morning void midstream UACR to confirm abnormal random ACR."
          ]
        }
      ],
      "evidence": [
        "R1"
      ],
      "url": "https://biod.ai/tools/kidney/rules/acr-001"
    },
    {
      "id": "ACR-002",
      "name": "Transient albuminuria confounder warning",
      "group": "Albuminuria",
      "status": "active",
      "classification": "Priority 41",
      "summary": "Transient albuminuria confounder warning. Evaluates uacr mg g at or above 30.",
      "sections": [
        {
          "heading": "Condition",
          "items": [
            "All of:",
            "  uacr mg g >= 30",
            "  Any of:",
            "    urinary tract infection == active",
            "    fever == present",
            "    vigorous exercise recent == true",
            "    menstruation == present",
            "    acute heart failure decompensation == true"
          ]
        },
        {
          "heading": "What it reports",
          "items": [
            "Albuminuria status: possible transient elevation",
            "Message: UACR may be transiently elevated; confirm after confounder resolves unless urgent clinical context requires immediate action."
          ]
        }
      ],
      "evidence": [
        "R1"
      ],
      "url": "https://biod.ai/tools/kidney/rules/acr-002"
    },
    {
      "id": "GFR-001",
      "name": "Compute initial adult race-free creatinine eGFR",
      "group": "GFR estimation",
      "status": "active",
      "classification": "Priority 50",
      "summary": "Compute initial adult race-free creatinine eGFR. Evaluates age years at or above 18.",
      "sections": [
        {
          "heading": "Condition",
          "items": [
            "All of:",
            "  age years >= 18",
            "  sex for equation present",
            "  serum creatinine mg dl present"
          ]
        },
        {
          "heading": "What it reports",
          "items": [
            "Computed feature: eGFRcr_2021",
            "Formula id: FORM-EGFRCR-2021"
          ]
        }
      ],
      "evidence": [
        "R3",
        "R4"
      ],
      "url": "https://biod.ai/tools/kidney/rules/gfr-001"
    },
    {
      "id": "GFR-002",
      "name": "Prefer combined eGFR when cystatin C is available",
      "group": "GFR estimation",
      "status": "active",
      "classification": "Priority 51",
      "summary": "Prefer combined eGFR when cystatin C is available. Evaluates eGFRcr 2021 present.",
      "sections": [
        {
          "heading": "Condition",
          "items": [
            "All of:",
            "  eGFRcr 2021 present",
            "  cystatin c mg l present"
          ]
        },
        {
          "heading": "What it reports",
          "items": [
            "Computed feature: eGFRcr_cys_2021",
            "Selected gfr for classification: eGFRcr_cys_2021",
            "Message: Combined creatinine-cystatin C estimate used for classification; both marker results remain visible."
          ]
        }
      ],
      "evidence": [
        "R1",
        "R3"
      ],
      "url": "https://biod.ai/tools/kidney/rules/gfr-002"
    },
    {
      "id": "GFR-003",
      "name": "Suggest cystatin C / combined eGFR for isolated possible G3a",
      "group": "GFR estimation",
      "status": "active",
      "classification": "Priority 52",
      "summary": "Suggest cystatin C / combined eGFR for isolated possible G3a. Evaluates eGFRcr 2021 at or above 45.",
      "sections": [
        {
          "heading": "Condition",
          "items": [
            "All of:",
            "  eGFRcr 2021 >= 45",
            "  eGFRcr 2021 < 60",
            "  uacr mg g < 30",
            "  other kidney damage marker == false",
            "  cystatin c mg l missing"
          ]
        },
        {
          "heading": "What it reports",
          "items": [
            "Action: Consider cystatin C for eGFRcr-cys confirmation before final isolated G3a classification, where available and clinically relevant."
