What medical tests detect kidney disease?
Because a person can have kidney disease without any symptoms, a doctor may first detect the condition through routine blood and urine tests. The National Kidney Foundation recommends three simple tests to screen for kidney disease: a blood pressure measurement, a spot check for protein or albumin in the urine, and a calculation of glomerular filtration rate (GFR) based on a serum creatinine measurement. Measuring urea nitrogen in the blood provides additional information.
Blood Pressure Measurement
High blood pressure can lead to kidney disease. It can also be a sign that the kidneys are already impaired. The only way to know whether a person’s blood pressure is high is to have a health professional measure it with a blood pressure cuff. The result is expressed as two numbers. The top number, which is called the systolic pressure, represents the pressure in the blood vessels when the heart is beating. The bottom number, which is called the diastolic pressure, shows the pressure when the heart is resting between beats. A person’s blood pressure is considered normal if it stays below 120/80, stated as “120 over 80.” The NHLBI recommends that people with kidney disease use whatever therapy is necessary, including lifestyle changes and medicines, to keep their blood pressure below 130/80.
Microalbuminuria and Proteinuria
Healthy kidneys take wastes out of the blood but leave protein. Impaired kidneys may fail to separate a blood protein called albumin from the wastes. At first, only small amounts of albumin may leak into the urine, a condition known as microalbuminuria, a sign of deteriorating kidney function. As kidney function worsens, the amount of albumin and other proteins in the urine increases, and the condition is called proteinuria. A doctor may test for protein using a dipstick in a small sample of a person’s urine taken in the doctor’s office. The color of the dipstick indicates the presence or absence of proteinuria.
A more sensitive test for protein or albumin in the urine involves laboratory measurement and calculation of the protein-to-creatinine or albumin-to-creatinine ratio. Creatinine is a waste product in the blood created by the normal breakdown of muscle cells during activity. Healthy kidneys take creatinine out of the blood and put it into the urine to leave the body. When the kidneys are not working well, creatinine builds up in the blood.
The albumin-to-creatinine measurement should be used to detect kidney disease in people at high risk, especially those with diabetes or high blood pressure. If a person’s first laboratory test shows high levels of protein, another test should be done 1 to 2 weeks later. If the second test also shows high levels of protein, the person has persistent proteinuria and should have additional tests to evaluate kidney function.
Glomerular Filtration Rate (GFR) Based on Creatinine Measurement
GFR is a calculation of how efficiently the kidneys are filtering wastes from the blood. A traditional GFR calculation requires an injection into the bloodstream of a substance that is later measured in a 24-hour urine collection. Recently, scientists found they could calculate GFR without an injection or urine collection. The new calculation—the eGFR—requires only a measurement of the creatinine in a blood sample.
In a laboratory, a person’s blood is tested to see how many milligrams of creatinine are in one deciliter of blood (mg/dL). Creatinine levels in the blood can vary, and each laboratory has its own normal range, usually 0.6 to 1.2 mg/dL. A person whose creatinine level is only slightly above this range will probably not feel sick, but the elevation is a sign that the kidneys are not working at full strength. One formula for estimating kidney function equates a creatinine level of 1.7 mg/dL for most men and 1.4 mg/dL for most women to 50 percent of normal kidney function. But because creatinine values are so variable and can be affected by diet, a GFR calculation is more accurate for determining whether a person has reduced kidney function.
The eGFR calculation uses the patient’s creatinine measurement along with age and values assigned for sex and race. Some medical laboratories may make the eGFR calculation when a creatinine value is measured and include it on the lab report. The National Kidney Foundation has determined different stages of CKD based on the value of the eGFR. Dialysis or transplantation is needed when the eGFR is less than 15 milliliters per minute (mL/min).
Blood Urea Nitrogen (BUN)
Blood carries protein to cells throughout the body. After the cells use the protein, the remaining waste product is returned to the blood as urea, a compound that contains nitrogen. Healthy kidneys take urea out of the blood and put it in the urine. If a person’s kidneys are not working well, the urea will stay in the blood.
A deciliter of normal blood contains 7 to 20 milligrams of urea. If a person’s BUN is more than 20 mg/dL, the kidneys may not be working at full strength. Other possible causes of an elevated BUN include dehydration and heart failure.
Additional Tests for Kidney Disease
If blood and urine tests indicate reduced kidney function, a doctor may recommend additional tests to help identify the cause of the problem.
Kidney imaging. Methods of kidney imaging—taking pictures of the kidneys—include ultrasound, computerized tomography (CT) scan, and magnetic resonance imaging (MRI). These tools are most helpful in finding unusual growths or blockages to the flow of urine.
Kidney biopsy. A doctor may want to examine a tiny piece of kidney tissue with a microscope. To obtain this tissue sample, the doctor will perform a kidney biopsy—a hospital procedure in which the doctor inserts a needle through the patient’s skin into the back of the kidney. The needle retrieves a strand of tissue less than an inch long. For the procedure, the patient lies facedown on a table and receives a local anesthetic to numb the skin. The sample tissue will help the doctor identify problems at the cellular level.