Diagnosis of Chronic Kidney Disease

by Diane W. Shannon, MD, MPH

Your doctor will ask about your symptoms and health history. A physical exam will be done.

You may have these tests:

Blood Tests

Blood tests measure the amount of wastes, proteins, or other products found in the bloodstream. The numbers tell how well your kidneys are working.

Tests may include:

Blood urea nitrogen (BUN) and creatinine —Waste products that kidneys remove from the blood. The numbers measure the glomerular filtration rate (GFR). GFR is a measurement of how well the kidneys are filtering wastes.
Complete blood count (CBC)—Measures the numbers of blood products to see if they’re in a normal range. For example, not enough red blood cells may point to anemia.
Other blood products such as minerals, hormones, or proteins.

Urine Tests

The kidneys filter blood and make urine. The proteins are supposed to return to the bloodstream. With chronic kidney disease (CKD), the protein stays in the urine. There are many proteins. One called albumin appears in the urine of people who have CKD. This CKD is caused by high blood pressure or diabetes.

Tests may include:

24 hour urine protein—the amount of protein made over 24 hours
Dipstick for urine protein—the amount of protein in a single sample taken first thing in the morning
Microalbumin screening in people who have type 1 or type 2 diabetes 24 hour urine albumin—the amount of this protein made over 24 hours
Dipstick for urine albumin—the amount of this protein in a single sample
Protein to creatinine ratio—amount of protein to the amount of creatinine in a sample
Albumin to creatinine ratio—amount of albumin to creatinine in a sample
Protein-to-creatinine ratio—amount of protein to the amount of creatinine in a sample
Albumin-to-creatinine ratio—amount of albumin to creatinine in a sample

Estimated Glomerular Filtration Rate

Your doctor can figure out the GFR based on your:

Gender
Age
Body size
Blood creatinine level

CKD stages are based on the GFR:

Stage	GFR
1	Over 90 mL/min (normal)
2	60 to 89 mL/min (mild decrease)
3	30 to 59 mL/min (moderate decrease)
4	15 to 29 mL/min (severe decrease)
5	under 15 mL/min (kidney failure or end-stage renal disease)

Imaging Tests

An ultrasound or CT scan can help your doctor look for problems in the urinary system. They may reveal a kidney stone, tumor, or other problem that’s causing CKD.

Kidney Biopsy

During a kidney biopsy, a small piece of tissue is removed. It’s examined under a microscope. The biopsy can tell how much kidney damage there is. It also may also help with finding a cause.

References:

About chronic kidney disease. National Kidney Foundation website. Available at: https://www.kidney.org/atoz/content/about-chronic-kidney-disease. Updated February 15, 2017. Accessed June 18, 2018.

Chronic kidney disease. Merck Manual Professional Version website. Available at: https://www.merckmanuals.com/professional/genitourinary-disorders/chronic-kidney-disease/chronic-kidney-disease. Updated March 2017. Accessed June 18, 2018.

Chronic kidney disease (CKD). Family Doctor—American Academy of Family Physicians website. Available at: https://familydoctor.org/condition/chronic-kidney-disease-ckd. Updated August 9, 2017. Accessed June 18, 2018.

Chronic kidney disease (CKD) in adults. EBSCO DynaMed Plus website. Available at: http://www.dynamed... . Updated May 14, 2018. Accessed June 18, 2018.

Chronic kidney disease tests & diagnosis. National Institute of Diabetes and Digestive and Kidney Diseases website. Available at: https://www.niddk.nih.gov/health-information/kidney-disease/chronic-kidney-disease-ckd/tests-diagnosis. Updated October 2016. Accessed June 18, 2018.

Last reviewed May 2018 by EBSCO Medical Review Board Adrienne Carmack, MD
Last Updated: 06/18/2018

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