Renal Disease

• Abnormal renal labs
  • Creatinine clearance <10cc/min
  • Creatinine clearance <15cc/min (IDDM)
  • Serum creatinine >8.0 mg/dl
  • Serum creatinine >6 mg/dl (diabetics)
• Co-morbid factors
  • Age > 75
  • Advanced cardiac disease
  • Advnced liver disease
  • Albumin <3.5 gm/dl
  • Chronic lung disease
  • Cachexia
  • Disseminated intravascular coagulation (DIC)
  • GI bleeding
  • Immunosuppression/AIDS
  • Malignancy-other organ systems
  • Mechanical ventilation
  • Platelet count <25000
  • Sepsis
• Renal Failure
  • Dialysis ineffective
  • Pt refused dialysis
  • Signs and symptoms
    • Intractable fluid overload not responsive to treatment
    • Intractable hyperkalemia (Serum K > 7) not responsive to treatment
    • Hepatorenal syndrome (elevated BUN with oliguria and urine sodium concentration <10mEq/l)
    • Oliguria (output <400cc/24 hrs)
    • Uremia
    • Uremic pericarditis
• Uremia
  • Signs and sypmtoms
    • Agitation
    • Confusion
    • Generalized pruritis
    • Intractable nausea/vomiting
    • Obtundation
    • Restlessness
    • "Restless legs"