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CPE-003 · synthetic case CKD-FX-018
Transient UACR confounder
Transient UACR confounder
Purpose: Prevent albuminuria diagnosis during active UTI
Inputs the engine received
Patient
- Age
- 49 years
Context
- Sex for equation
- female
- Urinary tract infection
- active
- Urine collection type
- random untimed
Laboratory
- Serum creatinine
- 0.82 mg/dL
- UACR
- 95 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 G2A2 (not a classification)
Clinical summary
A kidney abnormality was detected (eGFR 87.6 and UACR 95 mg/g), 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. 87.6 mL/min/1.73 m² (eGFRcr 2021, race-free), category G2 (60–89).
- Albuminuria. UACR 95 mg/g, category A2 (30–300 mg/g).
Calculations
- eGFRcr (CKD-EPI 2021, race-free)
- 87.6 mL/min/1.73 m²
Creatinine-based.
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.
- 2Obtain a subsequent first-morning-void midstream UACR to confirm an abnormal random ACR.Random-sample ACR is confirmed on first-morning void (KDIGO).
- 3Repeat UACR after the confounder resolves unless urgent clinical context requires immediate action.
Differentials, pitfalls and contradicting signals
- UACR may be transiently elevated (active urinary tract infection).
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 · 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 0.82 mg/dL · age 49 · sex female
eGFRcr 2021 = 87.6 mL/min/1.73 m²
DET-001Kidney abnormality detected
Inputs: UACR 95 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
ACR-001Confirm abnormal random ACR using first morning void
Inputs: UACR 95 mg/g · random untimed specimen
abnormal_unconfirmed_specimen: obtain a subsequent first-morning-void midstream UACR to confirm
ACR-002Transient albuminuria confounder warning
Inputs: UACR 95 mg/g · active urinary tract infection
possible_transient_elevation: confirm after the confounder resolves
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.
Live eGFR and CGA map
eGFR (mL/min/1.73 m²)
87.6
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 |
Indicative cell G2A2 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
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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