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-09

eGFR fell by more than 20% between visits

Confirmed CKD with creatinine 1.2 to 1.7 mg/dL over six months.

Synthetic · no real patientExtended demonstration caseKidney engine v1.2.0

Purpose: Confirmed CKD with creatinine 1.2 to 1.7 mg/dL over six months.

Inputs the engine received

Patient

Age: 58 years

Context

Sex for equation: male
CKD confirmed: Yes

Laboratory

Serum creatinine series: 1.2 mg/dL (2025-10-01) → 1.7 mg/dL (2026-04-15)
UACR: 60 mg/g

What the engine reports

Detected clinical pattern

Criteria for CKD Met — Classified

Chronicity is documented and the result is classified CKD G3aA2. This is criteria-based status, not a probability.

Chronicity: Chronicity confirmed (≥3 months)
CGA: CKD G3aA2

Clinical summary

CKD G3aA2: criteria met on documented chronicity (eGFR 46.2 and UACR 60 mg/g). Priority: complete risk stratification, review etiology and kidney-protective management.

Why this pattern was identified

Estimated GFR. 46.2 mL/min/1.73 m² (eGFRcr 2021, race-free), category G3a (45–59).
Albuminuria. UACR 60 mg/g, category A2 (30–300 mg/g).
CKD criteria met. CKD G3aA2 on documented chronicity. Criteria-based status, not a probability.

Calculations

eGFRcr (CKD-EPI 2021, race-free): 46.2 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.

1Specialist kidney-care referral per triggered criterion: Sustained eGFR fall >20%.KDIGO 2024 referral criteria.
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.

Progression signal: meaningful eGFR decline.

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 1.7 mg/dL · age 58 · sex male

eGFRcr 2021 = 46.2 mL/min/1.73 m²

DET-001Kidney abnormality detected

Inputs: eGFR 46.2 (<60) · UACR 60 mg/g (≥30)

kidney_abnormality_detected: determine chronicity and evaluate acute causes before confirming CKD

CGA-001Assign G category from selected indexed eGFR

Inputs: eGFR 46.2 (eGFRcr_2021)

G3a (45–59 mL/min/1.73 m²)

CGA-002Assign A category from UACR

Inputs: UACR 60 mg/g

A2 (30–300 mg/g)

CGA-004Complete CGA classification

Inputs: G3a · A2 · chronicity confirmed

CKD G3aA2

PROG-001Meaningful eGFR decrease on follow-up

Inputs: eGFR 70.1 → 46.2 (-34.2%)

meaningful_eGFR_decline: exceeds expected variability and warrants evaluation

KFRE-001KFRE eligible population

Inputs: CKD G3aA2 · age, sex, eGFR, UACR available

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

REF-001Nephrology referral triggers

Inputs: Sustained eGFR fall >20%

Specialist kidney care referral indicated or to be considered per the triggered criterion

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.

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Live eGFR and CGA map

eGFR (mL/min/1.73 m²)

46.2

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 G3aA2. 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 G3aA2. This is criteria-based status, not a probability.

Chronicity: Chronicity confirmed (≥3 months)
CGA: CKD G3aA2

Clinical summary

CKD G3aA2: criteria met on documented chronicity (eGFR 46.2 and UACR 60 mg/g). Priority: complete risk stratification, review etiology and kidney-protective management.

Why this pattern was identified

Estimated GFR. 46.2 mL/min/1.73 m² (eGFRcr 2021, race-free), category G3a (45–59).
Albuminuria. UACR 60 mg/g, category A2 (30–300 mg/g).
CKD criteria met. CKD G3aA2 on documented chronicity. Criteria-based status, not a probability.

Calculations

eGFRcr (CKD-EPI 2021, race-free): 46.2 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.

1Specialist kidney-care referral per triggered criterion: Sustained eGFR fall >20%.KDIGO 2024 referral criteria.
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.

Progression signal: meaningful eGFR decline.

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 1.7 mg/dL · age 58 · sex male

eGFRcr 2021 = 46.2 mL/min/1.73 m²

DET-001Kidney abnormality detected

Inputs: eGFR 46.2 (<60) · UACR 60 mg/g (≥30)

kidney_abnormality_detected: determine chronicity and evaluate acute causes before confirming CKD

CGA-001Assign G category from selected indexed eGFR

Inputs: eGFR 46.2 (eGFRcr_2021)

G3a (45–59 mL/min/1.73 m²)

CGA-002Assign A category from UACR

Inputs: UACR 60 mg/g

A2 (30–300 mg/g)

CGA-004Complete CGA classification

Inputs: G3a · A2 · chronicity confirmed

CKD G3aA2

PROG-001Meaningful eGFR decrease on follow-up

Inputs: eGFR 70.1 → 46.2 (-34.2%)

meaningful_eGFR_decline: exceeds expected variability and warrants evaluation

KFRE-001KFRE eligible population

Inputs: CKD G3aA2 · age, sex, eGFR, UACR available

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

REF-001Nephrology referral triggers

Inputs: Sustained eGFR fall >20%

Specialist kidney care referral indicated or to be considered per the triggered criterion

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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