This damage happens over many years. As more damage occurs, the kidneys are unable to keep the body healthy - then dialysis or a kidney transplant may be needed to maintain health. How can I lower my risk for CKD? The steps you take to manage your diabetes and high blood pressure also help protect your kidneys. Choosing healthy foods, quitting smoking, and being more physically active are all important steps. What are the symptoms of CKD? Most people with CKD have no symptoms until their kidneys are about to fail.
The only way to know if you have kidney disease is to get tested. The sooner kidney disease is found, the sooner you can take steps to begin treatment and keep your kidneys healthier longer. How do you check for CKD? A blood test and a urine test are used to find kidney disease. Because you are at risk, you should get these tests regularly:. Can CKD get better? CKD usually will not get better and is likely to get worse.
Treatment helps slow kidney disease and keep the kidneys healthier longer. How is CKD treated? The National Kidney Disease Education Program, operating under the NIH, is working with clinical laboratories and autoanalyzer manufacturers to calibrate serum creatinine assays using an international standard and to build GFR reporting into the systems. The practical implication of having the GFR readily available goes beyond the issue of classification of chronic disease: it allows adjustment of drug doses to the level of kidney function.
Urine normally contains small amounts of protein. However, a persistent increase in protein excretion usually is a sign of kidney damage. The type of protein, such as low-molecular-weight globulins or albumin, depends on the type of kidney disease. Increased excretion of low-molecular-weight globulins is a sensitive marker of some types of tubulointerstitial disease. Increased excretion of albumin is a sensitive marker of chronic kidney disease resulting from diabetes mellitus, glomerular disease, or hypertension.
Evaluation of proteinuria or microalbuminuria generally does not require a timed overnight or hour urine collection NKF grades R and C. If two or more quantitative tests performed one to two weeks apart are positive, persistent proteinuria should be diagnosed, and the patient should undergo further evaluation for chronic kidney disease see guideline 2 in part I 3. In adults with chronic kidney disease, proteinuria should be monitored with the albumin-to-creatinine ratio NKF grade O.
Just as a hour urine collection for creatinine has been the gold standard for determining creatinine clearance, a hour urine collection for protein has been the gold standard for quantitative evaluation of proteinuria. An alternative method is measurement of the ratio of protein or albumin to creatinine in an untimed urine specimen. These ratios correct for variations in urinary protein concentration related to hydration and are more convenient than timed urine collections.
Evidence indicates that the ratio of protein or albumin to creatinine in a spot urine sample provides an accurate estimate of the excretion rate. It usually is unnecessary to obtain a timed urine collection overnight or hour for these evaluations. Albumin measurements may be more costly and technically difficult than total protein measurements.
Therefore, the total protein-to-creatinine ratio is an acceptable alternative if the albumin-to-creatinine ratio is high. The proposed algorithm for the evaluation of proteinuria distinguishes between patients who are at increased risk for kidney disease and asymptomatic, healthy patients who are not at increased risk Figure 1. Alternatively, testing can begin with a spot urine test for the albumin-to-creatinine ratio.
A positive test should be repeated using a quantitative measurement. Only patients with persistent proteinuria are diagnosed with chronic kidney disease. This guideline is useful to family physicians because it eliminates the need for patients to provide a hour urine sample for quantification of proteinuria. The suggestion to measure albumin excretion, rather than total protein excretion, is a departure from current clinical practice. Note, however, that albumin assays may not be available at all clinical laboratories.
In addition to proteinuria, markers of damage to the kidneys include abnormalities in the urinary sediment and abnormal findings on imaging studies. Some types of chronic kidney disease are defined by constellations of markers. For other types of chronic kidney disease, new markers are needed to identify kidney damage that occurs before a reduction in the GFR.
Examination of urinary sediment or dipstick testing for red and white blood cells should be performed in patients with chronic kidney disease and in patients who are at risk for the disease. Imaging studies of the kidneys also should be obtained in these patients. Several new urinary markers, including tubular and low-molecular-weight proteins and specific mononuclear cells, show promise. At present, however, they should not be used for clinical decision-making NKF grade C. As discussed in guideline 5, abnormal urinary albumin or total protein excretion is a highly sensitive marker of glomerular diseases, including diabetic kidney disease.
Urinary sediment examination, kidney imaging studies, and specific clinical presentations also can suggest the type of chronic kidney disease. A urinary sediment examination, especially when performed in conjunction with an assessment for proteinuria, is useful in detecting chronic kidney disease and identifying its type.
Urine dipsticks include reagent pads that are sensitive for detecting red blood cells hemoglobin , white blood cells leukocyte esterase , and bacteria nitrites. The dipsticks cannot detect tubular epithelial cells, fat, or casts, crystals, fungi, or parasites.
The decision to perform a urinary sediment examination or urine dipstick test depends on the type of kidney disease that is being considered.
This test is a measure of how well the kidneys are removing wastes and excess fluid from the blood. It is calculated from the serum creatinine level using age and gender. Normal GFR can vary according to age as you get older it can decrease. The normal value for GFR is 90 or above.
A GFR below 60 is a sign that the kidneys are not working properly. Once the GFR decreases below 15, one is at high risk for needing treatment for kidney failure, such as dialysis or a kidney transplant. Urea nitrogen comes from the breakdown of protein in the foods you eat. A normal BUN level is between 7 and As kidney function decreases, the BUN level rises. This test uses sound waves to get a picture of the kidney. It may be used to look for abnormalities in size or position of the kidneys or for obstructions such as stones or tumors.
This imaging technique uses X-rays to picture the kidneys. A single symptom may not mean something serious. Kidney function tests can help determine the reason. To test your kidney function, your doctor will order a set of tests that can estimate your glomerular filtration rate GFR.
Your GFR tells your doctor how quickly your kidneys are clearing waste from your body. A urinalysis screens for the presence of protein and blood in the urine. There are many possible reasons for protein in your urine, not all of which are related to disease. Infection increases urine protein, but so does a heavy physical workout. Your doctor may want to repeat this test after a few weeks to see if the results are similar.
Your doctor may also ask you to provide a hour urine collection sample. This can help doctors see how fast a waste product called creatinine is clearing from your body. Creatinine is a breakdown product of muscle tissue. This blood test examines whether creatinine is building up in your blood. The kidneys usually completely filter creatinine from the blood. A high level of creatinine suggests a kidney problem. The blood urea nitrogen BUN test also checks for waste products in your blood.
BUN tests measure the amount of nitrogen in the blood. Urea nitrogen is a breakdown product of protein. However, not all elevated BUN tests are due to kidney damage. Common medications, including large doses of aspirin and some types of antibiotics, can also increase your BUN.
You may need to stop certain drugs for a few days before the test.
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