Acute Kidney Injury and Chronic Kidney Disease

Acute Kidney Injury and Chronic Kidney Disease

Comparison of Acute Kidney Injury and Chronic Kidney Disease

Acute Kidney Injury

Chronic Kidney Disease

Onset

Sudden

Gradual, often over many years

Most common cause

Acute tubular necrosis

Diabetic nephropathy

Diagnostic criteria

Acute reduction in urine output and/or Elevation in serum creatinine

GFR <60 mL/min/1.73 m2 for >3 mo. and/or Kidney damage >3 mo.

Reversibility

Potentially

Progressive and irreversible

Primary cause of death

Infection

Cardiovascular disease

  • Acute Kidney Injury
    • Causes of Acute Kidney Disease
      • Prerenal
      • Intrarenal
      • Postrenal
    • Etiology and Pathophysiology
      • Prerenal
        • Causes are factors that reduce systemic circulation, causing reduction in renal blood flow
          • Severe dehydration, heart failure, lowered CO
        • Decreases glomerular filtration rate
          • Causes oliguria
        • Autoregulatory mechanisms attempt to preserve blood flow
      • Intrarenal
        • Causes include conditions that cause direct damage to kidney tissue
          • Prolonged ischemia, nephrotoxins
          • Hemoglobin released from hemolyzed RBCs
          • Myoglobin released from necrotic muscle cells
        • Acute tubular necrosis (ATN)
          • Results from ischemia, nephrotoxins, or sepsis
          • Severe ischemia causes disruption in basement membrane
          • Nephrotoxic agents cause necrosis of tubular epithelial cells
          • Potentially reversible
      • Postrenal
        • Causes include mechanical obstruction of outflow
          • Benign prostatic hyperplasia
          • Prostate cancer
          • Calculi
          • Trauma
          • Extrarenal tumors
          • Bilateral ureteral obstruction