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CPE-003 · synthetic case CKD-FX-014

Possible monoclonal protein-related kidney disease

Synthetic · no real patientReviewed acceptance scenarioKidney engine v1.2.0

Purpose: Use UACR/uPCR discrepancy and systemic features

Inputs the engine received

Patient

Age: 71 years

Context

Sex for equation: male
UPCR UACR disproportion: Yes
Anemia present: Yes
Hypercalcemia present: Yes

Laboratory

eGFR selected: 36 mL/min/1.73 m²
UACR: 65 mg/g
UPCR: 2400 mg/g

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 G3bA2 (not a classification)
Pattern: Possible non albumin proteinuria
Pattern: Possible monoclonal protein related kidney disease

Clinical summary

A kidney abnormality was detected (eGFR 36 and UACR 65 mg/g), but chronicity is not established; CKD is not confirmed. Pattern flagged for adjudication: possible non albumin proteinuria. Priority: confirm persistence and exclude acute or transient causes.

Why this pattern was identified

Estimated GFR. 36 mL/min/1.73 m² (externally reported), category G3b (30–44).
Albuminuria. UACR 65 mg/g, category A2 (30–300 mg/g).

Calculations

eGFR (externally reported): 36 mL/min/1.73 m²

Patterns for physician adjudication

Evidence shown, not scored: pattern weights are not clinically validated.

Possible monoclonal protein-related kidney pattern

Supporting

anemia
hypercalcemia
non-albumin-predominant proteinuria
older adult

Contradicting or missing

No monoclonal protein testing available in the entered data

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.
2Clinician-directed serum and urine monoclonal protein evaluation and specialist review.Two or more monoclonal-protein clues are present.
3Specialist kidney-care referral per triggered criterion: Cause uncertain or hereditary concern.KDIGO 2024 referral criteria.

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 · 5 rules

DET-001Kidney abnormality detected

Inputs: eGFR 36 (<60) · UACR 65 mg/g (≥30)

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

CAUSE-003Non-albumin predominant proteinuria pattern

Inputs: UPCR 2400 mg/g · UACR 65 mg/g · UPCR/UACR disproportion

possible_non_albumin_proteinuria: consider clinician-directed evaluation for tubular or monoclonal protein process

CAUSE-004Monoclonal protein-related kidney disease concern

Inputs: anemia · hypercalcemia · non-albumin-predominant proteinuria · older adult

possible_monoclonal_protein_related_kidney_disease: clinician-directed serum/urine monoclonal protein evaluation and specialist review

REF-001Nephrology referral triggers

Inputs: Cause uncertain or hereditary concern

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.

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)

externally reported

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

Indicative cell G3bA2 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

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

This case also carries values that have no field here: eGFR_selected. They are included in the calculation until you clear the form.

Live result · computed in your browser

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 G3bA2 (not a classification)
Pattern: Possible non albumin proteinuria
Pattern: Possible monoclonal protein related kidney disease

Clinical summary

Why this pattern was identified

Estimated GFR. 36 mL/min/1.73 m² (externally reported), category G3b (30–44).
Albuminuria. UACR 65 mg/g, category A2 (30–300 mg/g).

Calculations

eGFR (externally reported): 36 mL/min/1.73 m²

Patterns for physician adjudication

Evidence shown, not scored: pattern weights are not clinically validated.

Possible monoclonal protein-related kidney pattern

Supporting

anemia
hypercalcemia
non-albumin-predominant proteinuria
older adult

Contradicting or missing

No monoclonal protein testing available in the entered data

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.
2Clinician-directed serum and urine monoclonal protein evaluation and specialist review.Two or more monoclonal-protein clues are present.
3Specialist kidney-care referral per triggered criterion: Cause uncertain or hereditary concern.KDIGO 2024 referral criteria.

Why it matters

Evidence and rule trace · 5 rules

DET-001Kidney abnormality detected

Inputs: eGFR 36 (<60) · UACR 65 mg/g (≥30)

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

CAUSE-003Non-albumin predominant proteinuria pattern

Inputs: UPCR 2400 mg/g · UACR 65 mg/g · UPCR/UACR disproportion

possible_non_albumin_proteinuria: consider clinician-directed evaluation for tubular or monoclonal protein process

CAUSE-004Monoclonal protein-related kidney disease concern

Inputs: anemia · hypercalcemia · non-albumin-predominant proteinuria · older adult

possible_monoclonal_protein_related_kidney_disease: clinician-directed serum/urine monoclonal protein evaluation and specialist review

REF-001Nephrology referral triggers

Inputs: Cause uncertain or hereditary concern

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.

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