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CPE-003 · synthetic case CKD-FX-002

Persistent severely increased albuminuria with mildly decreased GFR

Synthetic · no real patientReviewed acceptance scenarioKidney engine v1.2.0

Purpose: Ensure G2A3 is not collapsed into A2

Inputs the engine received

Patient

Age: 62 years

Context

Sex for equation: male

Laboratory

Serum creatinine: 1.18 mg/dL
UACR series: 540 mg/g (2025-11-10, first morning void) → 612 mg/g (2026-03-15, first morning void)

What the engine reports

Detected clinical pattern

Criteria for CKD Met — Classified

Chronicity is documented and the result is classified CKD G2A3. This is criteria-based status, not a probability.

Chronicity: Chronicity confirmed (≥3 months)
CGA: CKD G2A3

Clinical summary

CKD G2A3: criteria met on documented chronicity (eGFR 69.8 and UACR 612 mg/g). Priority: complete risk stratification, review etiology and kidney-protective management.

Why this pattern was identified

Estimated GFR. 69.8 mL/min/1.73 m² (eGFRcr 2021, race-free), category G2 (60–89).
Albuminuria. UACR 612 mg/g, category A3 (>300 mg/g).
Persistence. Abnormal results are dated at least three months apart.
CKD criteria met. CKD G2A3 on documented chronicity. Criteria-based status, not a probability.

Calculations

eGFRcr (CKD-EPI 2021, race-free): 69.8 mL/min/1.73 m²

Recommended next steps

For physician consideration. Urgent review always comes first.

1Specialist kidney-care referral per triggered criterion: Persistent A3 albuminuria.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.

Abnormal results are present on dated measurements separated by at least three months, supporting chronicity.

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 1.18 mg/dL · age 62 · sex male

eGFRcr 2021 = 69.8 mL/min/1.73 m²

DET-001Kidney abnormality detected

Inputs: UACR 612 mg/g (≥30)

kidney_abnormality_detected: determine chronicity and evaluate acute causes before confirming CKD

CHR-001CKD chronicity confirmed through longitudinal evidence

Inputs: UACR ≥30 on 2 dated results spanning 125 days

chronicity_status: confirmed

CGA-001Assign G category from selected indexed eGFR

Inputs: eGFR 69.8 (eGFRcr_2021)

G2 (60–89 mL/min/1.73 m²)

CGA-002Assign A category from UACR

Inputs: UACR 612 mg/g

A3 (>300 mg/g)

CGA-004Complete CGA classification

Inputs: G2 · A3 · chronicity confirmed

CKD G2A3

KFRE-002KFRE not used in G1–G2 as release decision tool

Inputs: G2

not_eligible_for_primary_KFRE_output

REF-001Nephrology referral triggers

Inputs: Persistent A3 albuminuria

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.

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)

69.8

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 G2A3. 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