In the hospital setting in Guyana, ultrasound is often requested to differentiate acute from chronic kidney disease. However, corticomedullary differentiation is sometimes expected as the main determining factor in this diagnosis. This is not accurate.
Corticomedullary differentiation is an important feature of renal ultrasound that helps to distinguish between the cortex and medulla of the kidney. It is determined by the different tissue characteristics of the cortex and medulla1. Corticomedullary differentiation is lost in many renal diseases such as chronic kidney disease (CKD), acute tubular necrosis (ATN), glomerulonephritis, acute allograft rejection2. Ultrasonography can be used to assess corticomedullary differentiation and renal cortical echogenicity3.
1. onlinelibrary.wiley.com2. radiologykey.com3. onlinelibrary.wiley.com
Can it differentiate between acute and chronic renal disease?
According to a study published in PubMed, renal length, parenchymal thickness, and echogenicity differed significantly between patients with acute and chronic renal failure1. However, another study published in Verywell Health states that when there is evidence of renal impairment, the healthcare provider’s first task is to differentiate between chronic kidney disease and acute kidney injury. This is because AKI is often reversible if treated promptly and appropriately. By contrast, CKD is a progressive disease requiring lifelong monitoring and care2.
According to a study published in Radiology Key, loss of corticomedullary differentiation (CMD) has been observed in renal insufficiency, secondary to a variety of etiologies, including glomerulonephritis, acute tubular necrosis, end-stage chronic renal failure, obstructive hydronephrosis, Fabry’s disease, and acute allograft rejection1. Another study published in Verywell Health states that there is no single test that can differentiate between acute and chronic kidney disease.
1. pubmed.ncbi.nlm.nih.gov2. verywellhealth.com3. iris-kidney.com4. healthline.com5. pubmed.ncbi.nlm.nih.gov6. verywellhealth.com7. radiologykey.com8. pubmed.ncbi.nlm.nih.gov
How is acute kidney disease differentiated from chronic?
According to a post by American Academy of Family Physicians, chronic kidney disease is defined by the presence of a marker of kidney damage, such as proteinuria (ratio of greater than 30 mg of albumin to 1 g of creatinine on untimed [spot] urine testing), or a decreased glomerular filtration rate for three or more months1. CKD is defined as abnormalities of kidney structure or function, present for more than 3 months, with implications for health2.
1. aafp.org2. kidney.org3. ncbi.nlm.nih.gov4. www2.gov.bc.ca5. mayoclinic.org
What are the criteria for acute kidney injury?
According to a post by American Academy of Family Physicians, acute kidney injury is characterized by abrupt deterioration in kidney function, manifested by an increase in serum creatinine level with or without reduced urine output. The spectrum of injury ranges from mild to advanced, sometimes requiring renal replacement therapy1. In adults, acute kidney injury can be detected by using any of the following criteria: A rise in serum creatinine of 26 micromol/L or greater within 48 hours. A 50% or greater rise in serum creatinine known or presumed to have occurred within the past 7 days2.
1. aafp.org2. cks.nice.org.uk3. aafp.org4. aafp.org5. uptodate.com
Differentiation between acute versus chronic renal disease is a completely based on clinical guidelines. Imaging can help us understand the extent of disease once a diagnosis is made but there are often no changes on ultrasound in acute or chronic diseases of the kidney and the findings can overlap between acute and chronic. The exception is the shrunken, echogenic kidneys of irreversible End Stage Renal Disease.
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