Synthetic data only. Never enter patient information; nothing is sent or stored. For clinicians. Not FDA cleared.For licensed clinicians. Educational demonstration on synthetic data. Never enter real patient identifiers or protected health information: everything runs in your browser and nothing is sent or stored. Clinical decision support only; not FDA cleared; physician review is required.

CPE-003 · synthetic case CKD-EX-04

Documented prior CKD supports chronicity

A single eGFR of about 50 in a patient with CKD documented years ago.

Synthetic · no real patientExtended demonstration caseKidney engine v1.2.0

Purpose: A single eGFR of about 50 in a patient with CKD documented years ago.

Inputs the engine received

Patient

Age: 70 years

Context

Sex for equation: male
Prior documented CKD: Yes

Laboratory

Serum creatinine: 1.45 mg/dL
UACR: 20 mg/g

What the engine reports

Detected clinical pattern

Criteria for CKD Met — Classified

Chronicity is documented and the result is classified CKD G3aA1. This is criteria-based status, not a probability.

Chronicity: Chronicity supported by external evidence
CGA: CKD G3aA1

Clinical summary

CKD G3aA1: criteria met on documented chronicity (eGFR 51.8 and UACR 20 mg/g). Priority: complete risk stratification, review etiology and kidney-protective management.

Why this pattern was identified

Estimated GFR. 51.8 mL/min/1.73 m² (eGFRcr 2021, race-free), category G3a (45–59).
Albuminuria. UACR 20 mg/g, category A1 (<30 mg/g).
CKD criteria met. CKD G3aA1 on documented chronicity. Criteria-based status, not a probability.

Calculations

eGFRcr (CKD-EPI 2021, race-free): 51.8 mL/min/1.73 m²
KFRE 2- and 5-year risk: Eligible — not computed

Recommended next steps

For physician consideration. Urgent review always comes first.

1Consider cystatin C (eGFRcr-cys) before final isolated G3a classification, where available and clinically relevant.eGFRcr is the least reliable near the G2/G3a boundary without albuminuria.
2Confirm complete risk stratification (CGA) and review etiology, blood pressure and kidney-protective management.
3Monitor eGFR and UACR longitudinally at an interval set by the CGA risk category.

Missing information

Cystatin C (optional; improves GFR accuracy near decision thresholds).
Urine sediment / microscopy (supports etiologic adjudication).

Why it matters

CKD with albuminuria and reduced GFR is associated with higher risks of kidney progression and cardiovascular disease, and the CGA category sets monitoring intensity.

Evidence and rule trace · 9 rules

DQ-004eGFR calculation assay provenance

Inputs: creatinine assay IDMS traceability not confirmed

eGFR computed with unknown/non-confirmed standardized assay; interpret with assay provenance visible.

GFR-001Compute initial adult race-free creatinine eGFR

Inputs: creatinine 1.45 mg/dL · age 70 · sex male

eGFRcr 2021 = 51.8 mL/min/1.73 m²

DET-001Kidney abnormality detected

Inputs: eGFR 51.8 (<60)

kidney_abnormality_detected: determine chronicity and evaluate acute causes before confirming CKD

CHR-002CKD chronicity may be supported by non-laboratory evidence

Inputs: prior documented CKD

confirmed_by_external_evidence: physician adjudication required for final classification

GFR-003Suggest cystatin C / combined eGFR for isolated possible G3a

Inputs: eGFRcr 51.8 · UACR 20 mg/g · no other damage marker · cystatin C missing

Consider cystatin C for eGFRcr-cys confirmation before final isolated G3a classification

CGA-001Assign G category from selected indexed eGFR

Inputs: eGFR 51.8 (eGFRcr_2021)

G3a (45–59 mL/min/1.73 m²)

CGA-002Assign A category from UACR

Inputs: UACR 20 mg/g

A1 (<30 mg/g)

CGA-004Complete CGA classification

Inputs: G3a · A1 · chronicity confirmed

CKD G3aA1

KFRE-001KFRE eligible population

Inputs: CKD G3aA1 · age, sex, eGFR, UACR available

Eligible for a validated KFRE calculation. Not computed here: a version-controlled, externally validated implementation is required.

Evidence

R1 · KDIGO 2024 Clinical Practice Guideline for the Evaluation and Management of Chronic Kidney Disease. Kidney Disease: Improving Global Outcomes (KDIGO), 2024.
R3 · 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.
R4 · NKF/ASN recommendations implementing race-free CKD-EPI equations. National Kidney Foundation / American Society of Nephrology, 2021.

Physician adjudication required. Clinical decision support for physician review. Criteria-based status is not a probability. Findings require physician adjudication and correlation with the complete clinical context. Validation-only release: not for production clinical use.

Change the values

The same engine, starting from this case. Change any value and watch the pattern and the rule trace react.

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Live eGFR and CGA map

eGFR (mL/min/1.73 m²)

51.8

CKD-EPI 2021 creatinine, race-free

GFR \ ALB	A1<30	A230–300	A3>300
G1≥90
G260–89
G3a45–59	●
G3b30–44
G415–29
G5<15

Classified: CKD G3aA1. Colors follow the KDIGO risk heat map: green low, yellow moderately increased, orange high, red very high.

