- maintain fluid balance
- excrete waste products
- conserve nutrients
- ensure acid-base balance
- help regulate glucose levels
- play a role in hormone secretion which is key to blood pressure regulation.
Criteria indicating terminal prognosis for patients with end-stage renal disease can be as follows:
Patient meets criteria for dialysis and/or renal transplant and refuses. Patient with renal failure on dialysis who chooses to discontinue dialysis. and Lab criteria:
- Creatinine clearance <10 mL/min (<15mL/min with diabetes)
- Serum creatinine > 8.0 mg/dl (>6.0 mg/dl with diabetes)
Signs and symptoms on progressive uremia
- Confusion and obtundation
- Intractable nausea and emesis
- Generalized pruritis
- Restlessness
- Oliguria: Urine output <400ml /24 hours
- Intractable hyperkalemia : Serum potassium > 7.0, not responsive to medical management
- Pericarditis
- Intractable fluid overload
- Hepatorenal syndrome
Acute renal failure: Comorbid illness associated with a poor prognosis
- Mechanical ventilation
- Chronic lung disease
- Advanced liver disease
- Immunosuppression /AIDS
- Cachexia
- Age>75 years
- Gastrointestinal bleeding
- Malignancy
- Advanced cardiac disease
- Sepsis
- Serum albumin <3.5
- Platelet count <25,000
- Disseminated intravascular coagulation (DIC)