          ]
        }
      ],
      "evidence": [
        "R1",
        "R3"
      ],
      "url": "https://biod.ai/tools/kidney/rules/gfr-003"
    },
    {
      "id": "GFR-004",
      "name": "Creatinine reliability limitation",
      "group": "GFR estimation",
      "status": "active",
      "classification": "Priority 53",
      "summary": "Creatinine reliability limitation. Evaluates low muscle mass is true.",
      "sections": [
        {
          "heading": "Condition",
          "items": [
            "Any of:",
            "  low muscle mass == true",
            "  amputation == true",
            "  bodybuilder or extreme exercise == true",
            "  creatine supplement use == true",
            "  cirrhosis == true",
            "  heart failure == true",
            "  malnutrition == true",
            "  cancer or catabolic state == true",
            "  medication affecting creatinine secretion == true"
          ]
        },
        {
          "heading": "What it reports",
          "items": [
            "Warning: Non-GFR determinant may distort creatinine-based eGFR. Consider eGFRcr-cys or measured GFR according to clinical decision importance."
          ]
        }
      ],
      "evidence": [
        "R1",
        "R3"
      ],
      "url": "https://biod.ai/tools/kidney/rules/gfr-004"
    },
    {
      "id": "CGA-001",
      "name": "Assign G category from selected indexed eGFR",
      "group": "CGA classification",
      "status": "active",
      "classification": "Priority 60",
      "summary": "Assign G category from selected indexed eGFR. Evaluates chronicity status starts with confirmed.",
      "sections": [
        {
          "heading": "Condition",
          "items": [
            "All of:",
            "  chronicity status starts with confirmed",
            "  eGFR selected present"
          ]
        },
        {
          "heading": "What it reports",
          "items": [
            "G1: eGFR >= 90",
            "G2: 60 <= eGFR < 90",
            "G3a: 45 <= eGFR < 60",
            "G3b: 30 <= eGFR < 45",
            "G4: 15 <= eGFR < 30",
            "G5: eGFR < 15"
          ]
        }
      ],
      "evidence": [
        "R1"
      ],
      "url": "https://biod.ai/tools/kidney/rules/cga-001"
    },
    {
      "id": "CGA-002",
      "name": "Assign A category from UACR",
      "group": "CGA classification",
      "status": "active",
      "classification": "Priority 61",
      "summary": "Assign A category from UACR. Evaluates uacr mg g present.",
      "sections": [
        {
          "heading": "Condition",
          "items": [
            "All of:",
            "  uacr mg g present"
          ]
        },
        {
          "heading": "What it reports",
          "items": [
            "A1: uACR < 30",
            "A2: 30 <= uACR <= 300",
            "A3: uACR > 300"
          ]
        }
      ],
      "evidence": [
        "R1"
      ],
      "url": "https://biod.ai/tools/kidney/rules/cga-002"
    },
    {
      "id": "CGA-003",
      "name": "G1/G2 requires damage marker to label CKD",
      "group": "CGA classification",
      "status": "active",
      "classification": "Priority 62",
      "summary": "G1/G2 requires damage marker to label CKD. Evaluates G category in [G1,G2].",
      "sections": [
        {
          "heading": "Condition",
          "items": [
            "All of:",
            "  G category in [G1,G2]",
            "  kidney damage marker == false"
          ]
        },
        {
          "heading": "What it reports",
          "items": [
            "Analysis status: ckd not demonstrated by available data",
            "Message: G1 or G2 alone does not establish CKD without a marker of kidney damage."
          ]
        }
      ],
      "evidence": [
        "R1"
      ],
      "url": "https://biod.ai/tools/kidney/rules/cga-003"
    },
    {
      "id": "CGA-004",
      "name": "Complete CGA classification",
      "group": "CGA classification",
      "status": "active",
      "classification": "Priority 63",
      "summary": "Complete CGA classification. Evaluates chronicity status starts with confirmed.",
      "sections": [
        {
          "heading": "Condition",
          "items": [
            "All of:",
            "  chronicity status starts with confirmed",
            "  G category present",
            "  A category present"
          ]
        },
        {
          "heading": "What it reports",
          "items": [
            "Analysis status: confirmed ckd classified",
            "Output pattern: CKD confirmed; cause pattern {cause_pattern_or_undetermined}; {G_category}{A_category}."
