Early detection of kidney ailment

Symptoms:

1. Blood in urine. Most often not visible. But sometimes may appear tea color urine
2. Protein in urine. Microalbumin is even early, esp in diabetics. Foamy urine may not be due to protein in urine. For simple self testing, you can use urine dipstix that has protein test part.
3. Swelling of face, legs. Even minimal swelling may be significant, since we are talking about early detection.
4. Tiredness. This is surely a vague symptoms. Who does not become tired, esp at the end of a hard day.  
5. Pale, low urine output.
6. High Blood Pressure. Especially when it is hard to bring it to good control (despite medications).

How to test:

1. Simplest.  Self testing with urine stick (for protein). Problem, high rate of false positive, meaning the test shows positive but actually the person does not have kidney problem.  So need to go to second level test, to avoid unnecessary anxious moments.
2. Urine analysis with laboratory. Mid stream (meaning catch the urine after the first 2 seconds of peeing), away from menses/period. Cheap, single sample. If the urine contains blood and protein, and microscopic pic also show blood cells, then problem is more likely to be present
3. Blood test for kidney function- creatinine, urea
4. Ultrasound kidney
5. 24 hr urine collection for creatinine clearance and urine protein 
6. Kidney isotope scan
7. Kidney biopsy (a sampling method of kidney tissue, examined by pathologist (specialist doctor in diagnosis of diseases with lab methods using microscope)

Since 60% or so of kidney failure in Malaysia (same trend in most parts of the world) is due to diabetes, it is very important that all diabetics take note of this and screen for this complication yearly. In fact there is an extra urine test called urine microalbumin, to detect extra early diabetic kidney disease. Good diabetes control is important part of prevention of kidney failure.

Other causes:

1. IgA nephropathy or other nephropathy. Essentially an autoimmune problem.  Exact trigger not wellknown.
2. Hypertensive nephropathy- due to high blood pressure
3. NSAID or pain killer nephropathy. Yes, painkiller like ponstan, voltaren can cause kidney failure. Antibiotic gentamicin, streptomycin (injection type) can also cause problem. But not high blood pressure or diabetes medication.
4. Polycystic kidney disease, an inherited illness, through autosomal dominance
5. Very large, long standing kidney stone

These are the causes for slowly progressing, insiduous kidney problem. Acute sudden onset kidney disease can be due to all sort of acute serious infections (malaria is one) or sudden change of health status ie heart attack.