Barts and The London Renal Centre | Our services | Chronic kidney disease clinic
Chronic kidney disease clinic
You may be referred to us directly by your GP or from a consultant at another hospital. At your first appointment with us you will meet a specialist nurse who will talk you through a series of initial tests and investigations, which are detailed below. The tests will help us to diagnose the condition and if appropriate, develop a suitable treatment plan for you. The correct treatment pathway cannot be given until a number of these tests are completed.
Following the tests, you may be referred back to your GP with a treatment plan in place for you to follow. If you require further advice you can have time with one of our renal consultants in the nephrology clinic.
Specialist nurses will run these tests and investigations, which may include:
You will be asked to give a sample of your urine to test for the presence of protein, blood, glucose, and acidity or alkaline levels. Often patients with kidney disease may have blood in the urine that is not visible to the naked eye – also known as microscopic haematuria. It is important to monitor all of these elements because they are indicators of kidney problems.
We also undertake a urine test over a 24-hour period - where you give a sample of urine at various stages throughout the day and night - and you will be required to stay overnight in hospital. Normal levels of protein in urine means that the sample should contains less than or equal to 150mg of protein. Higher levels may indicate a problem with kidney function.
Our renal screening clinic organises for patients to receive blood tests that are essential in diagnosing kidney dysfunction. Your blood will be taken by one of our nurses and sent to our laboratory for testing. The individual tests include:
Blood urea nitrogen (BUN)
Urea is a by-product of protein which is formed in the liver and filtered out from our blood via the kidneys. The blood urea nitrogen blood test measures the amount of nitrogen in the urea and high BUN levels can indicate kidney dysfunction.
Creatinine
Creatinine is a by-product of muscle energy metabolism (similar to urea) and is also filtered from the blood by the kidneys. The level of creatinine produced by individual patients depends on their muscle mass. When kidney function is normal, creatinine levels usually remain constant. An elevated blood creatinine level may indicate kidney dysfunction.
Other elements which are partly regulated by the kidneys are also tested and are useful in helping us to evaluate overall kidney function. We test the levels of sodium, potassium, chloride, bicarbonate, calcium, magnesium, protein, uric acid and glucose in the blood.
A kidney biopsy (also known as a renal biopsy) is an important test to diagnose kidney disease. It is often the only way to make an exact diagnosis of a patient’s kidney condition. A kidney biopsy is usually done on a day-case basis (meaning you don’t have to stay overnight in hospital) although in some cases a kidney biopsy may be an urgent test that is conducted during a hospital stay.
A kidney biopsy involves taking a very small sample from the kidney using a very fine needle under a local anaesthetic. The sample is then examined in minute detail to support the doctor’s diagnosis. For more details about having a kidney biopsy, please click here.
The initial scan we do is an ultrasound of the kidneys. This takes place during your clinic appointment and involves an ultrasound technician moving a hand-held probe across your skin around the area of your kidneys.
This estimates the size of both kidneys, which may help us to evaluate whether the kidney disease is acute or chronic. It also helps to either diagnose or exclude obstruction to the passing of urine; a common occurrence in the elderly with prostate problems.
Address for our renal screening clinic:
Renal dialysis and transplant outpatients unit
Basement, East Wing
Royal London Hospital
Whitechapel
London
E1 1BB