          ]
        }
      ],
      "evidence": [
        "R1"
      ],
      "url": "https://biod.ai/tools/kidney/rules/cga-004"
    },
    {
      "id": "CGA-005",
      "name": "Incomplete classification when UACR absent",
      "group": "CGA classification",
      "status": "active",
      "classification": "Priority 64",
      "summary": "Incomplete classification when UACR absent. Evaluates chronicity status starts with confirmed.",
      "sections": [
        {
          "heading": "Condition",
          "items": [
            "All of:",
            "  chronicity status starts with confirmed",
            "  G category present",
            "  uacr mg g missing"
          ]
        },
        {
          "heading": "What it reports",
          "items": [
            "Analysis status: confirmed ckd incomplete risk classification",
            "UACR required for A category and risk assessment"
          ]
        }
      ],
      "evidence": [
        "R1"
      ],
      "url": "https://biod.ai/tools/kidney/rules/cga-005"
    },
    {
      "id": "CAUSE-001",
      "name": "Possible diabetic kidney disease pattern",
      "group": "Etiology patterns",
      "status": "active",
      "classification": "Priority 70",
      "summary": "Possible diabetic kidney disease pattern. Evaluates ckd confirmed is true.",
      "sections": [
        {
          "heading": "Condition",
          "items": [
            "All of:",
            "  ckd confirmed == true",
            "  diabetes mellitus == true",
            "  persistent albuminuria == true",
            "Supportive (not required):",
            "  diabetic retinopathy == present",
            "  eGFR decline over time == true"
          ]
        },
        {
          "heading": "What it reports",
          "items": [
            "Cause pattern: possible diabetic kidney disease",
            "Language constraint: Do not assert definitive diabetic etiology without clinician adjudication."
          ]
        }
      ],
      "evidence": [
        "R1"
      ],
      "url": "https://biod.ai/tools/kidney/rules/cause-001"
    },
    {
      "id": "CAUSE-002",
      "name": "Possible hypertensive kidney disease pattern",
      "group": "Etiology patterns",
      "status": "active",
      "classification": "Priority 71",
      "summary": "Possible hypertensive kidney disease pattern. Evaluates ckd confirmed is true.",
      "sections": [
        {
          "heading": "Condition",
          "items": [
            "All of:",
            "  ckd confirmed == true",
            "  longstanding hypertension == true",
            "  A category in [A1,A2]",
            "  active urine sediment == false"
          ]
        },
        {
          "heading": "What it reports",
          "items": [
            "Cause pattern: possible hypertensive kidney disease",
            "Language constraint: Etiology remains provisional; exclude competing causes."
          ]
        }
      ],
      "evidence": [
        "R1"
      ],
      "url": "https://biod.ai/tools/kidney/rules/cause-002"
    },
    {
      "id": "CAUSE-003",
      "name": "Non-albumin predominant proteinuria pattern",
      "group": "Etiology patterns",
      "status": "active",
      "classification": "Priority 72",
      "summary": "Non-albumin predominant proteinuria pattern. Evaluates upcr mg g at or above 500.",
      "sections": [
        {
          "heading": "Condition",
          "items": [
            "All of:",
            "  upcr mg g >= 500",
            "  uacr mg g available",
            "  upcr uacr disproportion == true"
          ]
        },
        {
          "heading": "What it reports",
          "items": [
            "Cause pattern: possible non albumin proteinuria",
            "Consider clinician-directed evaluation for tubular or monoclonal protein process"
          ]
        }
      ],
      "evidence": [
        "R1",
        "R5"
      ],
      "url": "https://biod.ai/tools/kidney/rules/cause-003"
    },
    {
      "id": "CAUSE-004",
      "name": "Monoclonal protein-related kidney disease concern",
      "group": "Etiology patterns",
      "status": "active",
      "classification": "Priority 73",
      "summary": "Monoclonal protein-related kidney disease concern. Evaluates kidney abnormality detected is true.",
      "sections": [
