Do you prefer an isotonic sodium bicarbonate infusion over other isotonic IV fluids when managing those with AKI in the setting of light chain cast nephropathy?

Theoretically, the physiologic rationale for using isotonic sodium bicarbonate over isotonic saline in light chain cast nephropathy is that urine alkalinization reduces the interaction between light chains and Tamm-Horsfall protein and therefore reduces cast formation. However, there are no strong clinical data demonstrating the superiority of isotonic sodium bicarbonate over isotonic saline in light chain cast nephropathy. Therefore, the choice between isotonic sodium bicarbonate and isotonic saline should be based on the clinical setting.

If the patient has concurrent hypercalcemia, isotonic saline is preferred over isotonic sodium bicarbonate, since urine alkalinization increases the risk of calcium phosphate precipitation, thereby promo...