Diagnosis of Kidney problems

Hello and welcome once again. Diagnosing most kidney problems (especially when the condition is well established) can be quite straightforward. We use a combination of physical exam, scans and blood and urine tests to assess kidneys qualitatively and quantitatively. Each person is different so 'ONE SIZE DOES NOT FIT ALL'.

Obtaining detailed history including previous medical problems and current symptoms along with physical examination form an important corner stone of my assessment. Hence 'virtual consultations' have limitations.

Although very simple and cheap, a good urine examination is called a 'POOR MAN'S KIDNEY BIOPSY' and can give us a wealth of information about your kidneys. A 'Routine Exam' of urine involves testing urine for protein, red blood cells, white blood cells, nitrite, bilirubin, crystals and casts. Most of these are now a days done by automated machines except the last two (crystals and casts) which need microscopic examination by a trained lab personnel. Looking at the result I can tell if you might be having an infection in the urine, inflammation in kidneys, tendency to form various kidney stones, etc. based on the routine test, if I suspect infection, I ask for a "URINE CULTURE'; if I suspect protein leak, I ask for 'Sport Urine for Protein Creatinine Ratio' and/ or 24 hour urine for estimation of proteinuria. I also ask for various different tests on a 24 hour collection of urine in patents with hypertension (to look for cause of high BP) and those with kidney stones (to diagnose the type and/ or cause of stones).

Blood tests can be very varied but the most important ones that I do as baseline to assess kidneys is called 'KIDEY FUNCTION TEST (KFT)'. This encompasses Sodium, Potassium, Chloride, Bicarbonate, Urea/ Blood Urea Nitrogen (BUN), and Creatinine. Based on the history and available information from examination, I might want to look at Complete Blood Count (CBC), Liver Function Tests (LFT), Bone Profile (Calcium, Magnesium, Phosphate), Blood sugars, and Lipid profile (fasting) to name a few.There are certain special blood tests that we undertake when we suspect immune system problem. These tests are Antinuclear antibody screen (ANA), ANCA, Anti-GBM antibodies, Complement levels, Blood protein electrophoresis, Serum free Light chains, etc.

Scans are the fourth cornerstone. The most common scan that I order is an 'ULTRASOUND of the kidneys and bladder'. This gives us information about any structural abnormality of your kidneys, bladder and also some information about the capacity and emptying capability of your bladder. It can pick up presence of most types of kidney stones, cysts, growth, and obstruction to urine flow in kidney or ureters. In short, if done well by an experienced sonographer with a decent machine, it gives a wealth of information that can be very valuable in diagnosis and treatment of kidney ailments. Other scans that we rely on less often are - CT scan, Neuclear medicine scan of kidneys and MRI scan.

Very rarely I recommend a 'KIDNEY BIOPSY' which simply is obtaining a tiny piece of kidney tissue for the purpose of various tests in the lab. By doing this we can assess the type, site, and extend of problem in the kidney. This will help us to prognosticate and guide the patient in his/ her treatment. Once again I would like to stress that this is a test that I advice very rarely in my practice since it is an invasive procedure and carries a small amount of risk, which can be serious in a tiny minority.

Most of the times I do not blindly request a battery of tests to my patients which I feel is akin to 'Fishing' in the dark. I base my decision of what combination of tests to request based on my initial assessment after listening to patient's history and abnormalities (if any) I find on examining the patient. Results of these tests and ongoing assessments in my follow up clinic will determine subsequent tests. This ensures that my patents get value for money.

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