An important factor to consider when seeing a patient with an elevated SCr level is whether this is an acute process or simply the initial presentation of CKD. Several findings may help to differentiate between these diagnoses. A history of poor growth or chronic hypertension may support a diagnosis of CKD, whereas patients with AKI should have normal growth and normal preceding blood pressure values. Anemia may be present with either diagnosis; however, more severe anemia may be seen with CKD but is rare with AKI. While a single set of laboratory data may be collected and reviewed in the ED setting, a progressive rise in blood urea nitrogen (BUN) and creatinine over the course of several hours or a few days suggests an acute injury process, as opposed to the progression seen over weeks to months in worsening CKD.
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