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Kidney diseases Diagnosis

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Diagnosis

Initial Visit

Medical history

• Assessment of the main renal signs and symptoms
• Some pre-existing diseases may be associated with actual renal diseases, e.g. diabetes, arterial hypertension, gout, analgesic abuse, or former episodes of kidney diseases (malformations, urolithiasis, recurrent urinary tract infections)
• Family history

Important clinical signs and symptoms

The main symptoms why patients consult their physicians can be divided into four groups:

Alterations of micturition

• Dysuria: e.g. in prostatic hypertrophy, urethritis or cystitis
• Increased frequency: e.g. residual urine, edema, cystitis
• Urgency: e.g. in cystitis
• Anuria (≤ 200 ml/day) and oliguria (≤ 500 ml/day): e.g. obstruction of the urinary tract, renal failure
• Polyuria (≥ 3000 ml/day): e.g. decompensated pancreatic diabetes

Pain

• Dull flank pain: e.g. acute pyelonephritis, obstruction, nephritic syndrome
• Suprapubic pain: e.g. cystitis (see urinary tract infections)
• Colic pain: urolithiasis

Edema

In renal diseases, an edema occur in the following disorders:

• Nephritic syndrome (glomerular nephritis)
• Nephrotic syndrome
• Renal failure

Hematuria

75 percent of all cases of hematuria are caused by tumors, urinary tract obstructions, urolithiasis or infections.

• Macroscopic hematuria: visible blood in the urine
• Microscopic hematuria: detected by means of Combur-Test® urine test strip or microscope

Clues for evaluation of hematuria

Distinguish between a hematuria with and without pain (hematuria without pain is to be suspected as a tumor) Distinguish between initial hematuria (e.g. urethra), terminal hematuria (e.g. bladder neck or trigone) or total hematuria (e.g. kidney, bladder, prostate) Urine: include examination with Combur-Test® urine test strip and microscope Ensure there is no contamination from menstrual blood in women Watch out! A urologic evaluation has to be performed during the bleeding phase of every macroscopic hematuria In about 15 percent of microscopic hematuria the cause is not detected. The American Urological Association recommends some kind of follow-up procedure because some patients with a negative result for asymptomatic microscopic hematuria eventually develop a serious urologic disease.

Diagnostics Procedures

With early detection and management, and in coordination with the nephrologist, the primary care provider has an opportunity to reduce or delay the progression to end-stage kidney failure.

Urine test strips

Urine test strips are a central and cost-effective diagnostic instrument, their ease of use yielding quick and reliable information on pathological changes in the urine. Their significance lies primarily in first-line diagnostics. Routine testing of the urine with multiparameter strips, allowing a determination of the complete urine status, is therefore the first step in the diagnosis of very wide range of disease pictures.

Roche Diagnostics' Combur-Test® urine test strips are most suitable for rapid screening of diseases of the kidney and the urogenital tract in your office with high sensitivity and sufficiently high diagnostic specificity.

Screening urinalysis parameters for diseases of the kidney and urogenital tract are:

• Leukocytes
• Nitrite
• Protein
• Blood
• Specific Gravity
• pH

For early detection of microalbuminuria, particularly if diabetic or hypertensive nephropathy is suspected, use Micral-Test®, an immunological test which allows the specific detection of human albumin in urine. With a cut-off at 20 mg/l the sensitivity is 97 percent and the specificity is 71 percent. Therefore Micral-Test® detects also albumin concentrations which are below the detection limit of conventional urine test strips.

Other urine tests

• Urine culture with susceptibility testing: a standard method used to detect bacteriuria, but is lengthy and requires special laboratories
• Microscopic urinalysis: detection of bacteriuria, pyuria, hematuria and assessment of casts as well as other cell constituents. It is unsuitable in physicians' offices
• 24-hour urine: quantitative assessment of proteinuria and creatinine clearance

Blood

• Detection of higher concentrations of substances usually eliminated with the urine, e.g. creatinine, urea and uric acid in order to estimate glomerular filtration rate
• Clearance tests to determine the renal function

Creatinine, urea and uric acid can immediately be determined in the physician's office with the Reflotron® Plus or Reflotron® sprint meters using Reflotron® Tests.

Imaging

• Sonography: fast and non-invasive method for a general practitioner to assess the urinary tract
• Plain X-rays of the abdomen: of less importance in nephrology today
• Intravenous urography
• Computer tomography scanner and nuclear spin tomography

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