Teaching case · Synthetic values
The missing test
Read the record. Decide what it can establish, and what it cannot.
Synthetic values only. This teaching case is not a patient diagnosis or a product-performance claim; clinical interpretation and care remain with the clinician.
Routine visit
Case 0158-year-old man · type 2 diabetes · hypertension
Single visit; prior kidney results are not shown.
| eGFR | 78mL/min/1.73 m² |
|---|---|
| Serum creatinine | 1.1mg/dL |
| uACRUrine albumin-to-creatinine ratio | Not orderedMissing result |
| HbA1c | 7.4% |
| Blood pressure | 138/84mmHg |
| CKD diagnosis code | None |
No other marker of kidney damage is recorded.
02 · The explanationRead the explanation
What the record supports
Neither conclusion is supported. An eGFR of 78 does not establish CKD without another marker of kidney damage. The uACR result is missing. This record neither confirms nor excludes CKD.
What information would you review next?
Review prior kidney results and obtain the missing uACR. Interpret findings in clinical context and assess chronicity.
The urine result informs the albuminuria category. Prior eGFR and urine results, or other clinical evidence, may establish chronicity: abnormalities present for at least three months. A single result is not a diagnosis; repeat assessment must not delay necessary care.
03 · The risk map
Why uACR matters
The eGFR places this case in G2. Its albuminuria category is unknown. Raised urine albumin can indicate kidney damage even when eGFR is 60 or above, if the finding persists for at least three months.
Case position: G2, eGFR 78Albuminuria category unknown
| eGFR (G)Albumin (A) → | A1<30 mg/g | A230–300 | A3>300 |
|---|---|---|---|
| G1 ≥90 | Low risk | Moderately increased risk; CKD when the raised albumin persists, detectable only by urine albumin testing | High risk; CKD when the raised albumin persists, detectable only by urine albumin testing |
| G2 60–89Case: eGFR 78 | Low risk | Moderately increased risk; CKD when the raised albumin persists, detectable only by urine albumin testing | High risk; CKD when the raised albumin persists, detectable only by urine albumin testing |
| G3a 45–59 | Moderately increased risk | High risk | Very high risk |
| G3b 30–44 | High risk | Very high risk | Very high risk |
| G4 15–29 | Very high risk | Very high risk | Very high risk |
| G5 <15 | Very high risk | Very high risk | Very high risk |
CKD when persistent, but visible only if someone ordered a urine albumin test and the finding is confirmed over time
eGFR below 60 (G3a–G5): the only rows a creatinine threshold can see
Source: KDIGO 2024 CKD guideline.
See the reasoning in the product
The walkthrough shows the output a clinician reviews. It is not a diagnosis, and clinical decisions remain with the treating clinician.