Acute kidney injury (AKI) happens fast and can often be reversed. Chronic kidney disease (CKD) develops slowly and does not go away. Both make it hard for the body to remove fluid, potassium, and waste.
Side by side
| AKI | CKD | |
|---|---|---|
| Onset | Hours to days | Months to years |
| Reversible? | Often | No, but it can be slowed |
| Common causes | Dehydration, shock, kidney-toxic drugs, blockage | Diabetes and high blood pressure |
| Defined by | A quick rise in creatinine or drop in urine output | GFR under 60 for 3 months or more |
Three causes of AKI
- Prerenal (before the kidney): not enough blood flow, from dehydration, bleeding, shock, or heart failure.
- Intrarenal (in the kidney): damage from drugs like aminoglycosides, NSAIDs, and IV contrast, or from infection.
- Postrenal (after the kidney): a blockage, like an enlarged prostate or kidney stones.
Kidney labs
| Lab | Normal |
|---|---|
| Creatinine | 0.6 to 1.2 mg/dL |
| BUN | 10 to 20 mg/dL |
| GFR | 90 or higher (CKD stage 5 is under 15) |
Signs of kidney failure
- Swelling, weight gain, crackles (fluid overload)
- High potassium (dangerous heart rhythms)
- Anemia, because the kidneys make less erythropoietin
- Metabolic acidosis
- High phosphorus and low calcium
- Itching, nausea, and confusion from waste buildup (uremia)
Nursing care
- Strict intake and output and daily weights
- Watch potassium closely
- Avoid kidney-toxic drugs when possible, and make sure doses are adjusted for kidney function
- Diet as ordered: usually limited sodium, potassium, phosphorus, and fluids
Related: Dialysis nursing care and High and low potassium.
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Quick answers
What is the difference between AKI and CKD?
AKI comes on quickly and can often be reversed. CKD develops over months to years, is defined by a GFR under 60 for at least 3 months, and does not go away.
What are prerenal, intrarenal, and postrenal causes of AKI?
Prerenal is low blood flow to the kidney, intrarenal is damage within the kidney, and postrenal is a blockage after the kidney.
Evidence & Clinical Sources
- KDIGO kidney disease guidelines
- Hinkle & Cheever, Brunner & Suddarth's Textbook of Medical-Surgical Nursing, Wolters Kluwer
Reviewed against current guidelines and drug labels. Always follow your program, a current drug reference, and facility policy. Our sources policy
For learning only. Lab ranges and policies vary. Always follow your nursing program, a current drug reference, and your facility's policies.