        {
          "heading": "Condition",
          "items": [
            "All of:",
            "  kidney abnormality detected == true",
            "  Two or more of:",
            "    anemia present == true",
            "    hypercalcemia present == true",
            "    bone pain == true",
            "    non albumin predominant proteinuria == true",
            "    older adult == true"
          ]
        },
        {
          "heading": "What it reports",
          "items": [
            "Cause pattern: possible monoclonal protein related kidney disease",
            "Clinician-directed serum/urine monoclonal protein evaluation and specialist review"
          ]
        }
      ],
      "evidence": [
        "R1",
        "R5"
      ],
      "url": "https://biod.ai/tools/kidney/rules/cause-004"
    },
    {
      "id": "CAUSE-005",
      "name": "Possible medication-associated kidney injury",
      "group": "Etiology patterns",
      "status": "active",
      "classification": "Priority 74",
      "summary": "Possible medication-associated kidney injury. Evaluates acute process possible is true.",
      "sections": [
        {
          "heading": "Condition",
          "items": [
            "All of:",
            "  acute process possible == true",
            "  recent potential nephrotoxic exposure == true"
          ]
        },
        {
          "heading": "What it reports",
          "items": [
            "Cause pattern: possible medication associated kidney injury",
            "Medication reconciliation and clinician review of timing/dose/monitoring"
          ]
        }
      ],
      "evidence": [
        "R1"
      ],
      "url": "https://biod.ai/tools/kidney/rules/cause-005"
    },
    {
      "id": "PROG-001",
      "name": "Meaningful eGFR decrease on follow-up",
      "group": "Progression",
      "status": "active",
      "classification": "Priority 80",
      "summary": "Meaningful eGFR decrease on follow-up. Evaluates ckd confirmed is true.",
      "sections": [
        {
          "heading": "Condition",
          "items": [
            "All of:",
            "  ckd confirmed == true",
            "  percent change eGFR from prior <= -20"
          ]
        },
        {
          "heading": "What it reports",
          "items": [
            "Progression flag: meaningful_eGFR_decline",
            "Message: A >20% fall in eGFR on subsequent testing exceeds expected variability and warrants evaluation."
          ]
        }
      ],
      "evidence": [
        "R1"
      ],
      "url": "https://biod.ai/tools/kidney/rules/prog-001"
    },
    {
      "id": "PROG-002",
      "name": "Hemodynamically active therapy eGFR change",
      "group": "Progression",
      "status": "active",
      "classification": "Priority 81",
      "summary": "Hemodynamically active therapy eGFR change. Evaluates hemodynamically active therapy recently initiated or increased is true.",
      "sections": [
        {
          "heading": "Condition",
          "items": [
            "All of:",
            "  hemodynamically active therapy recently initiated or increased == true",
            "  percent change eGFR from pretherapy <= -30"
          ]
        },
        {
          "heading": "What it reports",
          "items": [
            "Progression flag: therapy_associated_eGFR_decline_requires_evaluation",
            "Message: A >30% GFR reduction after hemodynamically active therapy warrants evaluation; do not automatically discontinue kidney-protective therapy."
          ]
        }
      ],
      "evidence": [
        "R1"
      ],
      "url": "https://biod.ai/tools/kidney/rules/prog-002"
    },
    {
      "id": "PROG-003",
      "name": "UACR doubling",
      "group": "Progression",
      "status": "active",
      "classification": "Priority 82",
      "summary": "UACR doubling. Evaluates ckd confirmed is true.",
      "sections": [
        {
          "heading": "Condition",
          "items": [
            "All of:",
            "  ckd confirmed == true",
            "  uacr ratio current to prior >= 2"
          ]
        },
        {
          "heading": "What it reports",
          "items": [
            "Progression flag: uACR_doubling",
            "Message: A doubling of ACR exceeds expected laboratory variability and warrants evaluation."
