From Testing to Treatment

Understanding Your Kidney Disease Roadmap

Being told that your kidney test is abnormal can start a long, sometimes confusing process.

A healthcare professional may order blood tests, urine tests, kidney ultrasounds, chest X-rays, heart tests, CT scans, or other studies. In certain situations, a kidney biopsy may also be recommended.

Patients may wonder:

Why do I need so many tests?
What is each test looking for?
Why are some tests being repeated?
Are my kidneys permanently damaged?
Can the cause be treated?
Is my condition getting worse?
Will I eventually need dialysis?
Why are doctors testing my heart when the problem is my kidneys?

These tests are not usually ordered at random. Each test helps answer a different part of the kidney-health puzzle.

Together, the results create a roadmap that may help doctors identify the cause, protect remaining kidney function, manage complications, slow progression, and prepare for future treatment before an emergency develops.

Why Doctors Order So Many Tests

The kidneys perform several important jobs.

They help:

Filter waste from the blood
Remove excess sodium and fluid
Balance potassium and other electrolytes
Regulate blood pressure
Maintain the body’s acid balance
Support red blood cell production
Help maintain healthy bones and minerals

Because the kidneys affect many parts of the body, doctors may need several types of tests to understand what is happening.

They may be trying to determine:

How well the kidneys are filtering
Whether kidney damage is present
Whether the condition is temporary or long-term
How quickly kidney function is changing
Whether blood or protein is leaking into the urine
Whether there is a blockage
Whether the kidneys are unusually small, large, scarred, or swollen
Whether a cyst, stone, infection, or mass is present
Whether diabetes or high blood pressure is contributing
Whether an immune or inflammatory disease is involved
Whether the heart is affecting kidney function
Whether kidney disease is causing anemia or mineral problems
Whether treatment is helping
Whether dialysis or transplant planning may eventually be needed

Not every patient needs every test. The testing plan should be based on the person’s symptoms, medical history, laboratory results, kidney function, medications, and overall health.

The Roadmap Often Begins With an Abnormal Result

Kidney disease may first be discovered during:

A routine physical examination
Blood testing for another medical condition
Diabetes monitoring
High blood pressure treatment
A hospital stay
An emergency-room visit
A heart evaluation
Testing before surgery
A urine test showing blood or protein
An examination for swelling or shortness of breath
A medication review

Many people have few or no symptoms during the earlier stages of chronic kidney disease.

A person may feel well, continue working, and continue producing urine even as kidney function declines.

This is why abnormal blood or urine results should not be ignored simply because the person does not feel sick.

Step One: Medical History and Physical Examination

Before ordering more tests, a healthcare professional will usually ask questions about the person’s health and symptoms.

The medical history may include questions about:

Diabetes
High blood pressure
Heart disease
Heart failure
Family history of kidney disease
Previous kidney injury
Kidney stones
Urinary infections
Autoimmune conditions
Cancer
Recent infections
Surgery or hospitalization
Changes in urination
Swelling
Shortness of breath
Weight gain or weight loss
Pain
Nausea or poor appetite
Medications
Over-the-counter pain relievers
Vitamins and supplements
Herbal products
Drug or alcohol use
Previous laboratory results

The physical examination may include:

Blood-pressure measurement
Heart-rate measurement
Weight
Examination for swelling
Listening to the heart
Listening to the lungs
Examining the abdomen
Looking for signs of dehydration
Checking the skin
Reviewing circulation
Evaluating signs of fluid overload

These questions and observations help the healthcare professional decide which tests are necessary.

Step Two: Blood Tests for Kidney Function

Blood tests help show how well the kidneys are filtering and whether kidney disease is affecting other parts of the body.

Several different blood tests may be ordered.

Creatinine

Creatinine is a waste product created through normal muscle activity.

Healthy kidneys remove most creatinine from the bloodstream. When kidney filtration declines, the creatinine level may rise.

A higher creatinine level may suggest reduced kidney function, but it should not be interpreted in isolation.

