Points to be remembered for Physiological changes in pregnancy?
Absolute Indications of urgent dialysis :
Uremic Symptoms like Uremic pericarditis / Uremic encephalopathy / Uremic bleeding
Volume overload state / CHF .
But here urea is mildly elevated to 86 , K+ is 4.4 , ONLY Creat is high and Ca+2 is high with anemia . So here none of the above mentioned indications are present so we won’t get much benefit from doing dialysis . A/c to given scenario : pt. Is just in AKI due to Multiple Myeloma
To treat AKI in MM : we start chemo based on BORTEZOMIB + high dose Dexa : they will handle light chains accumulated in kidney because they are the main culprit of it ( dialysis can’t remove these deposited / accumulated light chains ) . BORTEZOMIB has rapid action . Lenalidomide takes time to act and is started once aki start resolving .
Start on ivF . Why ?
1st line treatment of Hypercalcemia is ivF with NS ( and m/c cause of aki in MM is Hypercalcemia and Light chain cast nephropathy )
ivF will maintain Urine output so will prevent precipitation/ accumulation of light chains in TUBULES
with ivF we also start Bicarb therapy to make urine alkaline so that precipitation of Light chains can be halted .