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Preface and Contents

Chronic Kidney Disease : Symptoms and Diagnosis

Diagnosis of CKD

48. Save Your Kidneys
Diagnosis of CKD

CKD is commonly asymptomatic in early stages. Usually, CKD is initially diagnosed when hypertension is detected, a blood test showing elevated serum creatinine is requested or urine tests positive for albumin. A person must be screened for CKD if he is at high risk for developing kidney damage (diabetic, hypertensive, older age, family history of CKD).

1. Hemoglobin

Hemoglobin levels are usually low. Anemia is due to decreased erythropoietin production by the kidney.

2. Urine test

Albumin or protein in the urine (called albuminuria or proteinuria) is an early sign of CKD. Even small amounts of albumin in the urine, called microalbuminuria, may be the earliest sign of CKD. Since proteinuria can be also due to fever or heavy exercise, it is best to exclude other causes of proteinuria before diagnosing CKD.

3. Serum creatinine, blood urea nitrogen and eGFR

An easy and inexpensive way to measure kidney function is a blood level of creatinine. Together with age and sex, the serum creatinine is used in many formulas to estimate kidney function or glomerular filtration rate (eGFR). Regular monitoring of creatinine helps to assess progression and treatment response in CKD. On the basis of eGFR, CKD is divided into five stages. This staging is useful to recommend additional testing and suggestions for proper management.

4. Ultrasound of the kidney

The ultrasound is a simple, effective and inexpensive test in the diagnosis of CKD. Shrunken kidneys are diagnostic of chronic kidney disease. However, normal or even large kidneys are seen in CKD caused by adult polycystic kidney disease, diabetic nephropathy and amyloidosis. Ultrasound is also helpful to diagnose CKD due to urinary obstruction or kidney stones.

5. Other tests

CKD causes disturbances in different functions of the kidneys. To evaluate these disturbances different tests are performed such as: tests for electrolyte and acid-base balance (sodium, potassium, magnesium, bicarbonate), tests for anemia (hematocrit, ferritin, transferrin saturation, peripheral smear), tests for bone disease (calcium, phosphorus, alkaline phosphatase, parathyroid hormone), other general tests (serum albumin, cholesterol, triglycerides, blood glucose and hemoglobin A1c) and ECG and echocardiography.

Three simple tests can save your kidneys. Check blood pressure, urine for protein and eGFR.
When should a patient with CKD contact the doctor?

Patients with CKD should contact the doctor immediately, if he or she develops:

  • Rapid unexplained weight gain, marked reduction in urine volume, aggravation of swelling, shortness of breath or difficulty in breathing while lying down in bed.
  • Chest pain, very slow or fast heart rate.
  • Fever, severe diarrhea, severe loss of appetite, severe vomiting, blood in vomiting or unexplained weight loss.
  • Severe muscle weakness of recent origin.
  • Development of confusion, drowsiness or convulsion.
  • Recent worsening of well controlled high blood pressure.
  • Red urine or excessive bleeding.
Small and contracted kidneys, seen on ultrasound, are the hallmark sign of chronic kidney disease.