          ]
        }
      ],
      "evidence": [
        "R1"
      ],
      "url": "https://biod.ai/tools/kidney/rules/prog-003"
    },
    {
      "id": "KFRE-001",
      "name": "KFRE eligible population",
      "group": "Risk prediction (KFRE)",
      "status": "active",
      "classification": "Priority 83",
      "summary": "KFRE eligible population. Evaluates ckd confirmed is true.",
      "sections": [
        {
          "heading": "Condition",
          "items": [
            "All of:",
            "  ckd confirmed == true",
            "  G category in [G3a,G3b,G4,G5]",
            "  age years present",
            "  sex for equation present",
            "  eGFR selected present",
            "  uacr mg g present"
          ]
        },
        {
          "heading": "What it reports",
          "items": [
            "Risk calculation: KFRE_4_variable",
            "Implementation requirement: Use only a version-controlled externally validated KFRE implementation with calibration documentation; do not hand-code unverified coefficients."
          ]
        }
      ],
      "evidence": [
        "R1"
      ],
      "url": "https://biod.ai/tools/kidney/rules/kfre-001"
    },
    {
      "id": "KFRE-002",
      "name": "KFRE not used in G1-G2 as release decision tool",
      "group": "Risk prediction (KFRE)",
      "status": "active",
      "classification": "Priority 84",
      "summary": "KFRE not used in G1-G2 as release decision tool. Evaluates G category in [G1,G2].",
      "sections": [
        {
          "heading": "Condition",
          "items": [
            "All of:",
            "  G category in [G1,G2]"
          ]
        },
        {
          "heading": "What it reports",
          "items": [
            "Risk calculation: not_eligible_for_primary_KFRE_output",
            "Message: KFRE developed for G3-G5 should not be used as a validated release decision output in G1-G2."
          ]
        }
      ],
      "evidence": [
        "R1"
      ],
      "url": "https://biod.ai/tools/kidney/rules/kfre-002"
    },
    {
      "id": "KFRE-003",
      "name": "Risk-based referral and care planning thresholds",
      "group": "Risk prediction (KFRE)",
      "status": "active",
      "classification": "Priority 85",
      "summary": "Risk-based referral and care planning thresholds. Evaluates KFRE validated output available is true.",
      "sections": [
        {
          "heading": "Condition",
          "items": [
            "All of:",
            "  KFRE validated output available == true"
          ]
        },
        {
          "heading": "What it reports",
          "items": [
            "five_year_risk_3_to_5_percent_or_more: Consider nephrology referral in conjunction with clinical criteria.",
            "two_year_risk_gt_10_percent: Consider timing of multidisciplinary kidney care.",
            "two_year_risk_gt_40_percent: Consider modality education and KRT preparation pathway in conjunction with clinical criteria."
          ]
        }
      ],
      "evidence": [
        "R1"
      ],
      "url": "https://biod.ai/tools/kidney/rules/kfre-003"
    },
    {
      "id": "ANEMIA-001",
      "name": "Anemia in CKD screening pattern",
      "group": "Complications",
      "status": "active",
      "classification": "Priority 90",
      "summary": "Anemia in CKD screening pattern. Evaluates ckd confirmed is true.",
      "sections": [
        {
          "heading": "Condition",
          "items": [
            "All of:",
            "  ckd confirmed == true",
            "  Any of:",
            "    sex for equation == male AND hemoglobin g dl < 13",
            "    sex for equation == female AND hemoglobin g dl < 12"
          ]
        },
        {
          "heading": "What it reports",
          "items": [
            "Complication pattern: anemia in ckd context",
            "Evaluate with CBC, reticulocytes, ferritin and TSAT",
            "Do not assign renal anemia cause without excluding other etiologies"
          ]
        }
      ],
      "evidence": [
        "R5"
      ],
      "url": "https://biod.ai/tools/kidney/rules/anemia-001"
    },
    {
      "id": "ANEMIA-002",
      "name": "Expanded anemia evaluation when initial workup insufficient",
      "group": "Complications",
      "status": "active",
      "classification": "Priority 91",
      "summary": "Expanded anemia evaluation when initial workup insufficient. Evaluates anemia in ckd context is true.",
      "sections": [
        {
          "heading": "Condition",
          "items": [
            "All of:",
            "  anemia in ckd context == true",
            "  initial anemia cause not explained == true"
          ]
        },
        {
          "heading": "What it reports",
          "items": [
            "Consider peripheral smear, haptoglobin, LDH, CRP, vitamin B12, folate, liver function tests, monoclonal protein evaluation, TSH, PTH and bleeding evaluation as clinically indicated"
          ]
        }
      ],
      "evidence": [
        "R5"
      ],
      "url": "https://biod.ai/tools/kidney/rules/anemia-002"
    },
    {
      "id": "ACIDOSIS-001",
      "name": "Low bicarbonate in CKD context",
      "group": "Complications",
      "status": "active",
      "classification": "Priority 92",
      "summary": "Low bicarbonate in CKD context. Evaluates ckd confirmed is true.",
      "sections": [
        {
          "heading": "Condition",
          "items": [
            "All of:",
            "  ckd confirmed == true",
            "  bicarbonate mmol l < 22"
          ]
        },
        {
          "heading": "What it reports",
          "items": [
            "Complication pattern: low serum bicarbonate in ckd",
            "bicarbonate_mmol_l < 18: clinically_significant_acidosis_risk",
            "Language constraint: Do not automatically prescribe alkali; recommend clinician evaluation of persistence, cause and intervention appropriateness."
