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CPE-003 · synthetic case CKD-EX-08
Creatinine rise after an NSAID
Creatinine 1.0 to 1.6 mg/dL over four days with recent ibuprofen use.
Purpose: Creatinine 1.0 to 1.6 mg/dL over four days with recent ibuprofen use.
Inputs the engine received
Patient
- Age
- 58 years
Context
- Sex for equation
- male
- Recent potential nephrotoxic exposure
- Yes
- Medications
- nsaid
Laboratory
- Serum creatinine series
- 1 mg/dL (2026-05-20) → 1.6 mg/dL (2026-05-24)
What the engine reports
Creatinine trajectory meets an AKI safety trigger. Urgent clinician review is required; the current value must not be used alone to finalize chronic CKD staging.
Detected clinical pattern
Possible Acute Process — Do Not Stage as CKD
The creatinine trajectory meets an acute kidney injury trigger. The current value must not be used alone to finalize chronic CKD staging.
- Chronicity: Acute process possible
- Pattern: Possible medication associated kidney injury
Clinical summary
Priority safety finding: possible acute kidney injury. Creatinine trajectory suggests a possible acute process; chronic staging is deferred. Priority: urgent clinician review.
Why this pattern was identified
- Estimated GFR. 49.6 mL/min/1.73 m² (eGFRcr 2021, race-free), category G3a (45–59).
Calculations
- eGFRcr (CKD-EPI 2021, race-free)
- 49.6 mL/min/1.73 m²
Creatinine-based.
Recommended next steps
For physician consideration. Urgent review always comes first.
- 1Urgent clinician review for possible AKI or AKI on CKD.AKI safety gate precedes CKD classification (KDIGO AKI).
- 2Review renal-risk medications for indication, dose, interactions, monitoring and alternatives.
Missing information
- UACR (required for the A category, risk assessment and a complete classification).
Why it matters
A rapid creatinine rise can reflect reversible injury. Staging chronic disease on an acute value risks misclassification and delays evaluation of the acute cause.
Evidence and rule trace · 6 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 1.6 mg/dL · age 58 · sex male
eGFRcr 2021 = 49.6 mL/min/1.73 m²
SAFE-AKI-001Possible acute kidney injury based on creatinine trajectory
Inputs: creatinine 1 → 1.6 mg/dL · ≥1.5× baseline within 7 days
acute_process_possible: current value must not be used alone to finalize chronic CKD staging
DET-001Kidney abnormality detected
Inputs: eGFR 49.6 (<60)
kidney_abnormality_detected: determine chronicity and evaluate acute causes before confirming CKD
CAUSE-005Possible medication-associated kidney injury
Inputs: acute process possible · recent potential nephrotoxic exposure
possible_medication_associated_kidney_injury: medication reconciliation and clinician review
MED-NEPHRO-001Potential nephrotoxin exposure flag
Inputs: nsaid
Review indication, dose, interactions, monitoring and alternatives. Not an automatic contraindication.
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.
- R7 · KDIGO Clinical Practice Guideline for Acute Kidney Injury. KDIGO, 2012.
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.
Live eGFR and CGA map
eGFR (mL/min/1.73 m²)
49.6
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 |
No cell is shown until there are data. 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
Switches the engine to the combined eGFRcr-cys equation.
Albuminuria
Chemistry
Kidney findings and red flags
Context
Transient albuminuria confounders
Creatinine may be unreliable
Complications (persistent)
Therapy
Documented history and special populations
More kidney cases
CKD-FX-001
Persistent moderately increased albuminuria with preserved GFR
Persistent moderately increased albuminuria with preserved GFR
CKD-FX-002
Persistent severely increased albuminuria with mildly decreased GFR
Persistent severely increased albuminuria with mildly decreased GFR
CKD-FX-003
Single reduced eGFR without chronicity
Single reduced eGFR without chronicity
CKD-FX-004
Acute creatinine rise before CKD staging
Acute creatinine rise before CKD staging
CKD-FX-005
Isolated suspected G3a requiring cystatin C confirmation support
Isolated suspected G3a requiring cystatin C confirmation support
CKD-FX-006
Combined eGFR reclassification support
Combined eGFR reclassification support
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