How to Diagnose Chronic Kidney Disease

Chronic kidney disease (CKD) is a global health problem. In the U.S., the number of patients enrolled in the end-stage renal disease (ESRD) program (Medicare funded program) has increased from 10,000 in 1973 to 472,099 in 2004. In 2004 alone, 104,364 patients entered the ESRD program. This article will cover causes, signs, symptoms and important tests for diagnosing CKD.

Instructions

Difficulty: Moderately Easy

1. Know the causes of CKD. Hypertension, poorly controlled diabetes, vasculitis (such as Lupus), scleroderma, neoplasia (such as multiple myeloma), autoimmunity (such as sarcoidosis and Sjögren's syndrome), drugs (numerous) and genetic abnormalities (such as polycystic kidney disease) can all cause CKD.
   * Infections (glomerulonephritis)
   * Obstructive uropathy (chronic urinary obstruction such as due to prostatic disease or metastatic cancer)
   * Hypercalcemia (chronically elevated blood calcium levels)
2. If you are experiencing any of the following signs and symptoms, discuss them with your health care provider: decreased or no urine output, discolored urine (especially with red blood cell casts), flank pain (unilateral or bilateral), edema (swelling of feet, puffy eyes, etc.), incidentally discovered elevations in the plasma creatinine, concentration or abnormalities on urinalysis, low hemoglobin of unexplained origin, weakness and fatigue (from anemia), decreased appetite, vomiting, mental status changes or seizures, especially in presence of edema, and incidental finding of a renal cyst or mass on radiographic testing performed for some other reason, especially in presence of above mentioned signs and symptoms.
3. Numerous tests are available to diagnose CKD. Besides the ones that are used to identify the underlying cause (as mentioned in Step 1), the following tests are specific for kidneys: serum creatinine, BUN (Blood Urea Nitrogen), GFR (Glomerular Filteration Rate), urinalysis, FENa (Fractional Urine sodium excretion), complete blood count, plasma erythropoitin level (hormone that is secreted by kidneys necessary for blood cell production), serum calcium and phosphate levels, vitamin D levels, kidney ultrasound, helical CT scan, MRI (some cases), PET scan (especially in malignancies), kidney biopsy, inulin or iothalamate clearance, cimetidine induced competitive inhibition of creatinine secretion, and serum cystatin C.
4. Kidney Early Evaluation Program (KEEP). The NKF-sponsored KEEP is a screening program for individuals 18 years of age or older who are at high risk for developing CKD. KEEP offers free blood and urine testing, on-site consultation by a physician, referrals and additional follow-ups for those whose test results are abnormal, and for individuals with diabetes, hypertension and/or positive family history of CKD.

Tips & Warnings

• The NIDDK (National Institute of Diabetes and Digestive and Kidney Diseases) has started the NKDEP (National Kidney Disease Education Program) that aims at increasing awareness of the risk for CKD among the primary care physicians.