The result may also be affected by:

Age
Muscle mass
Body size
Amputation
Diet
Certain medications
Dehydration
Severe illness
Recent strenuous exercise

A creatinine level that is normal for one person may not represent normal kidney function for someone else.

Doctors commonly use creatinine to estimate glomerular filtration rate.

Estimated Glomerular Filtration Rate

The estimated glomerular filtration rate (eGFR) indicates how well the kidneys filter the blood.

In general, a lower eGFR suggests lower kidney filtration.

Healthcare professionals usually look at:

The current eGFR
Previous eGFR results
How quickly the number is changing
Whether the result remains abnormal
Whether urine albumin or other kidney damage is present
The person’s age, history, and overall condition

One low eGFR does not always prove that a person has chronic kidney disease.

Kidney function may temporarily decline because of:

Dehydration
Infection
Severe illness
Low blood pressure
Medication effects
Urinary blockage
Heart failure
Acute kidney injury

Chronic kidney disease generally involves kidney damage or reduced kidney function that continues for at least three months.

Blood Urea Nitrogen

Blood urea nitrogen, commonly called BUN, measures a waste product created when the body breaks down protein.

BUN may rise when kidney filtration declines, but it can also be affected by:

Dehydration
High protein intake
Internal bleeding
Infection
Certain medications
Severe illness
Liver function

BUN is usually interpreted along with creatinine, eGFR, symptoms, and other laboratory results.

Cystatin C

In some situations, a healthcare professional may order a cystatin C test.

Cystatin C is another substance that can be used to estimate kidney filtration. It may be helpful when creatinine-based estimates are less reliable, such as in someone with unusually high or low muscle mass.

Not everyone with kidney disease needs cystatin C testing.

Electrolyte and Acid-Balance Tests

The kidneys help regulate several electrolytes and minerals.

Blood testing may include:

Potassium
Sodium
Chloride
Bicarbonate
Calcium
Phosphorus
Magnesium

These tests help identify complications that may affect the heart, nerves, muscles, bones, blood vessels, or breathing.

For example:

Potassium that is too high or too low can affect the heartbeat.
Low bicarbonate may indicate that too much acid is building up in the body.
Abnormal calcium and phosphorus levels may contribute to bone and blood vessel problems.
Sodium levels may change with fluid imbalance, medications, or illness.

A person can have a serious electrolyte abnormality without obvious symptoms.

Blood Tests for Anemia and Nutrition

The kidneys help produce a hormone involved in red blood cell production.

As kidney function declines, some people develop anemia.

Testing may include:

Hemoglobin
Hematocrit
Iron levels
Ferritin
Transferrin saturation
Vitamin B12
Folate

Symptoms of anemia may include:

Fatigue
Weakness
Shortness of breath
Dizziness
Pale skin
Reduced ability to exercise
Fast heartbeat

Albumin and other blood tests may also be used to evaluate nutrition, inflammation, liver function, or protein loss.

A low albumin result can have several possible causes and does not automatically mean that a person is not eating enough protein.

Diabetes and Cholesterol Testing

Because diabetes is a major cause of kidney disease, doctors may test:

Fasting blood glucose
Random blood glucose
Hemoglobin A1C

Cholesterol and triglyceride testing may also be ordered because chronic kidney disease increases cardiovascular risk.

These results may help guide:

Diabetes medications
Dietary recommendations
Blood-pressure treatment
Cholesterol medications
Heart-risk reduction

Step Three: Urine Testing

Blood tests estimate how well the kidneys are filtering. Urine tests can reveal signs of kidney damage and help identify the possible cause.

Someone may have abnormal urine results even when the eGFR has not fallen significantly.

Routine Urinalysis

A urinalysis examines the urine for several substances and abnormalities.

It may check for:

Protein
Albumin
Blood
Glucose
White blood cells
Signs of infection
Crystals
Concentration
Acidity
Ketones
Other abnormal findings

Blood in the urine may come from the kidneys, bladder, urinary tract, prostate, stones, infection, or another condition.

