Round Details
September 30, 2026 at 07:39 AM UTC
Scenario: Chronic Kidney Disease - Multiple Medications
James Brown, 67-year-old male with Stage 3b Chronic Kidney Disease (eGFR 38) secondary to diabetic nephropathy. He also has Type 2 Diabetes and Hypertension. Current medications include: Losartan 50mg daily for renal protection, Metformin 500mg twice daily (reduced dose for CKD), Amlodipine 5mg daily for blood pressure, and Calcitriol 0.25mcg daily for vitamin D deficiency. He requires regular monitoring of renal function and electrolytes. No known drug allergies.
How did the LLMs do?
Same LLM Tests
Reconstructed text
James Brown is a 67-year-old man with active type 2 diabetes mellitus complicated by diabetic nephropathy and secondary stage 3b chronic kidney disease (CKD). His finalized laboratory result shows an estimated glomerular filtration rate (eGFR) of 38 mL/min/1.73 m². Additional active conditions include hypertension and unspecified vitamin D deficiency. He has no known drug allergies.
His active medications are losartan 50 mg once daily for renal protection related to CKD and diabetic nephropathy; metformin 500 mg twice daily for type 2 diabetes, with the dose reduced because of CKD; amlodipine 5 mg once daily for blood pressure control; and calcitriol 0.25 mcg once daily for vitamin D deficiency. An active plan calls for regular laboratory monitoring of renal function and electrolytes because of CKD, although the monitoring interval is not specified.
Comparison
No discrepancies found by any verifier.
Reconstructed text
James Brown is a 67-year-old male with no known allergies. He has several active medical conditions: chronic kidney disease stage 3b (eGFR 38, secondary to diabetic nephropathy), type 2 diabetes mellitus, hypertension, and vitamin D deficiency. His current medications include losartan 50mg daily for renal protection, metformin 500mg twice daily (reduced dose for CKD), amlodipine 5mg daily for blood pressure control, and calcitriol 0.25mcg daily for vitamin D deficiency. He is scheduled for regular monitoring of renal function and electrolytes starting January 1, 2024.
Comparison2 issues
Hallucinated:
- start date of january 1 2024 added for renal function and electrolyte monitoring
- regular renal function and electrolyte monitoring is stated to be scheduled starting january 1 2024 the original only says regular monitoring is required and provides no schedule or start date
Reconstructed text
Clinical Narrative
James Brown is a 67-year-old male (born 1958) with an active patient record. He has no known drug allergies, and this is confirmed.
Active Problems
All of the following conditions are active, confirmed problem list items.
- Type 2 diabetes mellitus (SNOMED 44054006) is the underlying cause of his renal disease.
- Diabetic nephropathy (ICD-10-CM E11.22, type 2 diabetes mellitus with diabetic chronic kidney disease) is documented as due to his type 2 diabetes.
- Stage 3b chronic kidney disease (ICD-10-CM N18.32) is documented as secondary to the diabetic nephropathy.
- It is supported by a final laboratory result showing an estimated glomerular filtration rate (eGFR) of 38 mL/min/1.73m², flagged as low. This was calculated with the CKD-EPI 2021 creatinine-based formula.
- Hypertension is coded as hypertensive chronic kidney disease with stage 1 through stage 4 or unspecified CKD (ICD-10-CM I12.9).
- Vitamin D deficiency, unspecified (ICD-10-CM E55.9).
Active Medications
All of the following are active orders taken by mouth.
- Losartan potassium 50 mg once daily. It is prescribed for renal protection in the setting of CKD stage 3b and diabetic nephropathy.
- Metformin hydrochloride 500 mg twice daily for type 2 diabetes. This is a reduced dose because of CKD stage 3b (eGFR 38).
- Amlodipine 5 mg once daily for hypertension.
- Calcitriol 0.25 mcg capsule once daily for vitamin D deficiency.
Laboratory Monitoring Orders
Two active laboratory orders are in place for CKD stage 3b:
- A renal function panel (LOINC 24362-6), with a note that regular monitoring of renal function is required.
- An electrolyte panel (LOINC 24326-1), with a note that regular monitoring of electrolytes is required.
No specific monitoring interval, dates, or scheduled appointments are documented in the record.
