How to distinguish between acute renal failure and chronic renal failure？

Learn kidney failure friends is important to understand is divided into acute renal failure and chronic renal failure, renal failure. Distinguish between acute and chronic treatment of the patient is advantageous for. How that distinguish acute renal failure and chronic renal failure it? 
Acute and chronic renal failure distinction, first clinical diagnosis, mainly based on the length of illness records, reference to other indicators; Second, the pathogenesis of diagnosis, biopsy diagnosis is to identify the pathogenesis of acute renal failure and chronic renal failure, the gold standard, but the current domestic hospitals have emergency biopsy condition is not common. Therefore, the selection and evaluation of the clinical identification of acute renal failure and chronic renal failure is extremely focused on non-invasive indicator. 
After the patient's analysis, we summarize this result: 
(1) The duration of the disease is to distinguish between acute and chronic renal failure basis. 50 cases of chronic renal failure patients as much as half a year of not feet, of which one third more acute onset, disease duration less than three months. So, as a conclusion based on the length of disease, especially chronic renal failure not reliable. My literature and Branch showed higher diagnostic change after biopsy ratio. 
(2) has been popular with the current domestic "B" super measure kidney size. Volume increase seen in the kidney usually considered acute renal failure, kidney smaller size seen in chronic renal failure. Our data show that regardless of acute or chronic renal failure, kidney real increases or decreases each accounted for only one-third of patients, the vast majority of cases of kidney size is normal, this part of the application B-measure kidney size on acute and chronic renal failure to identify without help. Recently, we showed a "B" over the more measured thickness measurement of renal parenchymal volume size more meaningful. 
(3) nail creatinine measurement is a non-invasive, simple screening method, which measures the value of serum creatinine reaction three months ago. Against the insidious onset or illness records is unknown, the size of a normal kidney patient, nail creatinine measurements can recognize three months ago of renal function, and its specificity of 84%, can be used as make up more than two materials. 
(4) anemia is one of the symptoms of chronic renal failure, has been printed textbooks as acute renal failure and chronic renal failure to identify one point, our department analysis of 100 cases of acute renal failure and chronic renal failure patients with anemia detection rate and no significant difference in severity. In the past we have reported 20 cases of rapidly progressive glomerulonephritis, half of which showed anemia. 
In addition, hemolytic uremic syndrome caused by high creatinine acute renal failure may exhibit severe anemia, acute renal failure, acute expansion can cause mild to moderate anemia. Erythropoietin due to acute interstitial nephritis acute nephritis hormone produced lower also be manifested as anemia. Therefore, we believe that indicators for anemia as the distinction between acute renal failure and chronic renal failure are not reliable. 
(5) nocturia, lower specific gravity are the symptoms of chronic renal failure. Our department of acute renal failure cases less than half the 1.015 specific gravity, biopsy cells are noticeably tubulointerstitial lesions, this phenomenon could explain lower specific gravity of acute renal failure. 
(6) other tangible components of urine cytology and clinical examination in the diagnosis can not be ignored. Urine total renal tubular cells, necrotic cells, the number and type of tube, often prompted tubular necrosis; their number the more the more severe the disease, renal function was worse; acute interstitial nephritis, acute renal failure, urinary sediment in performance out of eosinophils; large number of red blood cells in urine, especially red tube tips acute renal failure caused by glomerulonephritis. 
(7) Acute renal failure, especially acute tubular necrosis, urinary enzymes, brush border antigen binding protein in urine adenosine levels rise but also conducive to the differential diagnosis. 
(8) Our data failed to prompt serum calcium and phosphorus concentrations in differentiating acute renal failure and chronic renal failure in place to help. 

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