Protein in the urine may indicate damage to the kidney filters, but temporary protein may also occur during fever, intense exercise, severe illness, or dehydration.

Abnormal findings may need to be confirmed through repeat or more specialized testing.

Urine Albumin-to-Creatinine Ratio

The urine albumin-to-creatinine ratio, or uACR, measures the amount of albumin in a urine sample compared with creatinine.

Albumin is a protein normally found in the blood. Healthy kidneys generally filter out most albumin from the urine.

When the kidney filters are damaged, albumin may leak into the urine.

The uACR may help doctors:

Detect kidney damage early
Estimate future risk
Monitor progression
Evaluate diabetes-related kidney damage
Determine whether treatment is reducing urine protein
Guide certain medication decisions

The two central measurements used to identify and monitor chronic kidney disease are often the eGFR and urine albumin.

Protein in the Urine

Albumin is one type of protein, but doctors may sometimes measure total urine protein.

Larger amounts of protein in the urine may occur with conditions affecting the kidneys’ filtering units.

Protein loss may be associated with:

Foamy urine
Swelling
Low blood albumin
High cholesterol
Increased risk of blood clots
Faster kidney-disease progression

Not all foamy urine is caused by protein. Urine testing is needed to determine whether abnormal protein loss is present.

Twenty-Four-Hour Urine Collection

In some situations, a person may be asked to collect all urine produced during a 24-hour period.

This test may help measure:

Total protein loss
Creatinine clearance
Certain minerals
Kidney-stone risk factors
Urine volume
Other substances

The collection must usually include all urine produced during the specified period.

Missing part of the collection may make the result less accurate.

Patients should follow the laboratory’s instructions carefully regarding timing, storage, and return of the container.

Urine Culture

When an infection is suspected, a urine culture may be ordered.

This test can identify bacteria or other organisms and help determine which treatment may be effective.

A urine culture is different from a routine urinalysis, although the tests may be ordered together.

Why Blood and Urine Tests May Be Repeated

One abnormal result does not always provide the complete answer.

Doctors may repeat tests to determine whether the problem is:

Temporary
Improving
Stable
Progressing
Related to a medication
Related to dehydration
Related to infection
Related to high blood pressure
Related to diabetes
Related to urinary blockage
Related to heart failure
Part of chronic kidney disease

Repeated testing also helps identify trends.

A single test is one picture. Several tests over time create a clearer roadmap.

Step Four: Kidney Ultrasound or Sonogram

A kidney ultrasound, sometimes called a renal ultrasound or sonogram, uses sound waves to create images.

It does not usually expose the patient to ionizing radiation.

An ultrasound may examine the following:

Kidneys
Bladder
Urinary tract
Blood flow in certain situations

Doctors may use an ultrasound to look for:

Kidney size
Kidney shape
Cysts
Stones
Tumors or masses
Scarring
Urine backup
Hydronephrosis
Enlarged prostate effects
Bladder retention
Urinary blockage
Structural abnormalities

Kidneys that appear unusually small may suggest long-standing damage in some situations. Enlarged or abnormal-looking kidneys may suggest other conditions.

However, an ultrasound cannot always identify the exact disease affecting the microscopic filters inside the kidneys.

A normal-looking ultrasound does not necessarily mean that kidney function is normal.

Bladder Scans and Post-Void Testing

Some patients may have a bladder scan before or after urination.

This can help determine whether urine is remaining in the bladder instead of emptying normally.

Urine retention may occur because of:

Enlarged prostate
Nerve problems
Medication effects
Bladder weakness
Urinary obstruction
Other urologic conditions

An obstruction that continues for too long may damage the kidneys.

Step Five: CT Scans and MRI Studies

A CT scan or MRI may be ordered when a more detailed image is needed.

These studies may help evaluate:

Kidney stones
Cysts
Masses
Cancer
Blood vessels
Urinary obstruction
Kidney injuries
Infections
Unusual kidney anatomy
Problems in the surrounding organs

A CT scan uses X-rays to create detailed images.