Comparison7 issues
Hallucinated:
- birth year 1958 added the original gives only age 67
- hypertension recharacterized as hypertensive chronic kidney disease icd10cm i129 the original states only hypertension and attributes the ckd to diabetic nephropathy
- calcitriol capsule formulation added the original does not specify a dosage form
- egfr calculation method ckdepi 2021 creatininebased formula added not in the original
- the egfr of 38 is described as a finalized laboratory result calculated using the ckdepi 2021 creatininebased formula neither the result status nor the calculation method is specified in the original
- an active renal function panel order loinc 243626 is added the original states that regular renal function monitoring is required but does not document an existing order
- all medications are specified as taken by mouth administration routes are not explicitly documented in the original
Cross LLM Tests
Reconstructed text
James Brown is a 67-year-old male with stage 3b chronic kidney disease (eGFR 38 mL/min/1.73 m²) secondary to diabetic nephropathy, type 2 diabetes mellitus with diabetic nephropathy, hypertension, and vitamin D deficiency. He has no known drug allergies. Current medications include losartan 50 mg daily for renal protection, metformin 500 mg twice daily (reduced dose due to chronic kidney disease) for type 2 diabetes, amlodipine 5 mg daily for blood pressure control, and calcitriol 0.25 micrograms daily for vitamin D deficiency. Regular monitoring of renal function and electrolytes is planned.
Comparison
No discrepancies found by any verifier.
Reconstructed text
James Brown is a male born in 1958. His active, confirmed problem-list diagnoses include type 2 diabetes mellitus complicated by diabetic nephropathy, with resulting stage 3b chronic kidney disease (CKD). He also has hypertension, coded as hypertensive chronic kidney disease, and vitamin D deficiency. A finalized laboratory result shows a low estimated glomerular filtration rate (eGFR) of 38 mL/min/1.73 m², calculated using the creatinine-based MDRD formula. This result is documented as supporting evidence for stage 3b CKD. His allergy record confirms no known drug allergies.
His active community prescriptions include losartan potassium 50 mg oral tablet once daily for renal protection in CKD and diabetic nephropathy; metformin hydrochloride 500 mg oral tablet twice daily for type 2 diabetes mellitus; amlodipine 5 mg oral tablet once daily for hypertension; and calcitriol 0.25 mcg orally once daily for vitamin D deficiency. The metformin dose is specifically documented as reduced because of stage 3b CKD and an eGFR of 38 mL/min/1.73 m².
Active laboratory orders are in place for a serum or plasma renal function panel and an electrolyte panel. Both orders specify the need for regular monitoring because of stage 3b CKD. No specific testing interval or appointment details are provided.
Comparison5 issues
Missing information:
- the patients stated age of 67 years is not explicitly retained
Hallucinated:
- egfr described as calculated using the creatininebased mdrd formula the original does not specify a calculation method
- hypertension described as coded as hypertensive chronic kidney disease which implies hypertension contributes to the ckd the original lists hypertension separately and attributes ckd to diabetic nephropathy
- birth year 1958 is added the original provides an age but no birth year or reference date
- active orders for renal function and electrolyte panels are asserted the original states only that regular renal function and electrolyte monitoring is required
Reconstructed text
Clinical Narrative
Patient: James Brown, 69-year-old male (born 1956). He has no known allergies.
Active Problems: Mr. Brown has chronic kidney disease stage 3b with an eGFR of 38, attributed to diabetic nephropathy. His other active conditions are type 2 diabetes mellitus, hypertension, and vitamin D deficiency.
Current Medications: He is on four active medication orders:
- Losartan 50 mg oral tablet, once daily, for renal protection.
- Metformin hydrochloride 500 mg oral tablet, twice daily. This is a reduced dose because of his chronic kidney disease.
- Amlodipine 5 mg oral tablet, once daily, for hypertension.
- Calcitriol 0.25 mcg oral capsule, once daily, for vitamin D deficiency.
Plan and Orders: There is an active order for regular monitoring of kidney function and electrolytes.
Documentation Note: Some codes in the record may not match their labels and should be checked:
- Kidney monitoring order: SNOMED CT code 386661006 is generally associated with "Fever," not "Monitoring of kidney function."
- CKD diagnosis: Code 709044004 generally corresponds to chronic kidney disease without a specified stage, not stage 3b specifically.
Comparison7 issues
Hallucinated:
- age changed from 67 to 69
- birth year 1956 added which is not in the original
- dosage forms added oral tablets for losartan metformin and amlodipine oral capsule for calcitriol which are not in the original
- documentation note added about snomed ct code 386661006 fever on the kidney monitoring order which is not in the original
- the medications are described as four active medication orders the original lists current medications without documenting order status
- an active order for renal function and electrolyte monitoring is asserted the original states that regular monitoring is required but does not document an order
- snomed ct code 386661006 and a warning that it denotes fever rather than kidney monitoring are added the original contains no monitoring code or coding discrepancy