Creatinine AKI CKD

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CKD stage III 
 - If HCO3 running < 22: Recommend NaHCO3 650 TID and monitor for volume expansion.
- Phosphate goal 2.7 - 4.6 (4.5 on 5.22.14) Recommend Phosphate binder of TUMS 500 mg TID between meals or calcium carbonate 0.5 to 1.0 meq/kg/day or Phoslo (Calcium Acetate) 667 mg, Two tid with meals ) 

Hypocalcemia (assoc with CKD)
- Recommend iPTH, 25-hydroxyvitamin-D and if < 30 start ergocalciferol 

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Fractional excretion of sodium is a useful test for differentiating prerenal azotemia from acute tubular necrosis, and should be done prior to diuretic administration. REF
Which of the following require dose changes in renal failure ? REF
- Lovenox - Yes
- Metoprolol - No
- Carvedilol - No
- Clopidogrel - No
- tPA - No, but hemorrhagic complications increase.


What unique property do ACE-I and AII inhibitor have ?  They decrease protenuria. (REF)
- ACE-Is are the most effective antihypertensives to prevent progression of KDs in DM & non-DMs.

Cr is an organic cation, as are the meds below. Approx 15% of UCr comes from tubular excretion.
- These increase serum Cr by competing with Cr for tubular secretion, but don't decr GFR.
1. cefoxitin - an organic cation
2. cimetidine - "
3. ketone  bodies - "
4. flucytosine - "
5. trimethoprim - "

Losartan has been shown to decrease uric acid. 2011 (102)

There are 5 things we need to look at when diagnosing AKI:
1. History
2. Examination
3. FeNa
4. UNa
5. Casts - Hyaline - 2/2 dehydration and urine stasis, muddy brown (ATN 70%), Heme & RBCs - rhabdomyolysis = treat with NS, diuretics and alkalinize the urine.

FENa = UNa/PNa / UCr/PCr * 100 - this eq does not apply if a diuretic is in place, so use:
FEurea = Uurea/Purea / Ucr/Pcr

Definitions: Oliguria - < 400 ml / day | < 1/2 cc/kg-day | < 30 ml/hr.
                  Anuria - < 100 ml / day to < 50 ml/day.

  AKI 
 Pre-renal
FeNa < 1%
UNa < 20 = Ks holding on to Na
 Renal (IKI)
FeNa > 2% < 35%
UNa - Depends    
 Post-renal
FeNa > 35%
UNa > 20



  Intrinsic Kidney Injury (IKI) Types 
 ATN 

- 70% of all cases of IKI
- MC - RT ischemia (map < 80)
- Also - drugs, contrast
- Cr > 1.4 or GFR stage 3,4 then protect kidneys ? What did this mean ?


 Interstitial Nephritis

- WBCs & Eos can look the same

 Glomerulonephritis

- Expect protein and blood
- Glomerulus = complex capillary mesh
- Nephrotic Glomerulonephritis
vs
- Nephritic Glomerulonephritis


Nephrotic Glomerulonephritis
- sclerotic in nature
- protein
- edema - periorbital in kids, ascites in adults
- hypogammaglobulins - increased infection esp H. Flu and Strep Pneumo
- decreased AIII = hypercoaguable = increased PEs & renal vein thrombosis



 Nephritis Glomerulonephrtis
- inflammatory in nature







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