side by side comparison

AKI vs CKD: Acute Reversible vs Chronic Progressive Kidney Failure

A creatinine of 4.0 means very different things depending on whether it was 0.9 yesterday or has been climbing for years. AKI and CKD demand opposite priorities — one is a rescue mission to restore function, the other is a long-game strategy to preserve what's left. Picking the wrong approach on the NCLEX costs you the question.

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Comparison

Side-by-side2 compared
Dimension
Acute Kidney Injury
Chronic Kidney Disease
Onset, cause & reversibility
  • ★Hours–days
  • potentially reversible if treated early
  • Prerenal (hypovolemia), intrarenal (ATN), postrenal
  • ★Months–years
  • irreversible nephron loss
  • Diabetes (#1), HTN (#2), GN, PKD
Urine output & presentation
  • ★Oliguric <400 mL/day, then diuretic 3–5 L/day
  • Triphasic course then recovery
  • Output normal until late, then ↓ to anuric
  • Chronic fatigue, uremic symptoms
BUN/Cr, GFR & electrolytes
  • Rapid BUN/Cr rise
  • BUN:Cr >20:1 prerenal
  • Hyperkalemia, metabolic acidosis
  • KDIGO stage
  • ★Staged by GFR: Stage 5 <15 = ESKD
  • ↑K, ↑phos, ↓Ca, chronic acidosis
Nursing priorities
  • Strict I&O, daily weights
  • hold nephrotoxins
  • Monitor K+ and telemetry in oliguric phase
  • Diet: low Na+/K+/phosphorus
  • fluid restriction
  • Fistula care
  • long-term adherence support
Treatment goal
  • Find and fix the cause
  • restore perfusion
  • Stop nephrotoxins
  • relieve obstruction
  • Slow progression: ACEi/ARB, BP <130/80
  • EPO for anemia
  • phosphate binders
Patient teaching
  • Avoid NSAIDs and nephrotoxins
  • Report ↓ urine, swelling, fatigue
  • Stay hydrated once recovering
  • Renal diet adherence (Na+/K+/phos)
  • Protect fistula
  • no BP/IV in that arm
  • Take phosphate binders with meals
Dialysis triggers — escalate
  • Emergent dialysis: refractory hyperkalemia
  • Pulmonary edema, severe acidosis, uremia
  • Planned dialysis when GFR < 15
  • Symptomatic ESKD
  • AV fistula early
Complications
  • Rapid uremia if untreated
  • Fluid overload, fatal arrhythmia
  • Secondary hyperparathyroidism, renal osteodystrophy
  • Anemia
  • uremic pericarditis
Onset, cause & reversibility

Acute Kidney Injury

  • ★Hours–days
  • potentially reversible if treated early
  • Prerenal (hypovolemia), intrarenal (ATN), postrenal

Chronic Kidney Disease

  • ★Months–years
  • irreversible nephron loss
  • Diabetes (#1), HTN (#2), GN, PKD
Urine output & presentation

Acute Kidney Injury

  • ★Oliguric <400 mL/day, then diuretic 3–5 L/day
  • Triphasic course then recovery

Chronic Kidney Disease

  • Output normal until late, then ↓ to anuric
  • Chronic fatigue, uremic symptoms
BUN/Cr, GFR & electrolytes

Acute Kidney Injury

  • Rapid BUN/Cr rise
  • BUN:Cr >20:1 prerenal
  • Hyperkalemia, metabolic acidosis
  • KDIGO stage

Chronic Kidney Disease

  • ★Staged by GFR: Stage 5 <15 = ESKD
  • ↑K, ↑phos, ↓Ca, chronic acidosis
Nursing priorities

Acute Kidney Injury

  • Strict I&O, daily weights
  • hold nephrotoxins
  • Monitor K+ and telemetry in oliguric phase

Chronic Kidney Disease

  • Diet: low Na+/K+/phosphorus
  • fluid restriction
  • Fistula care
  • long-term adherence support
Treatment goal

Acute Kidney Injury

  • Find and fix the cause
  • restore perfusion
  • Stop nephrotoxins
  • relieve obstruction

Chronic Kidney Disease

  • Slow progression: ACEi/ARB, BP <130/80
  • EPO for anemia
  • phosphate binders
Patient teaching

Acute Kidney Injury

  • Avoid NSAIDs and nephrotoxins
  • Report ↓ urine, swelling, fatigue
  • Stay hydrated once recovering

Chronic Kidney Disease

  • Renal diet adherence (Na+/K+/phos)
  • Protect fistula
  • no BP/IV in that arm
  • Take phosphate binders with meals
Dialysis triggers — escalate

Acute Kidney Injury

  • Emergent dialysis: refractory hyperkalemia
  • Pulmonary edema, severe acidosis, uremia

Chronic Kidney Disease

  • Planned dialysis when GFR < 15
  • Symptomatic ESKD
  • AV fistula early
Complications

Acute Kidney Injury

  • Rapid uremia if untreated
  • Fluid overload, fatal arrhythmia

Chronic Kidney Disease

  • Secondary hyperparathyroidism, renal osteodystrophy
  • Anemia
  • uremic pericarditis

★ marks the fact that sets a column apart.

Clinical Pearl

AKI = sudden creatinine spike, find the cause and fix it; CKD = slow GFR slide, slow the decline.

Component Topics

Acute Kidney Injury — AKICKD Stages & Management

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