chronic renal insufficiency VS chronic kidney disease

Daytonite, BSN, RN · Feb 8, 2007

They are both very vague medical diagnoses that the doctor most likely used in lieu of using symptoms as a diagnosis. The doctors know that the medical coders, who have to code the diagnoses and bill the patient's insurance company, don't like them to use symptoms as the patient's diagnosis. So instead, doctors will put down these vague, kind of bogus diagnoses for lack of something better to use because the billers need a medical diagnosis. (I've been a coder since I left clinical nursing and checked the ICD-9 codes on these. They both code to the same code number which is unusual and it is a very nonspecific medical diagnosis code which means that if the billers end up having to use these as this patient's final diagnoses, the hospital is probably going to have problems getting paid because the insurance company is likely to deny payment.) You are very unlikely to find many, if any, medical resources to list any definitive signs and symptoms of either one of these two conditions. You should be looking at the symptoms from the history and physical and the past medical history to help you figure out exactly what the doctor has based these diagnoses on since all medical diagnoses are based on the signs and symptoms the doctor observed during his assessment process. This should all have been documented. Hope you took the time to read these documents and copy the information down. Then, you can back into them by saying that renal insufficiency is a condition where the patient has XXXXX and list the symptoms the doctor listed.

I know from your previous questions that you like specific answers, but I don't think you're going to be able to get one for this. However, keep looking, but I very much doubt that you're going to find a medical reference that is going to help you here. If you know a physician, you might ask them what their opinion is on this.

You got a bum deal on this patient's medical diagnoses for your care plan, kiddo.

Advanced Practice Columnist / Guide · Feb 8, 2007

Both terms do get used interchangeably a lot. That is probably the reason why they share the same ICD9 code. However, chronic kidney disease is a general term used to define kidney damage of greater than 3 months duration with or without a decrease in glomerular filtration rate (GFR) OR a decrease in GFR below 60 with or without signs of kidney damage. Because Chronic Kidney Disease is a broad term, it encompasses all stages of this disease from mild to end-stage kidney disease requiring dialysis.

On the other hand, some experts use the term chronic renal insufficiency to describe the early stage of chronic kidney disease in which damage to the kidney has already impaired renal function but systemic manifestations are minimal. This is usually detected and diagnosed from a slightly elevated serum creatinine level over a period of 3 months.

Daytonite, BSN, RN · Feb 8, 2007

Do you provide a written reference for this? The OP is going to need a reference. I am sure she needs this information for a care plan she is working on. She most likely needs to describe the pathophysiology of these two conditions and has been unable to find it in any literature. You confirm what I know, that these are very general terms describing very general conditions.

I have had renal insufficiency myself for a number of years. My only symptom is a persistently elevated serum creatinine level.

Advanced Practice Columnist / Guide · Feb 8, 2007

The diagnostic criteria for Chronic Kidney Disease was developed by the National Kidney Foundation Kidney Disease Quality Outcomes Initiative. It is contained in their publication entitled: Clinical Practice Guidelines for Chronic Kidney Disease: Evaluation, Classification, and Stratification.

This is the link:

http://www.kidney.org/professionals/kdoqi/guidelines_ckd/toc.htm

Additional references:

Skorecki, K., Green, J., & Brenner, B. (2001). Chronic Renal Failure. In Braunwald, E., Fauci, A,. Kasper, D., Hauser, S., Longo, D., & Jameson, J. (eds.), Harrison's Principles of Internal Medicine (15th ed., pp. 1551-1552). New York: Mc Graw-Hill.

Winkelman, C. (2002). Chronic Renal Failure. In Ignatavicius, D., Workman, M. (eds.), Medical-Surgical Nursing, Critical Thinking for Collaborative Care (pp. 1675-1678). Philadelphia: W.B. Saunders.

Leng27RN,BSN · Feb 9, 2007

Thank you so much for giving your opinion, i'll try to look it up some more, it was just for my mini care plan, and i was just wondering about it just in case i encounter the same thing on my "real big" care plan. Thanks again.