An MRI uses a magnetic field and radio waves.

The correct test depends on what the doctor is trying to identify.

Understanding Imaging Contrast

Some CT and MRI studies use contrast material to make certain structures easier to see.

CT contrast and MRI contrast are not the same substance.

Before receiving contrast, tell the imaging team about:

Kidney disease
Previous kidney failure
Dialysis
Remaining urine production
Kidney transplant
Previous contrast reactions
Allergies
Pregnancy
Diabetes
Current medications
Recent laboratory results

Contrast is not automatically prohibited for every person with kidney disease. The benefits and risks depend on the type of contrast, the person’s current kidney function, whether the kidneys are acutely injured, the purpose of the test, and available alternatives.

Do not refuse or accept contrast based only on general information from another patient. Ask the ordering doctor and imaging team how the decision applies to your individual condition.

Step Six: Specialized Blood Testing

When the cause of kidney damage is unclear, a nephrologist may order additional blood tests.

These tests may look for:

Autoimmune disease
Lupus
Vasculitis
Abnormal immune activity
Complement abnormalities
Hepatitis
HIV
Certain infections
Abnormal blood proteins
Bone-marrow or blood disorders
Inherited conditions
Inflammation
Other less-common causes

Being tested for a condition does not mean the doctor has concluded that the patient has it.

Doctors often order a group of tests to rule out several possible causes.

Some test names may sound frightening. Ask the healthcare professional to explain:

What condition is the test checking for
Why is that condition being considered
What a positive result would mean
Whether another test would be needed to confirm it

Genetic Testing

Genetic testing may sometimes be considered when:

Kidney disease runs in the family
The disease began at a young age
Multiple family members have kidney failure
The kidneys have a particular structural pattern
An inherited condition is suspected
The cause remains unclear
The information could affect relatives or transplant decisions

Genetic results can be complicated.

Patients may benefit from genetic counseling before or after testing so they understand what the results may mean for themselves and family members.

Step Seven: Heart and Lung Testing

Heart and lung tests may be included because kidney function, blood pressure, circulation, and fluid balance are closely connected.

A patient with swelling, shortness of breath, chest symptoms, fluid overload, or heart disease may undergo additional testing.

Chest X-Ray

A chest X-ray may help doctors look for:

Fluid congestion in the lungs
Fluid around the lungs
Heart enlargement
Pneumonia
Other lung conditions
Possible causes of shortness of breath

A chest X-ray does not show every heart or lung problem, but it may provide important information when breathing symptoms or fluid overload are present.

Electrocardiogram

An electrocardiogram, also called an ECG or EKG, records the heart’s electrical activity.

It may help identify:

Abnormal heart rhythms
A very fast or slow heartbeat
Signs of previous heart damage
Changes related to abnormal potassium
Other electrical abnormalities

An ECG does not directly measure kidney function. It may be ordered because kidney-related electrolyte problems can affect the heart.

Echocardiogram

An echocardiogram uses sound waves to examine the heart.

It may provide information about:

How strongly the heart pumps
How the heart fills
Heart-chamber size
Heart-muscle thickness
Heart valves
Pressure patterns
Fluid around the heart
Ejection fraction

Heart weakness or stiffness may reduce blood flow to the kidneys and contribute to fluid retention.

Understanding heart function helps doctors determine whether the kidneys and heart may be affecting each other.

BNP or NT-proBNP Testing

BNP and NT-proBNP are blood tests that may help evaluate heart strain and possible heart failure.

The results must be interpreted carefully because kidney disease can also affect these levels.

A high result does not automatically provide a complete diagnosis. Doctors may consider it along with:

Symptoms
Physical examination
Kidney function
Chest imaging
Echocardiogram results
Medical history

Stress Tests and Other Heart Evaluations

Depending on symptoms and risk factors, a patient may also undergo:

Exercise stress testing
Medication-based stress testing
Nuclear heart imaging
Heart rhythm monitoring
Cardiac catheterization
Blood-vessel testing

These tests may be used when doctors are evaluating chest symptoms, circulation, surgical risk, heart disease, or transplant eligibility.

