If a kidney disease is suspected, the doctor will take a medical history, do a physical exam, and order urine tests, blood tests, imaging studies, or a biopsy to help make a diagnosis. These studies are usually suggested by a nephrologist, a doctor who specializes in the diagnosis and treatment of kidney diseases.
With urinalysis (a type of urine test), the doctor can quickly detect abnormalities (such as too many red blood cells) that may signal inflammation or irritation in the urinary tract. Urinalysis can also detect an of excess white blood cells, which is most commonly associated with bladder and kidney infections.
Certain blood tests tell doctors how well the kidneys are filtering waste products and balancing the bloodstream's chemical makeup.
Two other important diagnostic tools doctors use are blood pressure and growth measurements. Along with the heart, the kidneys are crucial to determining blood pressure. High blood pressure in a child is an important sign that the kidneys need to be evaluated. Accurate growth measurements can provide a clue to diagnosing some kidney diseases because kids with chronic kidney disease often have growth problems.
The doctor may use a kidney biopsy to evaluate kidney function. A biopsy is a procedure in which a small piece of the kidney tissue is removed with a needle. Performed while a child is under anesthesia, it's a simple procedure that can help make an accurate diagnosis of the kidney problem in about 9 out of 10 cases. It's especially helpful in the diagnosis of nephritis and nephrosis.
In addition to standard X-rays, other imaging studies a doctor may use to help diagnose kidney diseases include:
The most commonly used imaging study, an ultrasound is painless and requires no X-ray exposure or special preparation. A renal ultrasound shows details of the anatomy of the kidneys and bladder. It can rule out or diagnose obstructions, developmental abnormalities, tumors, and stones in the kidneys and urinary tract.
A CAT scan is often helpful in revealing the anatomy of the kidneys or bladder and, in some cases, is better than ultrasound for finding kidney stones. It can show if the kidneys have developed properly or if the flow of urine is blocked by a stone or a developmental abnormality.
A renal nuclear scan involves having special radioactive material injected into a vein. The radiation dose is less than that of a simple X-ray. The scan shows how the kidneys compare with each other in size, shape, and function. It also can detect scarring or other evidence of recurrent or chronic kidney infection.
VCUG is commonly used to evaluate the bladder and the ureters. This procedure involves putting a dye into the bladder to see whether there's an obstruction or a reflux of urine from the bladder back up to the kidneys when the child urinates.
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