AKI vs CKD
Differentiating Acute Kidney Injury from Chronic Kidney Disease.
Key Differentiating Features
| Parameter | AKI (Acute) | CKD (Chronic) |
|---|---|---|
| History | Recent onset (< 7 days) | Longstanding (> 3 months) |
| Previous Creatinine | Normal or lower baseline | Elevated baseline |
| Kidney Size (Ultrasound) | Normal (10-12 cm) or Enlarged | Small (< 9 cm) & Echogenic |
| Hemoglobin | Usually Normal | Anemia (Low EPO) |
| PTH (Parathyroid Hormone) | Normal | Elevated (Secondary Hyperparathyroidism) |
| Bone Disease | Absent | Renal Osteodystrophy |
| Neuropathy | Absent | Peripheral Neuropathy often present |
Ultrasound Clues
CKD Findings:
- Small size (< 9 cm)
- Increased cortical echogenicity (brighter than liver)
- Cortical thinning (< 10 mm)
- Loss of corticomedullary differentiation
Exceptions (Large Kidneys in CKD): Diabetic Nephropathy, HIV Nephropathy, Amyloidosis, Polycystic Kidney Disease.
Acute on Chronic
Patients with CKD are at higher risk for AKI. Diagnosis relies on:
- 1Clear rise in Cr from baseline
- 2New onset oliguria
- 3New active sediment (casts, RBCs)
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