Step Eight: When a Kidney Biopsy May Be Recommended

A kidney biopsy may be recommended when blood tests, urine tests, and imaging do not provide enough information.

A biopsy removes a very small amount of kidney tissue so that it can be examined under a microscope.

A biopsy may help identify:

Inflammation
Scarring
Immune deposits
Injury to the kidney filters
A specific glomerular disease
Nephrotic syndrome
Lupus-related kidney disease
Vasculitis
Certain infections
Medication-related damage
Rejection or other problems in a transplanted kidney
The amount of permanent damage
Whether a particular treatment may help

The biopsy result may provide a more specific diagnosis than blood or urine testing alone.

Why a Biopsy May Matter

Different kidney diseases can cause similar symptoms and laboratory findings.

For example, several conditions may cause:

Protein in the urine
Blood in the urine
Swelling
High blood pressure
A rising creatinine
A falling eGFR

However, the correct treatment may vary widely depending on the specific disease.

One condition may require immune-suppressing treatment. Another may require blood-pressure control and observation. Another may show too much permanent scarring for aggressive treatment to provide meaningful benefit.

A biopsy may help answer:

What type of kidney disease is present?
How active is the disease?
How much scarring is present?
Is the damage potentially treatable?
Is treatment working?
Is a transplanted kidney being rejected?
What is the likely outlook?

Why Not Everyone Needs a Kidney Biopsy

A biopsy is not required for every person with chronic kidney disease.

Doctors may be able to identify the likely cause through:

A long history of diabetes
Long-standing high blood pressure
Medical history
Blood testing
Urine testing
Ultrasound findings
Family history
Other clear clinical information

A biopsy may not be recommended when:

The result is unlikely to change treatment
The kidneys appear severely scarred or unusually small
The risk of bleeding is too high
Blood pressure cannot be safely controlled
The patient has certain bleeding problems
Another safer test can provide the needed information
The likely diagnosis is already sufficiently clear

The decision should balance the possible benefit of the information against the risks of the procedure.

How a Kidney Biopsy Is Usually Performed

Most kidney biopsies are performed through the skin.

The patient usually lies in a position that allows the doctor to reach the kidney safely.

The healthcare team may:

Use ultrasound or another imaging method to locate the kidney
Clean and numb the skin
Make a very small opening
Insert a biopsy needle
Ask the patient to hold their breath briefly
Remove one or more tiny tissue samples
Apply pressure and a bandage

A transplanted kidney biopsy may be performed differently because the transplanted kidney is usually located closer to the front of the lower abdomen.

The tissue is sent to a pathologist for detailed examination.

Preparing for a Kidney Biopsy

Before the procedure, the healthcare team may review:

Blood pressure
Blood counts
Blood-clotting tests
Kidney function
Allergies
Recent infections
Pregnancy status
Current medications
Blood thinners
Aspirin
NSAID pain medicines
Vitamins and supplements
Transportation home
Eating and drinking instructions

Blood thinners and certain other medications may increase the risk of bleeding.

Do not stop Eliquis, warfarin, aspirin, clopidogrel, or any other prescribed blood thinner without specific instructions from the doctor managing the biopsy and the clinician who prescribed the medication.

Stopping a blood thinner without medical guidance may increase the risk of stroke, blood clots, or other serious complications.

What Happens After a Kidney Biopsy

After a biopsy, the patient is usually observed for a period of time.

The healthcare team may monitor:

Blood pressure
Pulse
Urine
Pain
Bleeding
The biopsy area
Blood counts when necessary

The patient may need to remain lying down during part of the recovery period.

Some people may have:

Mild soreness
Tenderness near the biopsy area
A small amount of pink or blood-tinged urine for a limited period

Follow the discharge instructions carefully.

