Chronic renal failure differential diagnosis: Difference between revisions
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==Overview== | ==Overview== | ||
Differentiating [[chronic renal failure]] from [[acute renal failure]] | 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== | ==Distinguishing chronic renal failure from acute renal failure== | ||
Revision as of 15:51, 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 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, 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.
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.