Understanding Acute on Chronic Kidney Disease (Acute on CKD) is crucial for accurate clinical documentation and medical coding. This page provides information on Acute Kidney Injury on Chronic Kidney Disease, including diagnosis, treatment, and management strategies. Learn about the complexities of Acute on CKD and best practices for healthcare professionals.
Also known as
Acute kidney failure
Sudden loss of kidney function.
Glomerular diseases
Diseases affecting the kidney's filtering units.
Hypertensive diseases
High blood pressure and related disorders, often a cause or consequence of CKD.
Other disorders of urethra and urinary tract
Conditions impacting urine flow which can exacerbate CKD.
Follow this step-by-step guide to choose the correct ICD-10 code.
Is there evidence of both acute kidney injury and pre-existing chronic kidney disease?
Yes
Is the acute kidney injury specified as acute on chronic?
No
Do not code as acute on chronic kidney disease. Code the present condition(s) as documented.
When to use each related code
| Description |
|---|
| Sudden worsening of chronic kidney disease. |
| Gradual loss of kidney function over time. |
| Rapid decline in kidney function over hours or days. |
Coding requires documenting the specific type of AKI (prerenal, intrinsic, postrenal) impacting CKD for accurate severity and reimbursement.
Differentiating acute on chronic from acute or chronic kidney disease alone is crucial for correct coding and avoiding downcoding.
Properly documenting and coding the underlying chronic kidney disease stage with the acute component is essential for accurate risk adjustment.
Q: How do I differentiate acute on chronic kidney disease (acute on CKD) from an acute kidney injury (AKI) in a patient with pre-existing chronic kidney disease (CKD)?
A: Differentiating acute on chronic kidney disease (acute on CKD) from AKI in a patient with pre-existing CKD can be challenging, requiring a thorough evaluation of clinical presentation, past medical history including baseline kidney function, and laboratory data. While both involve a sudden decline in kidney function, acute on CKD is superimposed on an already established CKD, whereas AKI represents a new insult to previously normal or near-normal kidneys. Look for subtle signs of fluid overload, changes in electrolyte levels that are more exaggerated than expected for their baseline CKD, and a more rapid decline in estimated glomerular filtration rate (eGFR) than their underlying CKD trajectory would suggest. Careful review of medications, recent illnesses, and imaging studies can help identify contributing factors. Explore how incorporating a multidisciplinary approach, including nephrology consultation, can optimize patient outcomes in these complex cases.
Q: What are the best practices for managing fluid overload in a patient with acute on chronic kidney disease (Acute Kidney Injury on Chronic Kidney Disease)?
A: Managing fluid overload in acute on chronic kidney disease requires a multifaceted approach. Given the pre-existing reduced kidney function in these patients, fluid management is paramount. Restricting sodium and fluid intake is crucial. Loop diuretics are often the first-line therapy for diuresis, but their effectiveness can be blunted in advanced CKD. Consider implementing strategies such as close monitoring of daily weights, strict input/output charting, and optimizing medication regimens to address underlying causes of fluid retention. In cases of refractory fluid overload, renal replacement therapy may be necessary. Learn more about the role of ultrafiltration and other advanced fluid management techniques for patients with acute on CKD.
Patient presents with acute on chronic kidney disease (acute on CKD), manifesting as a rapid decline in kidney function superimposed on pre-existing chronic kidney disease. The patient's baseline creatinine was documented as [Baseline Creatinine Value] mg/dL on [Date]. Current creatinine is [Current Creatinine Value] mg/dL, representing a significant increase. The patient reports [Symptoms, e.g., decreased urine output, swelling in legs, shortness of breath, fatigue]. Differential diagnoses considered include acute kidney injury (AKI), exacerbation of chronic kidney disease, volume depletion, and obstructive uropathy. Assessment includes a thorough review of medications, recent illnesses, and relevant comorbidities such as hypertension, diabetes, and heart failure. Diagnostic workup includes urinalysis, complete blood count, comprehensive metabolic panel, and renal ultrasound to evaluate kidney size and structure and rule out obstruction. Treatment plan includes addressing the underlying cause of the acute deterioration, optimizing fluid balance, and close monitoring of renal function. Consideration for renal replacement therapy (dialysis) may be necessary depending on the severity of the acute kidney injury and the patient's overall clinical status. Patient education provided on medication management, dietary restrictions including sodium and potassium intake, and the importance of follow-up care. ICD-10 code N18.9 Chronic kidney disease, unspecified is used for the underlying CKD and an appropriate code for the acute kidney injury will be added based on the etiology (e.g., N17.9 Acute kidney failure, unspecified). Continued monitoring and reassessment will be performed to evaluate the patient's response to treatment and adjust the plan as needed.