Chronic renal failure differential diagnosis: Difference between revisions
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Differentiating [[chronic renal failure]] from [[acute renal failure]] is the most important diagnostic step in evaluating a patient with raised serum [[creatinine]] levels, as the latter two conditions can be treated with therapy specific to the underlying etiology. | Differentiating [[chronic renal failure]] from [[acute renal failure]] is the most important diagnostic step in evaluating a patient with raised serum [[creatinine]] levels, as the latter two conditions can be treated with therapy specific to the underlying etiology. | ||
==Acute | ==Distinguishing Chronic renal failure from Acute renal failure== | ||
*Previous measurements of [[serum creatinine]]: Normal [[creatinine]] levels from recent months or years suggests that the current disease process is more acute and hence reversible. On the other hand, long standing elevated values suggests a chronic disease process. | *Previous measurements of [[serum creatinine]]: Normal [[creatinine]] levels from recent months or years suggests that the current disease process is more acute and hence reversible. On the other hand, long standing elevated values suggests a chronic disease process. | ||
*Even if the elevated [[serum creatinine]] levels are chronic, there is a possibility of superimposed acute process over a chronic condition e.g: [[urinary tract obstruction]], infections, extra cellular fluid volume depletion, [[Nephrotoxicity|nephrotoxin exposure]]. | *Even if the elevated [[serum creatinine]] levels are chronic, there is a possibility of superimposed acute process over a chronic condition e.g: [[urinary tract obstruction]], infections, extra cellular fluid volume depletion, [[Nephrotoxicity|nephrotoxin exposure]]. | ||
Revision as of 15:44, 27 July 2012
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editor(s)-in-Chief: Aarti Narayan, M.B.B.S [2]
Overview
Differentiating chronic renal failure from acute renal failure is the most important diagnostic step in evaluating a patient with raised serum creatinine levels, as the latter two conditions can be treated with therapy specific to the underlying etiology.
Distinguishing Chronic renal failure from Acute renal failure
- Previous measurements of serum creatinine: Normal creatinine levels from recent months or years suggests that the current disease process is more acute and hence reversible. On the other hand, long standing elevated values suggests a chronic disease process.
- Even if the elevated serum creatinine levels are chronic, there is a possibility of superimposed acute process over a chronic condition e.g: urinary tract obstruction, infections, extra cellular fluid volume depletion, nephrotoxin exposure.
- If the history suggests an array of symptoms of recent onset e.g:fever, rash and/or polyarthralgia, it can be safely concluded that the renal insufficiency is a part of an acute process.
Increased BUN with normal GFR
- The key differentiating factor between the above condition and chronic renal failure is a normal glomerular filtration rate(GFR).
Etiology
- Prerenal azotemia
- Catabolic states
- High protein diet
- Gastrointestinal bleeding
- Glucocorticoids
- Tetracycline
References
1.Zeiger Roni F. "Harrison's Textbook of Internal Medicine". McGraw-Hill's Diagnosaurus 2.0.
2.Bargman JM, Skorecki K. "Chapter 280. Chronic Kidney Disease. In: Longo DL, Fauci AS, Kasper DL, Hauser SL, Jameson JL, Loscalzo J, eds. Harrison's Principles of Internal Medicine. 18th ed". New York: McGraw-Hill; 2012.