You can first see your family doctor or general practitioner if you suspect that you have kidney problems. Your doctor may then refer you to a nephrologist, who specializes in diseases of the kidney. Regular checkups are necessary so that doctors can monitor how the kidneys are working and continue to treat problems caused by chronic kidey disease (CKD). For example, bephrologists perform annual tests to screen for kidney damage related to diabetes. Or, you doctors will order regular blood and urine tests to monitor the health of the kidneys over time.
During a medical history, your doctor will ask about risk factors for kidney disease, such as diabetes and high blood pressure. Doctors will also want to diagnose possible problems that damaged the kidneys, including diet, and may ask specific questions about your eating habits. Come prepared to the doctor’s appointment by writing down a list of all medications, vitamins and supplements that you are taking as well as having a clear understanding of other medical conditions and diagnoses from the past.
If a physician suspects chronic kidney failure, they are likely to order urine and blood tests to check for increased levels of waste products, such as urea and creatinine. Abnormal results are typically the first sign of kidney disease. Diagnostic tests for CKD include:
Biopsy - A sample of kidney tissue, or biopsy, can be helpful in diagnosing the specific causes of kidney problems. In fact, analyzing kidney tissue may reveal the nature and extent of structural kidney damage. A biopsy can find causes of protein and blood in the urine and to monitor treatment effectiveness. A biopsy is obtained using a needle in tandem with diagnostic imaging equipment, and is useful when glomerular filter disease is suspected.
Blood pressure measurement - High blood pressure is a factor in kidney disease, and can be a sign of impaired kidneys. The surest test for high blood pressure is measurement with a blood pressure cuff. The result is displayed as two numbers. The top number, or systolic pressure, represents blood vessel pressure when the heart is beating. The bottom number, or diastolic pressure, shows the pressure between beats, when the heart is resting. Normal blood pressure is considered below 120/80, stated as “120 over 80.”
Blood tests – Blood test detect kidney problems and can help minimize damage to the kidneys. They can demonstrate how well the kidneys are removing waste and excess fluid. Blood testing can also indentify indicators of kidney and urinary disease such as the number of red blood cells and white blood cells (WBCs or leukocytes). Some common tests doctors order to help diagnosed kidney disease include:
Blood urea nitrogen (BUN) - Healthy kidneys remove urea from the blood, transferring it to the urine. If a person’s kidneys are impaired, urea remains in the blood.
Glomerular filtration rate (GFR) - A GFR test calculates the kidney’s efficiency in filtering waste from the blood. It requires an injection into the bloodstream of a substance that is measured once it passes into a 24-hour urine collection. A new version—the eGFR—requires only a measurement of the creatinine in a blood sample without an injection or urine collection.
Creatine levels - Blood tests can determine the milligrams of creatinine per one deciliter of blood (mg/dL). Elevated creatine levels are a warning sign that the kidneys are not fully working, but tests results are highly variable and are affected by diet.
Imaging tests - If doctors suspect a structural problem of the kidneys, they may order different imaging tests to evaluate the kidney. A picture of the kidneys can identify structural problems or blockage. Doctors many recommend one of several techniques such as an ultrasound, CT scan (computed tomography), isotope scans, or intravenous pyelogram (IVP) to create an image of the kidney(s). Different x-ray procedures can also be conducted, like an intravenous urogram, micturating cystogram, or renal arteriogram (or angiogram). Finally, a chest X-ray may be ordered to check for fluid retention in the lungs (pulmonary edema) in addition to tests that rule out other possible causes of signs and symptoms.
Urine tests - When symptoms are present suggesting infection, a urine culture can detect the presence of bacterial infection. Also doctors test for specific proteins in the urine as indicators of kidney disease. These include:
Microalbuminuria and proteinuria - Healthy kidneys remove waste from the blood, leaving protein untouched. Impaired kidneys can fail in separating blood protein (albumin) from waste. Doctors test for the presence or absence of proteinuria using a dipstick in a small sample of a person’s urine taken. Or, doctors can order the measurement and calculation of the protein-to-creatinine or albumin-to-creatinine ratio as a more sensitive test for protein in the urine.
Tests to monitors kidney function - People diagnosed with a kidney disease, should undergo regular laboratory tests to monitor kidney function. BUN and creatinine blood levels must be checked regularly as this may reveal deteriorating kidney health. Other clues may be taken from calcium and phosphate blood levels, and the balance of serum and urine electrolytes. A complete blood count (CBC) can be measured during routine checks. Urine total protein can be examined to monitor the effects of treatment for diabetes and nephrotic syndrome. Parathyroid hormone levels must be checked to prevent bone damage.
Once kidney disease has been diagnosed, doctors must first stage the progression of the disease before recommending treatment. But what does staging require? And how to doctors define each stage of kidney disease? Learn more about chronic kidney disease stages here.
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