Kidney functionAdd a prior result with dates to test chronicity

Age(years)

Sex for the equation

FemaleMale

Serum creatinine (current)(mg/dL)

Collection date

Serum creatinine (prior)(mg/dL)

Prior collection date

Cystatin C (optional)(mg/L)

Switches the engine to the combined eGFRcr-cys equation.

Albuminuria

UACR (current)(mg/g)

Collection date

UACR (prior)(mg/g)

Prior collection date

Specimen type

UPCR (optional)(mg/g)

Chemistry

Potassium(mmol/L)

Specimen hemolysis

Bicarbonate(mmol/L)

Hemoglobin(g/dL)

Creatinine rise within 4 weeks of ACEi/ARB(%)

Kidney findings and red flags

Context

Transient albuminuria confounders

Creatinine may be unreliable

Complications (persistent)

Therapy

Documented history and special populations

Live result · computed in your browser

Detected clinical pattern

Criteria for CKD Met — Classified

Chronicity is documented and the result is classified CKD G3aA1. This is criteria-based status, not a probability.

Chronicity: Chronicity supported by external evidence
CGA: CKD G3aA1

Clinical summary

CKD G3aA1: criteria met on documented chronicity (eGFR 51.8 and UACR 20 mg/g). Priority: complete risk stratification, review etiology and kidney-protective management.

Why this pattern was identified

Estimated GFR. 51.8 mL/min/1.73 m² (eGFRcr 2021, race-free), category G3a (45–59).
Albuminuria. UACR 20 mg/g, category A1 (<30 mg/g).
CKD criteria met. CKD G3aA1 on documented chronicity. Criteria-based status, not a probability.

Calculations

eGFRcr (CKD-EPI 2021, race-free): 51.8 mL/min/1.73 m²
KFRE 2- and 5-year risk: Eligible — not computed

Recommended next steps

For physician consideration. Urgent review always comes first.

1Consider cystatin C (eGFRcr-cys) before final isolated G3a classification, where available and clinically relevant.eGFRcr is the least reliable near the G2/G3a boundary without albuminuria.
2Confirm complete risk stratification (CGA) and review etiology, blood pressure and kidney-protective management.
3Monitor eGFR and UACR longitudinally at an interval set by the CGA risk category.

Missing information

Cystatin C (optional; improves GFR accuracy near decision thresholds).
Urine sediment / microscopy (supports etiologic adjudication).

Why it matters

CKD with albuminuria and reduced GFR is associated with higher risks of kidney progression and cardiovascular disease, and the CGA category sets monitoring intensity.

Evidence and rule trace · 9 rules

DQ-004eGFR calculation assay provenance

Inputs: creatinine assay IDMS traceability not confirmed

eGFR computed with unknown/non-confirmed standardized assay; interpret with assay provenance visible.

GFR-001Compute initial adult race-free creatinine eGFR

Inputs: creatinine 1.45 mg/dL · age 70 · sex male

eGFRcr 2021 = 51.8 mL/min/1.73 m²

DET-001Kidney abnormality detected

Inputs: eGFR 51.8 (<60)

kidney_abnormality_detected: determine chronicity and evaluate acute causes before confirming CKD

CHR-002CKD chronicity may be supported by non-laboratory evidence

Inputs: prior documented CKD

confirmed_by_external_evidence: physician adjudication required for final classification

GFR-003Suggest cystatin C / combined eGFR for isolated possible G3a

Inputs: eGFRcr 51.8 · UACR 20 mg/g · no other damage marker · cystatin C missing

Consider cystatin C for eGFRcr-cys confirmation before final isolated G3a classification

CGA-001Assign G category from selected indexed eGFR

Inputs: eGFR 51.8 (eGFRcr_2021)

G3a (45–59 mL/min/1.73 m²)

CGA-002Assign A category from UACR

Inputs: UACR 20 mg/g

A1 (<30 mg/g)

CGA-004Complete CGA classification

Inputs: G3a · A1 · chronicity confirmed

CKD G3aA1

KFRE-001KFRE eligible population

Inputs: CKD G3aA1 · age, sex, eGFR, UACR available

Eligible for a validated KFRE calculation. Not computed here: a version-controlled, externally validated implementation is required.

Evidence

R1 · KDIGO 2024 Clinical Practice Guideline for the Evaluation and Management of Chronic Kidney Disease. Kidney Disease: Improving Global Outcomes (KDIGO), 2024.
R3 · 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.
R4 · NKF/ASN recommendations implementing race-free CKD-EPI equations. National Kidney Foundation / American Society of Nephrology, 2021.

More kidney cases

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CKD-FX-003

Single reduced eGFR without chronicity

CKD-FX-004

Acute creatinine rise before CKD staging

CKD-FX-005

Isolated suspected G3a requiring cystatin C confirmation support

CKD-FX-006

Combined eGFR reclassification support

All kidney cases

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