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Chronic Kidney Disease in HIV-Infected Patients

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Diagnosis 4 Table 3. Laboratory Indicators of Proximal Tubular Dysfunction Abnormality Definition of Abnormality Comment Serum abnormalities Hypokalemia Serum potassium concentration below laboratory reference range • Trend is of more clinical relevance than single abnormal value • Neither sensitive nor specific Low serum bicarbonate Serum bicarbonate concentration below laboratory reference range • Trend is of more clinical relevance than single abnormal value • Nonspecific in the setting of reduced GFR Hypophosphatemia Serum phosphorous concentration below laboratory reference range • Normal value does not exclude urinary phosphorous wasting. However, hypophosphatemia combined with urinary wasting is diagnostic of renal tubular injury Urine abnormalities Urine glucose on dipstick Glycosuria in the absence of diabetes, or in diabetics with well-controlled blood glucose • Diagnostic of renal tubular injury Fractional excretion of phosphate (FE phos) <10% is normal and >20% is abnormal • Increased FE phos in the setting of normal kidney function is of more clinical relevance than when kidney function is impaired • Upward trend in urinary phosphate wasting is suggestive of tubular injury • Loss of phosphate may lead to osteomalacia

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