Dialysis: Diagnosis & Tests Menu

Diagnosis of Kidney Failure

Testing for kidney disease or kidney failure (end-stage renal disease, “ESRD”) is done when signs and symptoms of kidney dysfunction prompt a history and physical exam to pursue an appropriate diagnosis. A careful medication history is important.

Edema (fluid retention), bloating, fatigue, tremors, and cognitive changes all require pursuit of a kidney disease diagnosis or its elimination among other possibilities. Also, ongoing heart failure and cirrhosis, which can injure the kidney, should prompt diagnostics. In renal vascular disease from atherosclerosis and hypertension, the renal component is part of the big picture in the diagnostic and therapeutic approach of cardiovascular components.

Tests for Kidney Function of Failure

  • Urinalysis: A microscopic analysis of the urine to reveal casts (tubular-shaped debris from tubular disease in the kidney), red blood cells, white blood cells, and misshapen red blood cells; also, biochemical testing for albumin/protein.
  • Blood metabolic profile to identify abnormalities of electrolytes, BUN (blood urea nitrogen), and serum creatinine (for a BUN/creatinine ratio).
  • Albumim-to-creatinine ratio.
  • Ultrasound to identify obstruction or chronic changes of kidney disease. An obstruction will take management into a mechanical direction of relieving the obstruction; alternately, without obstruction, a negative ultrasound prompts a flowsheet of decisions based on whether or not there is pus (nephritis) in the urine (pyuria).
  • Kidney biopsy in cases of acute changes on imaging.

The glomerular filtration rate (GFR) is a quantitation of kidney function, determined by the sum of all of the functioning nephrons (filtering kidney cells). It is a number of mL filtered per minute multiplied by a constant of body size. Actual measurement is cumbersome and complicated, so most frequently GFR is done via quick estimations using formulas of creatinine clearance and serum creatinine.

Once the GFR becomes low enough, symptoms of uremia can emerge which will prompt a decision to begin dialysis.


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This information is provided by Vascular Health Clinics and is not intended to replace the medical advice of your doctor or healthcare provider. Please consult your healthcare provider for advice about a specific medical condition.

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