FORMULAS o o o o o Ccr= Creatinine concentration Ucr= Urine creatinine concentration V= urine flow rate Pcr= plasma creatinine concentration

Creatinine clearance equation adjusted for effects of body weight and age on muscle mass (Cockcroft-Gault) o Ccr=
( ) ( ( ) )

(*.85 if F)

o Ccr= creatinine clearance o Pcr= plasma creatinine

1. Fractional excretion of sodium (FENa) calculation (Rennke & Dennker, 2nd edition. p.215-216) FENa, precent= quantity of sodium excreted/sodium filtered x 100 =(
( ) )

UNa = sodium urine concentration PCr = Plasma Creatinine concentration PNa = Plasma sodium concentration UCr = Creatinine urine concentration FENa <1% = Favors prerenal disease & acute renal failure o This meaning that >99% of filtered sodium being reabsorbed FENa >2% = impaired tubular reabsorption due to acute tubular necrosis FENa allows direct look at sodium w/o confounding effect of the rate of water reabsorption

2. Urine and Serum (Plasma) osmolarity (Rennke & Dennker, 2nd edition. p35-36, CP p.54) ***Please note, I could not find info on osmolarity, so used osmolality instead***** Plasma osmolality (Posm) = ( ) ( ) PNa= sodium plasma concentration Among normal subjects, effective Posm ~ 2 x PNa

3. Anion Gap (Rhoades and Bell p.458-459, CP 145-149) Main use: determine possible etiology of metabolic acidosis o Uses principle that sum of all cations and anions are equal in any body fluid Metabolic acidosis caused by o Impaired acid excretion Renal failure Tubular disorders impairing bicarbonate reasbsorption o Increased acid production Endogenously (eg.-lactic acid or ketoacids) Diarrhea loss of bicarb net results of [ H+] in plasma o Addition acid ingestion For blood plasma: cations= anions [Na+] + [unmeasured cations] =[Cl-] + [HCO3-] + [unmeasured anions] Causes Anion Gap Metabolic acidosis (MUDPILES) Methanol (wood alcohol) blindness Uremia Diabetic ketoacidosis Paraldehyde (sedative hypnotic) Infection, INH, iron tablets Lactic acid Ethylene glycol (antifreeze) renal failure Salicylate Non-Gap Metabolic Acidosis Renal tubular acidosis (RTA)renal bicarb loss Diarrhea & other bowel loss GI losses Carbonic anhyrdrase inhibitors*