Patients may be told to avoid:

Heavy lifting
Strenuous exercise
Contact sports
Certain medications
Other activities that could increase bleeding risk

The exact restrictions and duration vary. Follow the biopsy team’s written instructions.

Possible Risks of a Kidney Biopsy

The most common concern after a kidney biopsy is bleeding.

Possible complications may include:

Blood in the urine
Bleeding around the kidney
Pain
A drop in blood pressure
A drop in hemoglobin
Need for observation or hospitalization
Need for a blood transfusion
Rare need for another procedure to stop bleeding
Infection, which is uncommon
Other rare complications

The healthcare team should explain the expected benefits, alternatives, and risks before the procedure.

Warning Signs After a Kidney Biopsy

Contact the biopsy team or seek urgent medical care as instructed for:

Increasing blood in the urine
Bright-red urine
Blood clots in the urine
Inability to urinate
Severe or worsening pain
Severe back, side, or abdominal pain
Dizziness
Fainting
Weakness
Fever
Chills
Redness, drainage, or increasing swelling at the biopsy site
Shortness of breath
Rapid heartbeat
Any rapidly worsening symptom

Call 911 for severe bleeding symptoms, fainting, severe breathing difficulty, chest pain, or another life-threatening emergency.

Understanding the Biopsy Report

Kidney biopsy reports may contain complex medical terms.

The report may describe:

Glomeruli
Tubules
Interstitium
Blood vessels
Inflammation
Fibrosis
Atrophy
Sclerosis
Immune deposits
Acute injury
Chronic injury
Rejection
Disease activity
Permanent scarring

Patients should ask the nephrologist to explain the findings in plain language.

Helpful questions include:

What is the exact diagnosis?
What caused the damage?
How much active disease is present?
How much permanent scarring is present?
Is treatment available?
What are the risks and benefits of treatment?
How will we know whether treatment is working?
What does this mean for my future kidney function?

Ask for a copy of the complete biopsy report for personal medical records.

Step Nine: How Testing Leads to Treatment

The purpose of testing is not only to name the disease.

The results may guide doctors to:

Control blood pressure more aggressively
Improve diabetes treatment
Reduce urine protein
Adjust heart-failure medication
Change a diuretic
Stop or replace a kidney-harming medication
Treat an infection
Remove a urinary obstruction
Treat an immune or inflammatory disease
Adjust sodium or fluid recommendations
Treat high potassium
Treat acid buildup
Treat anemia
Manage calcium and phosphorus
Refer the patient to a nephrologist
Refer the patient to a cardiologist
Refer the patient to a urologist
Increase the frequency of laboratory monitoring
Begin dialysis education
Plan dialysis access
Begin transplant evaluation

Testing may also show that immediate treatment is not necessary and that careful monitoring is the safest approach.

Why Some Medications Are Started After Testing

Certain medications may be prescribed to:

Lower blood pressure
Reduce protein loss in the urine
Protect heart function
Slow kidney-disease progression
Manage diabetes
Remove excess fluid
Control potassium
Correct acid imbalance
Treat anemia
Manage mineral and bone complications
Control an immune disease

Kidney function and potassium may need to be rechecked after some medications are started or adjusted.

A small change in creatinine may be expected with certain treatments, while a larger change may require evaluation.

Do not stop a newly prescribed medication based only on an isolated laboratory result without speaking with the prescribing clinician.

Step Ten: Watching Trends Over Time

Kidney disease is rarely captured by a single number.

Doctors may follow several measurements over time, including:

Creatinine
eGFR
Urine albumin
Urine protein
Potassium
Sodium
Bicarbonate
Calcium
Phosphorus
Hemoglobin
Albumin
Blood glucose
A1C
Blood pressure
Weight
Swelling
Urine output

The direction of the results may be more important than one isolated measurement.

For example:

Is eGFR stable or falling?
Is urine protein increasing or decreasing?
Is blood pressure controlled?
Is the remaining potassium safe?
Is the swelling getting worse?
Are medications helping?
Is anemia progressing?
Are symptoms changing?

