Acute vs Chronic Renal Failure | Acute Renal Failure vs Chronic

Renal Failure | ARF vs CRF

Acute renal failure is abrupt deterioration in renal function, which is usually, but not
invariably reversible over a period of days or weeks, and usually accompanied by a
reduction in urine volume. In contrast; chronic renal failure is the clinical syndrome of
the metabolic and systemic consequences of a gradual, substantial and irreversible
reduction in the excretory and homeostatic functions of the kidneys.
Both of these conditions, if untreated, ultimately results in end stage renal failure where
the death is likely without renal replacement therapy, and this article points out the
differences between acute and chronic renal failure with respect to their definition,
temporal relationship, causes, clinical features, investigation findings, management and
prognosis.
Acute Renal Failure (ARF)
It defines as a reduction in glomerular filtration rate (GFR) occurring over days or
weeks. The diagnosis of ARF is made, if there is an increase in serum creatinine of >50
micro mol/L, or increase in serum creatinine of >50% from the baseline, or reduction in
calculated creatinine clearance of >50%, or need for dialysis.
Causes of ARF are broadly categorized as pre-renal, intrinsic renal, post renal causes.
Pre renal causes are severe hypovolemia, impaired cardiac pump efficiency, and
vascular disease limiting renal blood flow. Acute tubular necrosis, renal parenchymal
disease, hepato-renal syndrome are some of the causes of intrinsic renal failure and
bladder outflow obstruction by pelvic malignancies, radiation fibrosis, bilateral stone
disease are some of the causes of post renal failure.
In ARF, usually the patient presents with few warning signs at the early stages but may
notice a reduction in urinary volume and features of intra vascular volume depletion in
the later stages.

The cause may be obvious like gastrointestinal bleeding, burns, skin disease, and
sepsis but can be hidden such as concealed blood losses, which can occur in trauma to
the abdomen. Features of metabolic acidosis and hyperkalaemia are often present.
Once the clinical diagnosis is made, patient is investigated with urinary full report,
electrolytes, serum creatinine, imaging. Ultra sound scan shows swollen kidneys and
reduced cortico-medullary demarcation. Renal biopsy should be performed in all
patients, with normal-sized, unobstructed kidneys, in whom the diagnosis of acute
tubular necrosis causing acute renal failure is not suspected.
Principles of management of ARF include recognition and treatment of life-threatening
complications such as hyperkalaemia and pulmonary oedema, recognition and
treatment of intra vascular volume depletion and diagnosis of the cause and treat where
possible.
Prognosis of acute renal ARF is usually determined by the severity of the underlying
disorder and other complications.
Chronic Renal Failure (CRF)
Chronic renal failure is defined as either kidney damage or a decreased glomerular
filtration rate of <60ml/min/1.73m2 for 3 or more months comparing to ARF, which
occurs suddenly or over a short period of time.
The most common cause could be chronic glomerulonephritis with ever increasing
number of diabetic nephropathy leading to CRF becoming common. Other causes
include chronic pyelonephritis, polycystic kidney disease, connective tissue disorders,
and amyloidosis.
Clinically the patients presents with malaise, anorexia, itching, vomiting, convulsions
etc. They may have a short stature, pale, show hyperpigmentation, bruising, signs of
fluid over load and proximal myopathy.

Patient is investigated to make the diagnosis, stage the disease, and assess the
complications.
Ultra sound scan of the kidney shows small kidneys, reduced cortical thickness,
together with increased echogenecity; though renal size may remain normal in chronic
renal failure, diabetic nephropathy, myeloma, adult poly cystic kidney disease, and in
amyloidosis.
Principles of management include recognition and treatment of life threatening
complications such as metabolic acidosis, hyperkalaemia, pulmonary edema, severe
anaemia, identifying the cause and treat where possible and take general measures to
reduce the progression of the disease.
The prognosis of patients with chronic renal failure shows that all cause mortality
increases as kidney function decreases, but renal replacement therapy has shown
increased survival, though the quality of life is severely affected.

What is the difference between acute renal failure and chronic renal failure?

In acute renal failure, as its name denotes impairment of renal function occurs
sudden or within a short period of time (days to weeks) in contrast to chronic
renal failure, which is diagnosed if more than 3 months.

ARF is usually reversible, but CRF is irreversible.

Most common cause of ARF is hypovolaemia, but in CRF, common causes are
chronic glomerulopathy and diabetic nephropathy.

In ARF, patient usually presents with reduced urine output, but CFR can
presents with constitutional symptoms or its long term complication.

ARF is a medical emergency.

ARF prognosis is better than CFR.

Table 1. Stages of Chronic Kidney Disease

Stage

Description

GFR*
mL/min/1.73 m2

*GFR is glomerular filtration rate, a measure of the kidney's function.

What is the difference between acute renal failure and chronic renal failure?

In acute renal failure, as its name denotes impairment of renal function occurs
sudden or within a short period of time (days to weeks) in contrast to chronic
renal failure, which is diagnosed if more than 3 months.

ARF is usually reversible, but CRF is irreversible.

Most common cause of ARF is hypovolaemia, but in CRF, common causes are
chronic glomerulopathy and diabetic nephropathy.

In ARF, patient usually presents with reduced urine output, but CFR can
presents with constitutional symptoms or its long term complication.

ARF is a medical emergency.

ARF prognosis is better than CFR.

Table 1. Stages of Chronic Kidney Disease

1

Slight kidney damage with normal or increased

filtration

More than 90

Mild decrease in kidney function

60 to 89

What is the difference between acute renal failure and chronic renal failure?

In acute renal failure, as its name denotes impairment of renal function occurs
sudden or within a short period of time (days to weeks) in contrast to chronic
renal failure, which is diagnosed if more than 3 months.

ARF is usually reversible, but CRF is irreversible.

Most common cause of ARF is hypovolaemia, but in CRF, common causes are
chronic glomerulopathy and diabetic nephropathy.

In ARF, patient usually presents with reduced urine output, but CFR can
presents with constitutional symptoms or its long term complication.

ARF is a medical emergency.

ARF prognosis is better than CFR.

Table 1. Stages of Chronic Kidney Disease

3

Moderate decrease in kidney function

30 to 59

Severe decrease in kidney function

15 to 29

Kidney failure

Less than 15 (or dialysis)