Evaluation for a kidney or urinary tract disorder begins with a medical history and physical examination. Doctors sometimes need to do tests or procedures to diagnose a kidney or urinary tract disorder.
History
A doctor obtains a medical history by interviewing a person. The interview includes questions about a person's symptoms, past medical history (what disorders the person has had), medications (prescribed and over-the-counter), drugs and substances (recreational [including alcohol and tobacco] and illicit), allergies, and disorders that run in the family. Typically, people with a possible disorder affecting the kidneys or urinary tract are asked about the following:
The amount, frequency, and timing of urination
Whether urination is painful or burns
Whether there is blood in the urine
Whether urine leakage occurs (urinary incontinence)
Whether starting the urinary stream is difficult
Whether it feels like the bladder does not empty completely
Whether they have had previous urinary tract infections, medical procedures involving the urinary tract, or surgery
Whether they have pain in the flank, side, lower back, or abdomen, or near the genitals (such as the groin or labia)
The diet and timing and type of food and fluid intake (sometimes)
For example, because some foods and medications may change the urine's color, doctors may ask about the person's diet. A person who is waking up often during the night to urinate may be asked about the amount, type, and timing of liquids drunk.
Physical Examination
Doctors then examine the person. They may try to feel the kidneys. The kidneys usually cannot be felt in normal adults and children, except sometimes in very thin people. Kidneys can be felt in normal newborns. Doctors may apply gentle pressure to the person's side or lower back (flank). Pain that occurs during this maneuver may suggest a problem with a kidney (such as swelling or infection). If a person has difficulty urinating and pressure in the lower abdomen, doctors may put a finger on the lower abdomen and tap on it. If the sound made by the tap is unusually dull, the bladder may be swollen (distended).
In men, doctors examine the genitals, including the testes, to ensure the testes are not swollen, tender, or abnormally placed. Doctors then do a rectal examination to determine whether the prostate gland is swollen. An enlarged prostate may inhibit the flow of urine.
In women, doctors may do a pelvic examination to determine whether inflammation or irritation of the vaginal lining (vaginitis) or the genital organs are contributing to urinary tract symptoms.
Doctors may also examine the person's skin for changes related to kidney disease. They may listen to the heart and lungs with a stethoscope to detect unusual heart and lung sounds that may indicate a kidney disorder. If doctors suspect chronic kidney disease, they check to ensure the person is not drowsy or confused.
Testing
After doctors complete the physical examination, they often need to examine a sample of urine. If doctors suspect an infection, they may also ask the laboratory to try to grow microorganisms from the urine sample (this is called a urine culture).
Doctors usually need to do imaging tests if they suspect blockage (obstruction) or an abnormality of the internal organs of the urinary tract.
To determine how well the kidneys are filtering waste from the blood, doctors often do tests on samples of blood and urine (kidney function tests).
Sometimes doctors need to look inside the bladder (cystoscopy) or examine a sample of cells from the urine or from the kidney or prostate (biopsy).