Keeping records helps patients understand the pattern and ask informed questions.

When a Nephrologist May Become Involved

A nephrologist is a doctor who specializes in kidney disease, blood-pressure problems, electrolyte abnormalities, fluid balance, dialysis, and kidney failure.

A referral may be considered when:

Kidney function is significantly reduced
Kidney function is declining quickly
Large amounts of protein are present in the urine
Blood is persistently present in the urine
The cause is unclear
Potassium or acid levels are difficult to manage
Blood pressure remains uncontrolled
A biopsy may be needed
An inherited or immune disease is suspected
Dialysis preparation may be approaching
Transplant evaluation should be discussed

Early referral may provide more time to slow progression, educate the patient, and prepare for future decisions.

When a Urologist May Become Involved

A urologist specializes in the urinary tract and related structures.

A urologist may become involved when testing suggests:

Urinary blockage
Enlarged prostate
Kidney stones
Bladder problems
Urine retention
Blood in the urine
A kidney or bladder mass
Structural urinary problems
Repeated urinary infections

A nephrologist and urologist have different roles, but they may work together when both kidney function and urinary structure are involved.

When Dialysis Planning May Begin

Dialysis planning does not always mean dialysis will begin immediately.

Planning may start while the patient still has remaining kidney function, so there is time to:

Learn about treatment choices
Consider home dialysis
Consider in-center dialysis
Discuss peritoneal dialysis
Protect arm veins
Create a fistula or other access when appropriate
Arrange home support
Address transportation
Review insurance and financial needs
Begin transplant evaluation
Prepare emotionally and practically

Waiting until an emergency may limit choices and result in a temporary dialysis catheter.

The decision to begin dialysis is based on more than one eGFR number. Doctors also consider symptoms, fluid control, electrolyte levels, nutrition, acid balance, and overall health.

When Transplant Evaluation May Begin

Kidney transplant evaluation may begin before dialysis or after dialysis has started.

Testing for transplant may include:

Blood-type testing
Antibody testing
Heart testing
Cancer screening
Infection testing
Dental evaluation
Imaging
Medication review
Psychosocial evaluation
Financial and insurance review
Other testing based on medical history

The transplant center is trying to determine whether transplantation can be performed safely and what risks must be managed.

Being asked to complete many tests does not mean the center is trying to discourage the patient. The team must evaluate the heart, lungs, blood vessels, infections, cancer risk, medications, and the ability to safely receive anti-rejection treatment.

Questions to Ask Before Any Test

Patients have the right to understand what is being recommended.

Consider asking:

What is the name of this test?
What are you trying to find out?
Is it checking kidney function, kidney damage, or the cause?
Why do I need it now?
Have I had this test before?
What did the previous result show?
Does the test involve radiation?
Does it use contrast?
Is the contrast appropriate for my kidney function?
Do I need to stop any medications?
Should I change what I eat or drink before the test?
What are the risks?
Are there alternatives?
What happens if I do not have the test?
How could the result change my treatment?
When should I expect the result?
Who will explain the result to me?
What symptoms should I report afterward?

Write down the answers, or bring someone who can help by listening and taking notes.

Keep Your Own Kidney Health Record

Patients should keep copies of important medical information whenever possible.

A kidney-health record may include:

Current medication list
Medication allergies
Creatinine results
eGFR results
Urine albumin or protein results
Potassium results
Hemoglobin results
Calcium and phosphorus results
Blood-pressure record
Weight record
Ultrasound reports
CT or MRI reports
Biopsy reports
Hospital discharge records
Nephrology notes
Cardiology reports
Dialysis records
Transplant information
Emergency contact instructions

The record can be stored:

In a binder
In a folder
On a secure phone application
Through a medical patient portal
With a trusted caregiver

Having this information available can be especially helpful during an emergency, hospitalization, move, insurance change, or visit with a new doctor.

Do Not Be Afraid to Ask for an Explanation

Medical testing can feel overwhelming, especially when unfamiliar words are used.

