Acute Kidney Injury vs Chronic Kidney Disease
Acute Kidney Injury and Chronic Kidney Disease are easy to mix up on the boards. Here's a side-by-side comparison — presentation, workup, imaging, and first-line treatment — drawn from our full outlines.
Acute Kidney Injury vs Chronic Kidney Disease at a glance
- Acute Kidney Injury: Abrupt decline in renal function categorized as prerenal, intrarenal, or postrenal.
- Chronic Kidney Disease: Persistent decline in GFR or kidney damage for ≥3 months, staged by eGFR and albuminuria.
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Side-by-side comparison
| Feature | Acute Kidney Injury | Chronic Kidney Disease |
|---|---|---|
| At a glance | Abrupt decline in renal function categorized as prerenal, intrarenal, or postrenal. | Persistent decline in GFR or kidney damage for ≥3 months, staged by eGFR and albuminuria. |
| Classic presentation | Asterixis, pericardial friction rub, and uremic frost suggest advanced uremia requiring urgent dialysis evaluation.; Often asymptomatic; detected on routine labs; Reduced urine output or change in urine appearance; Volume overload symptoms: dyspnea, edema, orthopnea (if oliguric); Uremic symptoms in advanced injury: nausea, anorexia,… | Small echogenic kidneys on ultrasound (except in diabetes, amyloid, HIV-associated nephropathy, and PKD where kidneys may be normal or enlarged).; Often asymptomatic until advanced (stage 4-5); Fatigue, weakness, anorexia, weight loss; Pruritus, restless legs, muscle cramps; Foamy urine (albuminuria), nocturia, peripheral edema; Late:… |
| Workup / key labs | KDIGO AKI: Stage 1 (Cr 1.5-1.9× baseline or +0.3 mg/dL; UOP <0.5 mL/kg/h × 6-12 h). Stage 2 (Cr 2.0-2.9× baseline; UOP <0.5 mL/kg/h × ≥12 h). Stage 3 (Cr ≥3× baseline, ≥4 mg/dL, or RRT initiation; UOP <0.3 mL/kg/h × ≥24 h or anuria ≥12 h).; BMP with serum creatinine and BUN — establish baseline and trajectory; Urinalysis with microscopy… | CKD requires kidney damage OR eGFR <60 for ≥3 months. Staged G1-G5 by eGFR (G1 ≥90, G2 60-89, G3a 45-59, G3b 30-44, G4 15-29, G5 <15) and A1-A3 by UACR (A1 <30, A2 30-300, A3 >300 mg/g).; Serum creatinine with eGFR (CKD-EPI 2021 race-free equation); Urine albumin-to-creatinine ratio (UACR) on spot sample — preferred over dipstick;… |
| Imaging | Renal ultrasound — rules out obstruction (hydronephrosis) and assesses kidney size/echogenicity; Bladder scan — postvoid residual >150-200 mL suggests outlet obstruction; CT without contrast if stones suspected | Renal ultrasound — assess size, echogenicity, cysts, obstruction |
| First-line treatment | Identify and treat underlying cause (volume, sepsis, obstruction, nephrotoxin withdrawal); Prerenal: isotonic crystalloid (lactated Ringer's or normal saline) — balanced solutions preferred; Postrenal: relieve obstruction with Foley catheter, percutaneous nephrostomy, or ureteral stent; Stop nephrotoxins: NSAIDs, ACEi/ARB (if… | BP target <120/80 (KDIGO 2021); use validated office BP measurement; ACEi (lisinopril, ramipril, enalapril) or ARB (losartan, valsartan, irbesartan) — first-line for albuminuria or diabetes; reduces progression; SGLT2 inhibitor — dapagliflozin, empagliflozin, canagliflozin — for diabetic or non-diabetic CKD with eGFR ≥20 and UACR ≥200… |
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