Since many CKD patients also have high blood pressure, blood pressure measurement is an important first step toward a proper diagnosis. However, doctors use two main tests to measure kidney function and determine a patient’s stage of kidney disease, according to Vassalotti. The first test is known as estimated glomerular filtration rate, or eGFR. A doctor will first do a blood test to determine how much creatinine — a chemical waste molecule generated by muscle metabolism — is present in the bloodstream. Creatinine levels, as well as factors such as age, gender and body size, are then used to estimate the rate of glomerular filtration (the rate at which the kidneys filter blood).
Another common test used to diagnose kidney disease is called the urine albumin to creatinine ratio test (ACR), or the microalbumin test. The test measures the amount of albumin, a blood protein, in the urine. This test is typically used to detect early signs of kidney damage in those at risk of developing kidney disease, according to the Mayo Clinic.
If a doctor finds that you have had a GFR below 60 for three months or more, he or she may diagnose you with chronic kidney disease. A GFR above 60 with signs of kidney damage — as indicated by high levels of albumin in the urine — may also result in a diagnosis of CKD, according to the National Kidney Foundation.
Once a diagnosis has been made, your doctor will likely investigate possible causes of the disease, monitor your kidney function and help plan your treatment.
According to the NKF, other possible tests that may be conducted after a diagnosis of CKD has been made include:
Imaging tests, such as ultrasound or CT scans: These help doctors learn more about the size and condition of kidneys, as well as whether other conditions, such as tumors or kidney stones, are present.
Kidney biopsy: This test may be done to check for specific types of kidney disease or to see how much damage has occurred in order to plan further treatment.Most kidney diseases do not have a specific drug treatment, according to Vassalotti, who said that the first goal in treating kidney disease is to address the underlying causes of the disease and stop the disease from progressing. This means treating conditions like diabetes and high blood pressure, he said.
Patients with hypertension, or high blood pressure, should take blood pressure medications and adopt a healthy diet and exercise routine. Those with acute infections, such as a urinary tract infection, should be treated with antibiotics or have any obstructions in the urinary tract removed, according to the Mayo Clinic. As patients undergo treatments for kidney disease or begin taking new medications, they need to keep all of their doctors in the loop about what medications and therapies they are using, according to Vassalotti.
“Many drugs are cleared by the kidney, so that drug may need to be dose-adjusted because of decreased kidney function or even avoided,” Vassalotti said. Even over-the-counter drugs can cause progression of kidney disease, he added.
Another important component of treating kidney disease is screening patients with CKD for cardiovascular disease. Though kidney and cardiovascular diseases affect different parts of the body, many of the risk factors for these conditions are the same and are also common, according to Vassalotti, who said that high blood pressure, type-2 diabetes and smoking are risk factors for both conditions.
Many studies have been published on the link between CKD and cardiovascular disease, Vassalotti said. A recent overview of the subject was published in the Journal of Nephropathology in 2014.
In severe cases and end-stage kidney disease, where there’s a complete or near-complete failure of the kidneys to excrete waste, concentrate urine and regulate electrolytes, the patient may need to undergo dialysis treatments, according to the Mayo Clinic.
There are two different kinds of dialysis treatment, according to the National Kidney Foundation. In hemodialysis, an artificial kidney called a hemodialyzer is used to remove waste and excess chemicals and fluid from the blood. To get blood from a patient’s body to the artificial kidney, a doctor performs a minor surgery to connect a blood vessel (usually in the arm or leg) to the artificial kidney.
In peritoneal dialysis, a patient’s blood is cleaned inside his or her body instead of by an external hemodialyzer. The doctor first performs a surgery to place a plastic tube, or catheter into the abdomen (also known as the peritoneal cavity). The abdomen is slowly filled with a fluid known as dialysate, which absorbs extra fluids and waste products from the blood located outside the abdomen walls. Once the dialysate has done its job, it travels back outside the body through the catheter. There are two main kinds of peritoneal dialysis: continuous ambulatory peritoneal dialysis (CAPD), which is done without a machine and automated peritoneal dialysis (APD), which requires a special machine called a cycler.