Patients may hear terms such as:

Creatinine
eGFR
Albuminuria
Proteinuria
Hydronephrosis
Glomerulonephritis
Fibrosis
Sclerosis
Nephrotic syndrome
Acute kidney injury
Chronic kidney disease
Cardiorenal syndrome
Renal biopsy

It is reasonable to ask the doctor to slow down and explain the meaning in plain language.

You may say:

“What does that mean in everyday language?”
“Can you show me which result is abnormal?”
“Is this temporary or permanent?”
“What can still be treated?”
“What should I do next?”
“Can I have a written copy?”

Understanding the diagnosis helps patients participate more fully in their care.

Testing Should Lead to a Clear Plan

After testing, patients should understand the next step.

The plan may include:

Repeating laboratory tests
Monitoring kidney function
Controlling blood pressure
Improving diabetes care
Adjusting medications
Changing sodium or fluid intake
Meeting with a renal dietitian
Treating an infection
Correcting a blockage
Completing more imaging
Scheduling a biopsy
Seeing a nephrologist
Preparing for dialysis
Beginning transplant evaluation

Before leaving the appointment, ask:

What did the tests show?
What is the working diagnosis?
What are we doing about it?
When will I be tested again?
What symptoms should I report?
Who should I call if the symptoms worsen?

Testing Is Part of Protecting Your Future

Testing is not only about proving that the kidneys are damaged.

Testing may help doctors:

Detect kidney disease earlier
Identify a treatable cause
Prevent additional injury
Avoid unsafe medications
Reduce protein loss
Control fluid overload
Manage heart complications
Monitor potassium and other electrolytes
Slow progression
Prepare for treatment before an emergency
Give patients time to understand their choices

Not every kidney condition can be reversed. However, understanding the cause and stage may create opportunities to protect remaining function and prevent avoidable complications.

The purpose of the roadmap is to replace confusion with knowledge.

Patients deserve to understand why a test is being ordered, what the result means, and how that result will affect the next step in their care.

You Are Not Just a Test Result

Kidney disease can make a person feel as though their life has become a collection of laboratory numbers, appointments, procedures, and medical decisions.

But the patient is more than an eGFR, a creatinine level, an ultrasound result, or a biopsy report.

Testing should help the healthcare team understand the person’s condition and create a safer, more individualized plan.

Marshall Kidney Foundation encourages patients and families to:

Ask questions
Keep records
Learn their results
Request plain-language explanations
Attend follow-up appointments
Report changes early
Participate in treatment decisions

Knowledge cannot eliminate every challenge, but it can help patients face them with greater preparation and confidence.

Medical Disclaimer

This information is provided for general educational and informational purposes only. It is not medical advice and should not be used to diagnose, treat, cure, reverse, or prevent kidney disease or any other medical condition.

The tests needed to evaluate kidney function vary according to symptoms, medical history, medications, laboratory results, urine findings, heart function, age, pregnancy status, transplant status, dialysis status, and other individual factors.

Not every patient requires every test described on this page. A normal test result does not always rule out kidney disease, and an abnormal result does not always confirm a permanent condition.

Do not stop blood thinners, aspirin, heart medications, diabetes medications, blood-pressure medications, diuretics, supplements, or other treatments before a test or kidney biopsy unless the responsible healthcare professional gives you specific instructions.

Tell the ordering doctor and imaging team about kidney disease, dialysis, a kidney transplant, medication allergies, prior contrast reactions, pregnancy, and current medications before undergoing imaging or receiving contrast material.

Contact the healthcare team for questions about test preparation, biopsy recovery, abnormal results, medication instructions, or worsening symptoms.

Call 911 or seek emergency medical care for severe breathing difficulty, chest pain, fainting, severe confusion, uncontrolled bleeding, severe weakness, blue or gray lips, or any rapidly worsening or life-threatening condition.

Marshall Kidney Foundation does not provide medical diagnosis, individualized testing recommendations, medication instructions, biopsy clearance, interpretation of personal laboratory results, or emergency services.

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