Kidney Function Tracker

Example: Male, 52 years, creatinine 95 umol/L

• Scr = 95 / 88.4 = 1.075 mg/dL
• Scr > 0.9, use: eGFR = 142 * (1.075/0.9)^(-1.200) * 0.9938^52
• eGFR = 142 * 0.779 * 0.724 = 80.1 mL/min/1.73m^2

2. CKD Staging

Stage change detection: Compare current vs. previous stage. If stage worsens (number increases), trigger "stage progression" alert. Pay special attention to G2->G3a and G3b->G4 transitions.

3. Albuminuria Classification

Trigger alert on A2->A3 transition indicating worsening kidney damage.

4. eGFR Decline Rate

Formula: Annual decline rate = (previous eGFR - current eGFR) / time interval in years

• Time interval (years) = days between tests / 365.25

Decline rate classification:

Steps:

1. Read memory/health/items/kidney-function.md ## History table
2. Extract two most recent eGFR entries
3. Calculate time interval (days / 365.25)
4. Calculate decline rate
5. If >= 3 data points, also compute 6-month and 1-year average decline rates

Require at least 2 eGFR readings >= 3 months apart for meaningful calculation. Single-interval rates may be affected by acute factors (dehydration, medications).

5. Monitoring Schedule (by CKD Stage)

Follow-up reminder logic:

1. Read latest CKD stage
2. Find most recent test date in ## History
3. Calculate next due date based on stage-appropriate frequency
4. If current date > due date: "Overdue" reminder
5. If <= 14 days to due date: "Upcoming" reminder

Output Format

Kidney Function Assessment Report

# Kidney Function Assessment Report

## Date
YYYY-MM-DD

## Current Indicators

| Indicator | Value | Reference | Status |
|-----------|-------|-----------|--------|
| Serum Creatinine | 95 umol/L (1.07 mg/dL) | 57-111 umol/L (male) | Normal |
| eGFR (CKD-EPI 2021) | 80.1 mL/min/1.73m^2 | >= 90 | Mildly decreased |
| ACR | 45 mg/g | < 30 | Moderately increased (A2) |

## CKD Stage
- **Current: G2 (Mildly decreased)**
- Previous: G2 (YYYY-MM-DD)
- Change: None

## Albuminuria Classification
- **Current: A2 (Moderately increased)**
- Previous: A1 (YYYY-MM-DD)
- **Change: A1 -> A2 (new microalbuminuria)**

## eGFR Decline Analysis

| Period | Start eGFR | End eGFR | Rate |
|--------|-----------|----------|------|
| Last interval | X | Y | Z mL/min/year |
| Last 6 months | X | Y | Z mL/min/year |
| Last 1 year | X | Y | Z mL/min/year |

## eGFR Trend

| Date | Scr (umol/L) | eGFR | Stage | ACR (mg/g) | Alb Category |
|------|-------------|------|-------|-----------|-------------|

## Alerts
1. [Priority] [Description]

## Monitoring Plan
- Current stage recommendation
- Adjusted recommendation if decline is rapid
- Next suggested test date
- Suggested test items

Data Persistence

Follow health-memory write protocol:

1. Update daily file: Insert/replace section ## Kidney Function [kidney-function-tracker · HH:MM]
2. Update items file (memory/health/items/kidney-function.md):
   • Update ## Recent Status: latest creatinine, eGFR, CKD stage, ACR, decline rate
   • Prepend row to ## History table
   • Trim rows older than 90 days

History table columns:

| Date | Scr (umol/L) | Scr (mg/dL) | eGFR | CKD Stage | ACR (mg/g) | Alb Category | Decline Rate | Notes |

Daily section format:

## Kidney Function [kidney-function-tracker · 10:00]
- Creatinine: 95 umol/L (1.07 mg/dL)
- eGFR (CKD-EPI 2021): 80.1 mL/min/1.73m^2
- CKD Stage: G2, Albuminuria: A2 (ACR 45 mg/g)
- Decline Rate: -8.4 mL/min/year (rapid)
- Alert: Rapid eGFR decline, new microalbuminuria

Alerts and Safety

Alert Thresholds (by priority)

Emergency (seek immediate care):

• eGFR < 15 (kidney failure)
• eGFR single drop > 25% (possible acute kidney injury)
• ACR > 300 and rapidly rising

Important:

• CKD stage progression (e.g., G2 -> G3a)
• Annual decline rate > 5 mL/min/1.73m^2
• ACR category A2 -> A3
• eGFR < 30 (recommend nephrology referral)

Attention:

• Annual decline rate 3-5 mL/min/1.73m^2
• ACR category A1 -> A2
• Creatinine rising for 3 consecutive readings
• Follow-up overdue

Medical Disclaimer

This skill is for health monitoring reference only. It does not constitute medical diagnosis or treatment advice. It does not confirm CKD diagnosis (requires comprehensive clinical judgment), formulate treatment plans, evaluate dialysis regimens, or replace nephrologist consultations.