In some cases, kidney failure can have a rapid onset. It can also develop in the final stages of chronic kidney disease. This is known as end stage renal disease (ESRD).

The kidneys are vital for filtering toxins and waste from the body. Waste products leave the body in the urine, removing potentially harmful substances and balancing fluid and electrolyte levels.

Doctors measure kidney function using estimated glomerular filtration rate (eGFR), which is a type of blood test.

An eGFR of less than 15 out of 100 means that a person’s kidneys are failing. Kidney failure can cause toxin buildup in the body, disrupt fluid balance, and damage other organs, such as the heart, lungs, and brain.

This article explains the difference between acute and chronic kidney failure. It will outline the symptoms, causes, diagnosis, treatment, and outlook for each.

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The main difference between acute and chronic kidney failure is the time it takes for the condition to develop.

Symptoms of acute renal failure

Acute renal failure, also known as acute kidney injury (AKI), develops in around 7% of people in the United States receiving treatment in a hospital for another condition. This type of kidney damage is reversible.

AKI does not always cause symptoms. Sometimes, the only sign might be someone urinating less often than usual.

Other symptoms include:

  • fluid buildup, which people refer to as edema, in the legs, ankles, and eyes
  • extreme fatigue
  • breathlessness
  • nausea
  • cognitive difficulties, such as a loss of sharpness or confusion
  • chest pain

In some cases, acute renal failure can cause seizures or a coma.

Symptoms of ESRD

Chronic kidney disease (CKD) develops in stages and does not typically cause symptoms until stages 4 or 5.

According to the most recent data from the United States Renal Data System, CKD led to ESRD for more than 120,000 people in 2015.

Symptoms may include any of those that occur with AKI and involve the following:

  • muscle twitches
  • muscle cramps
  • appetite loss
  • disturbed sleep
  • ongoing itching
  • hard to control high blood pressure

CKD is a chronic condition that occurs in roughly 10–14% of the United States population.

Kidney disease develops due to other conditions, diseases, or injuries. These affect the blood flow to the kidneys, the passage of urine away from the kidneys, or the overall health of kidney tissue.

Causes of AKI

A range of health problems can lead to kidney problems and lead to AKI, including:

  • Conditions that reduce blood flow to the kidneys: These might include low blood pressure, blood loss, and heart problems. The failure of other organs, such as the liver or heart, can also cause AKI. AKI can also result from severe allergic reactions, injuries, burns, and major surgical procedures.
  • Health problems that directly damage kidney tissue: Examples of kidney-damaging diseases include sepsis, a cancer called multiple myeloma, and diseases that affect the blood vessels, filters, and tubes of the kidneys, such as glomerulonephritis or vasculitis.
  • Conditions that stop urine from leaving the kidneys: Bladder, cervix, or prostate cancers can block the urinary tracts of the kidneys, as can an enlarged prostate. Kidney stones and blood clots can have a similar effect.

Most people with AKI get it when they are already in the hospital for another health problem. It develops in up to 67% of those who stay in an intensive care unit.

Causes of ESRD

ESRD occurs when CKD progresses to its final stages. CKD occurs due to two main causes: diabetes and high blood pressure.

High blood sugar levels due to uncontrolled diabetes can damage the blood vessels around the kidneys and the kidneys themselves.

There is also a link between high blood pressure and kidney disease. One can cause the other, meaning that people with CKD need to check their blood pressure regularly and take steps to control it if necessary.

Additionally, uncontrolled high blood pressure can lead to disease progression and ESRD in those with CKD.

Other kidney problems can lead to chronic kidney disease, including:

  • glomerulonephritis, which refers to inflammation of the kidneys’ filters
  • polycystic kidney disease, which is an inherited disease that leads to large cysts in the kidneys
  • anomalies in the kidneys and urinary tracts for fetuses in the womb
  • autoimmune diseases, such as lupus
  • obstructions such as kidney stones or tumors

Early diagnosis of acute kidney injury early is essential.

Healthcare professionals use the following to diagnose kidney disease:

  • measuring how much urine someone passes in a day
  • urine tests to measure how much protein is eliminated in the urine
  • eGFR testing to measure kidney function
  • blood tests to identify levels of a protein called creatinine and phosphorus and potassium levels
  • imaging tests to check for blockages or anomalies, including ultrasound scans
  • a biopsy

Early diagnosis of CKD is crucial for preventing disease progression. A doctor may measure eGFR when a person consults for other health problems, especially diabetes and high blood pressure, since CKD often involves no symptoms in its early stages.

Treatment cannot reverse kidney failure due to CKD. It typically focuses on preserving the remaining kidney function. If CKD does progress to ESRD, treatment then involves dialysis or a kidney transplant.

Treatment for CKD typically includes:

  • treating hypertension, diabetes, and high cholesterol
  • restricting protein
  • maintaining a moderate weight
  • quitting or avoiding smoking
  • avoiding medications that may harm the kidneys

Dialysis involves filtering a person’s blood. Someone with kidney failure can also undergo a kidney transplant.

Monitoring blood glucose, controlling blood pressure, and eating a nutritious diet are also vital for managing kidney disease.

AKI treatment involves identifying and treating the underlying cause. People with more severe AKI may need dialysis to filter their blood while their kidneys recover.

The outlook for someone with AKI depends on the cause and the extent of kidney damage.

However, with treatment, most people with AKI fully recover. Those with ESRF have a much higher mortality risk, with estimates ranging from 20% to 50% across 2 years.

Kidney disease is the ninth most common cause of death in the United States.

Acute and chronic renal failure mainly differ in how long they take to develop and whether the kidney damage is reversible.

Chronic ESRF most commonly occurs due to chronic high blood pressure and uncontrolled diabetes.

In comparison, AKI often develops during hospital stays for other serious health problems.

Kidney damage due to chronic ESRF is irreversible and has a more negative outlook than AKI. However, early diagnosis and diet changes can help slow disease progression.