          ]
        }
      ],
      "evidence": [
        "R1"
      ],
      "url": "https://biod.ai/tools/kidney/rules/acidosis-001"
    },
    {
      "id": "MBD-001",
      "name": "Possible CKD-MBD biochemical pattern requires serial assessment",
      "group": "Complications",
      "status": "active",
      "classification": "Priority 93",
      "summary": "Possible CKD-MBD biochemical pattern requires serial assessment. Evaluates ckd confirmed is true.",
      "sections": [
        {
          "heading": "Condition",
          "items": [
            "All of:",
            "  ckd confirmed == true",
            "  G category in [G3a,G3b,G4,G5]",
            "  Any of:",
            "    phosphate persistently elevated == true",
            "    PTH progressively or persistently high == true",
            "    calcium abnormality persistent == true"
          ]
        },
        {
          "heading": "What it reports",
          "items": [
            "Complication pattern: possible ckd mbd biochemical pattern",
            "Interpret serial phosphate, calcium and PTH together",
            "Evaluate modifiable factors and vitamin D status as clinically indicated",
            "Automatic phosphate binder recommendation",
            "Automatic calcitriol recommendation",
            "Fixed stage-specific PTH targets",
            "Calcium-phosphate product target rule"
          ]
        }
      ],
      "evidence": [
        "R6"
      ],
      "url": "https://biod.ai/tools/kidney/rules/mbd-001"
    },
    {
      "id": "MED-MET-001",
      "name": "Metformin renal impairment labeling flag",
      "group": "Medication safety",
      "status": "active",
      "classification": "Priority 100",
      "summary": "Metformin renal impairment labeling flag. Evaluates medication active is metformin.",
      "sections": [
        {
          "heading": "Condition",
          "items": [
            "All of:",
            "  medication active == metformin",
            "  eGFR selected < 30"
          ]
        },
        {
          "heading": "What it reports",
          "items": [
            "Medication flag: metformin contraindicated by renal function label",
            "Alert level: high",
            "Message: Metformin labeling contraindicates use below eGFR 30 mL/min/1.73 m2; clinician medication review required."
          ]
        }
      ],
      "evidence": [
        "R8"
      ],
      "url": "https://biod.ai/tools/kidney/rules/med-met-001"
    },
    {
      "id": "MED-MET-002",
      "name": "Metformin initiation/continuation review zone",
      "group": "Medication safety",
      "status": "active",
      "classification": "Priority 101",
      "summary": "Metformin initiation/continuation review zone. Evaluates medication active or proposed is metformin.",
      "sections": [
        {
          "heading": "Condition",
          "items": [
            "All of:",
            "  medication active or proposed == metformin",
            "  eGFR selected >= 30",
            "  eGFR selected < 45"
          ]
        },
        {
          "heading": "What it reports",
          "items": [
            "Medication flag: metformin renal review zone",
            "Message: Do not initiate in the eGFR 30-45 range per labeling; if already taking, assess benefit-risk of continuing. Verify current product labeling."
