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CPE-003 · synthetic case CKD-EX-13
Metformin in the eGFR 30–44 review zone
eGFR 38 on metformin.
Purpose: eGFR 38 on metformin.
Inputs the engine received
Patient
- Age
- 71 years
Context
- Sex for equation
- female
- Medication active
- metformin
Laboratory
- eGFR selected
- 38 mL/min/1.73 m²
What the engine reports
Detected clinical pattern
Kidney Abnormality Detected — CKD Not Confirmed
A single abnormal result does not establish CKD. Persistence over at least three months and exclusion of acute or transient causes are needed.
- Chronicity: Chronicity unconfirmed
- CGA: Indicative G3bA? (not a classification)
Clinical summary
A kidney abnormality was detected (eGFR 38), but chronicity is not established; CKD is not confirmed. Priority: confirm persistence and exclude acute or transient causes.
Why this pattern was identified
- Estimated GFR. 38 mL/min/1.73 m² (externally reported), category G3b (30–44).
Calculations
- eGFR (externally reported)
- 38 mL/min/1.73 m²
Recommended next steps
For physician consideration. Urgent review always comes first.
- 1Confirm persistence (repeat testing at ≥3 months) and evaluate acute or transient causes before labeling CKD.A single abnormal eGFR or UACR does not establish CKD.
Missing information
- UACR (required for the A category, risk assessment and a complete classification).
Why it matters
Isolated abnormal eGFR or UACR values are common and often transient. Labeling CKD early can misclassify patients, while missing persistent disease delays care. Confirmation at three months balances both.
Evidence and rule trace · 3 rules
DET-001Kidney abnormality detected
Inputs: eGFR 38 (<60)
kidney_abnormality_detected: determine chronicity and evaluate acute causes before confirming CKD
CHR-003Single abnormal result does not confirm CKD
Inputs: abnormality without dated evidence of ≥3 months
kidney_abnormality_unconfirmed: CKD is not confirmed
MED-MET-002Metformin initiation/continuation review zone
Inputs: eGFR 38 (30–44) · metformin active or proposed
Do not initiate in the eGFR 30–45 range per labeling; if already taking, assess benefit–risk of continuing. Verify current product labeling.
Evidence
- R1 · KDIGO 2024 Clinical Practice Guideline for the Evaluation and Management of Chronic Kidney Disease. Kidney Disease: Improving Global Outcomes (KDIGO), 2024.
- R8 · GLUCOPHAGE / GLUCOPHAGE XR Prescribing Information - Renal Impairment Recommendations. U.S. Food and Drug Administration (FDA) - Drugs@FDA labeling, 2017.
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)
38
externally reported
| GFR \ ALB | A1<30 | A230–300 | A3>300 |
|---|---|---|---|
| G1≥90 | |||
| G260–89 | |||
| G3a45–59 | |||
| G3b30–44 | |||
| G415–29 | |||
| G5<15 |
Indicative cell G3bA? only: CKD is not confirmed, so this is not a classification. 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
This case also carries values that have no field here: eGFR_selected. They are included in the calculation until you clear the form.
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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