Chronic Renal Failure Differential Diagnosis Table

Chronic Renal Failure Differential Diagnosis Table:

Chronic renal failure, also known as chronic kidney disease (CKD), is a defect in renal function to filter and excrete urine and wastes from the body. CKD has many stages, varying from mild dysfunction in the kidney to complete kidney dysfunction that requires kidney dialysis.
Chronic renal failure can happen from different comorbidities such as diabetes and hypertension or maybe from a problem in the kidney itself, such as obstruction.
Most patients don’t realize they have kidney problems unless they do routine check-ups or until the disease progresses, badly affecting the lung and heart.
Diagnosis of chronic renal failure mainly depends on lab tests of kidney function, such as creatinine, urea, BUN, and proteinuria. These tests are needed to measure creatinine clearance (CrCL) and glomerular filtration rate (GFR) to determine the stage of kidney disease.

How to Distinguish Chronic Renal Failure from Other Diseases

Distinguish Diabetic Nephropathy from Chronic Renal Failure – Diagnosis

Diabetic nephropathy is the loss of kidney function because of diabetes and an increase in blood glucose levels. Over time, high blood sugar levels lead to blood vessel damage, which affects kidney blood vessels, leading to end-stage renal disease. The hallmark of diabetic nephropathy is an increase in protein output in urine.

• Renal function tests such as blood and urine creatinine are needed to measure glomerular filtration rate (GFR) to determine the stage of kidney damage.
• Measuring albumin and protein in urine to assess their level and presence of abnormal amount which is very remarkable to disease.
• Measurement of blood pressure is routinely made since most cases of diabetic nephropathy either have hypertension that may have been a cause of the disease or a complication from diabetic nephropathy itself.

Distinguish Polycystic Kidney Disease from Chronic Renal Failure – Diagnosis

Polycystic kidney disease is an inherited disorder in which the patient has a gene that leads to the development of cysts on the kidney. This leads to the loss of kidney function and hypertension. Most people don’t recognize the presence of these cysts until 30 or 40 years old when symptoms start to appear.

• Ultrasound of the kidney is the most diagnostic test to detect kidney cysts. In some cases, an MRI or CT scan may be needed if smaller cysts that can’t be detected by ultrasound are suspected.
• Renal function tests to monitor kidney function and diagnose the stage of kidney disease.
• Blood pressure measurement is routinely needed since most patients will develop hypertension due to the loss of kidney function.

Distinguish Glomerulonephritis from Chronic Renal Failure – Diagnosis

Glomerulonephritis is an inflammation in the glomerular of the kidney, which is the part of the kidney that is responsible for the filtration of wastes. Glomerulonephritis can happen due to an autoimmune disorder or from infection. The first sign of glomerulonephritis is usually hematuria.

• Urinalysis is usually the first step in detecting glomerulonephritis; it will usually be high in red blood cells and protein.
• Imaging tests like CT, X-ray, or ultrasound can help to see evidence of inflammation in the kidney.
• Kidney biopsy is the most confirmative diagnostic test of glomerulonephritis and will determine the extent of kidney damage.
• Renal function tests, such as creatinine, BUN, and proteinuria, must be done to determine the stage of kidney disease.

Distinguish Systemic Lupus Erythematosus (SLE) from Chronic Renal Failure – Diagnosis

Systemic lupus erythematosus is an autoimmune disease that makes the body attack organs and tissues through a protein called autoantibodies which attack organs. When it attacks the kidney, it causes lupus nephritis, leading to a decrease in kidney function and sometimes failure, which may eventually need kidney dialysis.

• Antinuclear antibody (ANA) is the first diagnostic test for initial diagnosis of SLE, being positive in nearly all patients, but it doesn’t confirm SLE; further testing is needed since it can be positive in other autoimmune disorders.
• Other tests like Anti-double-stranded DNA (Anti-dsDNA) antibodies, Anti-Smith antibodies are used for further investigation to confirm SLE.
• Renal function tests are needed to monitor kidney function and staging of kidney disease.
• Other blood tests like CRP and ESR are used to monitor disease progression and response to treatment.

Distinguish Amyloidosis from Chronic Renal Failure – Diagnosis

Amyloidosis is a condition in which amyloid protein in the body builds up, leading to accumulation and deposits of this protein on the organs, causing organ dysfunction. This may occur in multiple organs; heart, liver, spleen, and mostly kidneys. Amyloidosis can occur due to a genetic condition and maybe from an autoimmune disorder like rheumatoid disease.

• Amyloidosis can be diagnosed primarily by measuring amyloid in blood by a simple amyloid serum test.
• Immunohistochemistry for detecting amyloid protein is a more reliable and accurate way for the diagnosis of amyloidosis.
• Echo and other tests like ultrasound, MRI, and CT scan are usually used to detect any organ dysfunction.
• Renal function tests to monitor and stage kidney disease.

Distinguish Nephrotic Syndrome from Chronic Renal Failure – Diagnosis

Nephrotic syndrome is a condition in which there’s a group of symptoms that indicate that kidneys are not functioning well. This includes edema, swelling, high cholesterol level, and the hallmark of the disease is proteinuria. There are many causes for nephrotic syndrome such as diabetic nephropathy and amyloidosis.

• Renal function test is important for knowing the degree of kidney dysfunction and damage.
• Urine analysis to identify the presence of protein in urine.
• Kidney ultrasound and kidney biopsy are important to know the underlying cause of nephrotic syndrome.
• Lipid profile is routinely needed since one of the symptoms of nephrotic syndrome is an increase in blood cholesterol.

Distinguish Prenal Artery Stenosis from chronic renal failure – Diagnosis

Renal artery stenosis is when there’s a blockage in the arteries of the kidney. This leads to a blockage of blood supply to the kidney, leading to sudden and deteriorating kidney function. The main symptom of nephrotic syndrome is refractory high blood pressure that may worsen if treated with blood pressure medication such as ACE inhibitors. There are several reasons for pre-renal artery stenosis, but the main cause is atherosclerosis.

• Most pre-renal artery stenosis can be diagnosed by imaging tests like renal angiography, ultrasound, or MRA, which will show a blockage of renal arteries.
• A key feature in the diagnosis of pre-renal artery stenosis is very high blood pressure that is refractory to two or three medications.

Distinguish Urinary Tract Obstruction from Chronic Renal Failure – Diagnosis

Urinary tract obstruction is the blockage of urine outflow from the kidney. This can happen because of several reasons, maybe the presence of stones or enlargement of the prostate that leads to pressure on the bladder.

• Bladder catheterization is the main diagnostic test that can prove that there’s a problem in urine outflow if the catheter drains a large amount of urine.
• Voiding cystourethrography (VCUG) is a kind of imaging test that can help identify the site of obstruction exactly.
• Other imaging tests like ultrasound, MRI, and CT can help in showing obstruction and its site too.
• Renal function tests like creatinine, urea, and BUN must be done to know the extent of kidney dysfunction.

Important Red Flags in Chronic Renal Failure

Chronic renal failure is often a progressive disease. Symptoms can be managed by medication, but eventually, the patient may need kidney dialysis or a kidney transplant.
It’s important if the patient feels any symptoms of swelling or edema to seek medical attention soon since this means that the kidney is failing and urine output is low, leading to accumulation.
If any symptoms of shortness of breath or dyspnea are present, this might mean that there’s lung edema, which can progress to congestive heart failure; this is a medical emergency.