          ]
        }
      ],
      "evidence": [
        "R8"
      ],
      "url": "https://biod.ai/tools/kidney/rules/med-met-002"
    },
    {
      "id": "MED-RASI-001",
      "name": "RAS inhibitor post-initiation monitoring",
      "group": "Medication safety",
      "status": "active",
      "classification": "Priority 102",
      "summary": "RAS inhibitor post-initiation monitoring. Evaluates ACEi or ARB initiated or dose increased is true.",
      "sections": [
        {
          "heading": "Condition",
          "items": [
            "All of:",
            "  ACEi or ARB initiated or dose increased == true"
          ]
        },
        {
          "heading": "What it reports",
          "items": [
            "Monitoring flag: check_BP_creatinine_potassium_in_2_to_4_weeks",
            "Message: Monitor BP, serum creatinine and potassium within 2-4 weeks after initiation or dose increase."
          ]
        }
      ],
      "evidence": [
        "R1"
      ],
      "url": "https://biod.ai/tools/kidney/rules/med-rasi-001"
    },
    {
      "id": "MED-RASI-002",
      "name": "RAS inhibitor creatinine change review",
      "group": "Medication safety",
      "status": "active",
      "classification": "Priority 103",
      "summary": "RAS inhibitor creatinine change review. Evaluates ACEi or ARB initiated or dose increased is true.",
      "sections": [
        {
          "heading": "Condition",
          "items": [
            "All of:",
            "  ACEi or ARB initiated or dose increased == true",
            "  serum creatinine increase percent within 4 weeks > 30"
          ]
        },
        {
          "heading": "What it reports",
          "items": [
            "Medication flag: RASi_change_requires_evaluation",
            "Message: Creatinine rise >30% within 4 weeks warrants evaluation of AKI, volume status, concomitant medicines and renovascular concern before therapy decision."
          ]
        }
      ],
      "evidence": [
        "R1"
      ],
      "url": "https://biod.ai/tools/kidney/rules/med-rasi-002"
    },
    {
      "id": "MED-SGLT2-001",
      "name": "Expected early eGFR dip after SGLT2i",
      "group": "Medication safety",
      "status": "active",
      "classification": "Priority 104",
      "summary": "Expected early eGFR dip after SGLT2i. Evaluates SGLT2i recently initiated is true.",
      "sections": [
        {
          "heading": "Condition",
          "items": [
            "All of:",
            "  SGLT2i recently initiated == true",
            "  reversible eGFR decrease present == true",
            "  severe acute red flag == false"
          ]
        },
        {
          "heading": "What it reports",
          "items": [
            "Message: An initial reversible eGFR decrease after SGLT2 inhibitor initiation is generally not by itself an indication to discontinue therapy; clinician review remains required."
          ]
        }
      ],
      "evidence": [
        "R1"
      ],
      "url": "https://biod.ai/tools/kidney/rules/med-sglt2-001"
    },
    {
      "id": "MED-NEPHRO-001",
      "name": "Potential nephrotoxin exposure flag",
      "group": "Medication safety",
      "status": "active",
      "classification": "Priority 105",
      "summary": "Potential nephrotoxin exposure flag. Evaluates kidney abnormality detected is true.",
      "sections": [
        {
          "heading": "Condition",
          "items": [
            "All of:",
            "  kidney abnormality detected == true",
            "  Any of:",
            "    NSAID active or requested == true",
            "    aminoglycoside active == true",
            "    vancomycin active == true",
            "    iodinated contrast planned == true",
            "    other nephrotoxin active == true"
          ]
        },
        {
          "heading": "What it reports",
          "items": [
            "Medication flag: renal risk medication review",
            "Message: Potential renal-risk medication or exposure detected; review indication, dose, interactions, monitoring and alternatives. Do not automatically label as contraindicated."
