How to Diagnose Kidney Failure

Kidney failure, or end-stage renal disease, means that your kidneys aren’t functioning well enough to keep you alive without treatments like transplants or dialysis.

If you have been living with chronic kidney disease, your healthcare provider may have been monitoring your kidney function and health. Acute renal failure is sudden kidney failure that occurs within hours to days.

To diagnose kidney failure, various tests are done, such as blood and urine tests to measure your kidneys’ ability to filter waste, and to check for proteins such as albumin. You may also have imaging tests or a kidney biopsy to rule out other diseases or explore the underlying cause of kidney failure.

This article will review how to diagnose kidney failure. Knowing what you might expect can help make things less stressful.

Self-test / home test

Currently, there is no self-examination for kidney failure. It’s important to be aware of the symptoms of kidney disease and kidney failure, which may indicate that you need to see your healthcare provider right away for an evaluation. Your provider can then conduct tests and order necessary tests to diagnose kidney failure.

There are home tests to check kidney function, but these should not be used to assess kidney failure. These are often recommended in the early stages of kidney disease for those who have difficulty leaving home or who do not have health insurance.

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physical examination

Because symptoms of kidney disease and kidney failure can sometimes be nonspecific, especially in the early stages, a physical exam may be helpful.

Examination of the chest and abdomen can show abdominal swelling or fluid accumulation in the lungs. Pain caused by light tapping on the back may indicate urinary tract obstruction. Your healthcare provider may probe your chest and abdomen by touch, pressing lightly to feel anything unusual. By doing so, they may find a lump or an enlarged kidney.

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A skin examination can reveal:

  • Paleness (low red blood cell count) due to anemia
  • Skin discoloration due to uropigmentation (the pigment that turns urine yellow is deposited into the skin due to elimination problems)
  • Hyperpigmentation (patches of skin darker than surrounding skin)
  • Petechiae (small rash-like blood spots) caused by abnormal platelets
  • Itchy scratches due to abnormal phosphorus levels
  • Dry skin due to sweat gland problems

People with acute renal failure may be slurred, confused, or drowsy, or have trouble concentrating.

All of these aspects of the physical examination can provide important information about the extent of kidney failure and aid in the diagnosis.

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Labs and Testing

In addition to a physical exam, your provider may order labs and tests to help assess kidney function and assess kidney failure. Testing can include:

  • Blood test for glomerular filtration rate (GFR): This measures whether the kidneys are filtering at a normal rate.
  • Urine albumin test: Healthy kidneys do not allow albumin to pass into the urine, so the amount of albumin in the urine can be used as an indicator of kidney function.

Understanding Glomerular Filtration Rate

  • A GFR of 60 or higher is normal.
  • A GFR below 60 can mean kidney disease.
  • A GFR less than or equal to 15 indicates renal failure; may indicate the need for dialysis or transplantation.

A kidney biopsy is sometimes required if a provider needs more information about the suspected disease process or how quickly kidney damage or failure is progressing.

This can be done by inserting a needle into the kidney under ultrasound guidance. The kidney tissue is then removed with a needle and examined microscopically in the laboratory.

New research is underway on less invasive tests. One of the studies involved using cotton thread-based colorimetric sensors to measure glucose and urea in sweat. The sensor can distinguish between normal and abnormal readings and could be a useful tool to help individuals measure and monitor their glucose (blood sugar) and/or urea levels in a non-invasive manner. More research needs to be done, but this is promising.

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imaging test

Imaging tests can help your healthcare provider better understand what may be happening to your kidneys.

Ultrasound uses sound waves to create images of your kidneys. It can check for any dimensional anomalies or obstacles.

CT (computed tomography) scans use X-rays for similar reasons, as well as to look for structural problems or abnormalities.

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Differential diagnosis

Especially with acute kidney failure, your healthcare provider will rule out other possible causes of your symptoms. The three categories of acute renal failure are:

  • Prerenal acute failure: marked by decreased renal blood flow
  • Endogenous acute renal failure: caused by damage to the renal parenchyma (the functional part of the kidney)
  • Postrenal acute renal failure: caused by urinary tract obstruction

Knowing more about what kind of acute kidney failure you have can help providers determine the cause of kidney failure. If there is a specific underlying cause, such as a toxin or blockage, it can be addressed while providing medical care and support.

Other possible causes of kidney failure symptoms include:

  • septicemia
  • Insufficient fluid intake
  • congestive heart failure
  • cirrhosis
  • toxin
  • HELLP syndrome
  • ischemia (reduced blood flow)
  • systemic lupus erythematosus
  • lymphoma
  • leukemia
  • prostate cancer
  • cervical cancer

Your provider will rule out these causes to ensure a proper diagnosis.

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Accurate diagnosis of renal failure is important to obtain appropriate treatment. To get a proper diagnosis, various blood and urine tests, as well as a physical exam, can be done. Depending on what the lab shows and the results of your physical exam, your healthcare provider may also order an imaging test, which can show more detail about what’s going on in your kidneys.

This may lead to a kidney biopsy for more clinical information. All of these tests can help your provider rule out other potential causes of your symptoms and come up with a definitive diagnosis that will help guide treatment.

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VigorTip words

It all seems overwhelming, especially when you’re worried about managing your kidney disease. Talk to your healthcare provider about the signs you should look out for and the diagnostic tests they will perform to monitor your condition. The test itself can cause anxiety, but an accurate diagnosis is required for proper treatment.