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.
Comparison
- ★Hours–days; potentially reversible if treated early
- Prerenal (hypovolemia), intrarenal (ATN), postrenal
- ★Months–years; irreversible nephron loss
- Diabetes (#1), HTN (#2), GN, PKD
- ★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
- 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
- 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
- Find and fix the cause; restore perfusion
- Stop nephrotoxins; relieve obstruction
- Slow progression: ACEi/ARB, BP <130/80
- EPO for anemia; phosphate binders
- 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
- Emergent dialysis: refractory hyperkalemia
- Pulmonary edema, severe acidosis, uremia
- Planned dialysis when GFR < 15
- Symptomatic ESKD; AV fistula early
- Rapid uremia if untreated
- Fluid overload, fatal arrhythmia
- Secondary hyperparathyroidism, renal osteodystrophy
- Anemia; uremic pericarditis
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
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
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
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
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
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
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
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.
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