          ]
        }
      ],
      "evidence": [
        "R1",
        "R8"
      ],
      "url": "https://biod.ai/tools/kidney/rules/med-nephro-001"
    },
    {
      "id": "REF-001",
      "name": "Nephrology referral triggers",
      "group": "Referral",
      "status": "active",
      "classification": "Priority 110",
      "summary": "Nephrology referral triggers. Evaluates eGFR selected below 30.",
      "sections": [
        {
          "heading": "Condition",
          "items": [
            "Any of:",
            "  eGFR selected < 30",
            "  KFRE five year risk >= 0.03",
            "  cause uncertain or hereditary == true",
            "  recurrent extensive nephrolithiasis == true",
            "  sustained eGFR fall gt 20 percent == true",
            "  ACR ge 300 with hematuria == true",
            "  persistent abnormal potassium == true",
            "  persistent acidosis == true",
            "  anemia or bone disease complication complex == true"
          ]
        },
        {
          "heading": "What it reports",
          "items": [
            "Specialist referral status: recommended or urgent by trigger",
            "Message: Specialist kidney care referral indicated/considered according to the triggered criterion and urgency."
          ]
        }
      ],
      "evidence": [
        "R1"
      ],
      "url": "https://biod.ai/tools/kidney/rules/ref-001"
    }
  ],
  "evidence": [
    {
      "id": "R1",
      "citation": "KDIGO 2024 Clinical Practice Guideline for the Evaluation and Management of Chronic Kidney Disease. Kidney Disease: Improving Global Outcomes (KDIGO), 2024.",
      "supports": [
        "CKD definition and chronicity",
        "CGA classification",
        "albuminuria confirmation",
        "risk prediction",
        "referral",
        "medication stewardship",
        "progression monitoring"
      ]
    },
    {
      "id": "R2",
      "citation": "KDOQI US Commentary on the KDIGO 2024 Clinical Practice Guideline for the Evaluation and Management of CKD. National Kidney Foundation - KDOQI / American Journal of Kidney Diseases, 2025.",
      "supports": [
        "US clinical implementation context",
        "deployment governance"
      ]
    },
    {
      "id": "R3",
      "citation": "eGFR Equations for Adults: 2021 CKD-EPI creatinine and creatinine-cystatin C race-free equations. National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK) / NIH, 2026.",
      "supports": [
        "eGFRcr computation",
        "eGFRcr-cys computation",
        "assay standardization",
        "adult eligibility"
      ]
    },
    {
      "id": "R4",
      "citation": "NKF/ASN recommendations implementing race-free CKD-EPI equations. National Kidney Foundation / American Society of Nephrology, 2021.",
      "supports": [
        "race-free eGFR policy",
        "US laboratory alignment"
      ]
    },
    {
      "id": "R5",
      "citation": "KDIGO 2026 Clinical Practice Guideline for the Management of Anemia in CKD - Executive Summary. KDIGO, 2026.",
      "supports": [
        "anemia thresholds",
        "first-line anemia workup",
        "iron deficiency terminology"
      ]
    },
    {
      "id": "R6",
      "citation": "KDIGO 2017 Clinical Practice Guideline Update for CKD-Mineral and Bone Disorder. KDIGO, 2017.",
      "supports": [
        "CKD-MBD serial interpretation",
        "avoid automatic calcitriol/binder outputs"
      ]
    },
    {
      "id": "R7",
      "citation": "KDIGO Clinical Practice Guideline for Acute Kidney Injury. KDIGO, 2012.",
      "supports": [
        "AKI creatinine/urine output safety gate"
      ]
    },
    {
      "id": "R8",
      "citation": "GLUCOPHAGE / GLUCOPHAGE XR Prescribing Information - Renal Impairment Recommendations. U.S. Food and Drug Administration (FDA) - Drugs@FDA labeling, 2017.",
      "supports": [
        "metformin medication safety thresholds"
      ]
    },
    {
      "id": "R9",
      "citation": "Clinical Decision Support Software Guidance for Industry and Food and Drug Administration Staff. U.S. Food and Drug Administration (FDA), 2026.",
      "supports": [
        "HCP independent-review design",
        "output transparency",
        "knowns/unknowns presentation",
        "automation-bias risk controls",
        "regulatory positioning"
      ]
    }
  ]
}