Chronic renal failure differential diagnosis

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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 and from the condition of having an increased BUN with a normal GFR are the most important diagnostic step in evaluating a patient with raised serum creatinine levels, as these conditions can be treated with therapy specific to the underlying etiology.

Distinguishing chronic renal failure from acute renal failure

• Elevated creatinine levels from recent weeks or months suggest that the current disease process is more acute and hence reversible. On the other hand, long standing elevated serum values suggests a chronic disease process.
• Even if the elevated serum creatinine levels are chronic, there is a possibility of the patient having a superimposed acute process over a chronic condition such as: a urinary tract obstruction, infections, extra cellular fluid volume depletion, or nephrotoxin exposure.
• If the patient's history suggests an array of recent onset symptoms e.g:fever, rash and/or polyarthralgia, it can be safely concluded that the renal insufficiency is a part of an acute process.

Distinguishing chronic renal failure from an increased BUN with normal GFR

• The key differentiating factor between the condition of an increased BUN with a normal GFR 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.