Being referred to a specialist can feel overwhelming, but try not to worry. If your general practitioner (GP) has referred you to a nephrologist, it usually means further assessment is needed to better understand your kidney health and determine whether specialist care is required. While this referral can feel concerning, it is an important step towards obtaining an accurate diagnosis and appropriate treatment.
A nephrologist specialises in diagnosing and managing conditions that affect the kidneys. During the assessment process, they will review your medical history, discuss your symptoms, perform a physical examination and evaluate any previous test results. Depending on your condition, they may also recommend additional investigations, such as blood tests, urine tests, imaging studies, or a kidney biopsy.
Understanding what to expect can help ease uncertainty and ensure you are well prepared for your appointment.
Key Takeaways
- Additional tests such as blood tests, urine tests, imaging, or a kidney biopsy may be recommended to diagnose kidney disease.
- Your doctor will review all test results before confirming a diagnosis and recommending a personalised treatment or monitoring plan.
- Follow-up appointments help monitor your kidney function and adjust your care as needed.
- Your doctor will consider your symptoms, examination findings and test results to determine whether kidney disease is present and what may be causing it.
What Happens During Your First Nephrology Appointment?
Your first appointment allows your nephrologist to understand your kidney health, identify possible causes of abnormal kidney function and determine whether further investigations are required. The consultation combines information from your medical history, physical examination and any previous test results to guide the next steps in diagnosis.
Preparing for your appointment
Preparing for your appointment helps ensure your doctor has the information needed to assess your kidney health accurately. Before your visit, they will usually review your referral letter and any available test results from your general practitioner (GP) or another healthcare provider.
If available, bring:
- Recent blood and urine test results
- Imaging reports, such as kidney ultrasounds or CT scans
- A list of your current medications, including supplements and herbal remedies
- Information about your personal and family medical history, particularly diabetes, high blood pressure or kidney disease
- Any questions or concerns you would like to discuss
Medical history and physical examination
During the consultation, your doctor will ask about your symptoms, medical history and overall health to identify factors that may be affecting your kidneys. They may discuss:
- Existing conditions such as diabetes or high blood pressure
- Changes in urination, swelling, blood in the urine or fatigue
- Current medications, including prescription medicines, supplements and herbal remedies
- Family history of kidney disease or other related conditions
A physical examination is also performed. This commonly includes measuring your blood pressure and checking for signs of fluid retention or other physical findings that may indicate kidney disease.
Reviewing previous test results
If you have already undergone blood tests, urine tests or imaging arranged by your GP or another doctor, your doctor will review these findings alongside your symptoms and examination. This helps determine whether a diagnosis can be made or whether additional investigations are needed.
Deciding whether further tests are needed
Not every patient requires the same investigations. Based on the information gathered during your consultation, your nephrologist will decide whether further tests are necessary to clarify the diagnosis, assess the severity of kidney disease or identify its underlying cause.
What Tests May Be Used to Diagnose Kidney Disease?
Additional investigations are recommended only when they are needed to better understand your kidney function or confirm a diagnosis. The specific tests depend on your symptoms, medical history and findings from your first appointment.
Blood tests
Blood tests evaluate how effectively your kidneys filter waste products and regulate important minerals and waste products.
Common blood tests include:
- Serum creatinine: Measures a waste product that rises when kidney function declines.
- Estimated glomerular filtration rate (eGFR): Estimates kidney filtering capacity and helps determine the stage of kidney disease.
- Blood urea nitrogen (BUN): Measures another waste product that may increase when kidney function is impaired.
- Electrolytes: Assesses minerals such as sodium and potassium, which may become abnormal in kidney disease.
Urine tests
Urine tests can detect early signs of kidney damage that may not be apparent on blood tests alone.
Your doctor may recommend:
- Urine albumin-to-creatinine ratio (ACR): Detects small amounts of protein in the urine, often an early sign of kidney disease.
- Urinalysis: Identifies blood, protein, glucose, bacteria and other abnormalities.
- 24-hour urine collection: Occasionally used to assess kidney function over an entire day.
Imaging
Imaging studies help evaluate the structure of the kidneys and urinary tract. A kidney ultrasound is the most commonly used imaging test and can identify abnormalities such as changes in kidney size, cysts, kidney stones or urinary obstruction. Depending on your condition, a CT scan or MRI may also be recommended.
Kidney Biopsy
A kidney biopsy is recommended only when additional information is required to confirm a diagnosis or determine the cause of kidney disease. During the procedure, a small sample of kidney tissue is collected using a thin needle and examined under a microscope to help guide diagnosis and treatment decisions.
What Happens After Your Assessment?
Once your consultation and any recommended investigations are complete, your nephrologist will review all the findings together to establish a diagnosis and develop an appropriate management plan.
Reviewing the Diagnosis
Your doctor considers your medical history, physical examination, blood tests, urine tests and imaging findings together rather than relying on a single result. This allows them to determine whether kidney disease is present, identify the underlying cause where possible and assess its severity.
Developing a Treatment Plan
If kidney disease is diagnosed, your doctor will recommend a treatment plan based on your condition and overall health. This may include medications, lifestyle modifications, management of underlying conditions such as diabetes or hypertension, or referral for additional treatment where appropriate.
Ongoing Monitoring
Many kidney conditions require regular follow-up to monitor kidney function over time. Repeat blood and urine tests, along with periodic consultations, allow your doctor to assess disease progression, monitor your response to treatment and adjust your management plan when necessary.
Receiving Personalised Kidney Care with Dr Alvin Ng
Kidney disease is not diagnosed using a single test. Your doctor will review your symptoms, examination findings and investigation results to understand what is affecting your kidneys and recommend the most appropriate next steps.
At The Kidney Health Care Clinic, we provide comprehensive assessment and management for a wide range of kidney conditions. Senior nephrologist Dr Alvin Ng works closely with patients to investigate abnormal kidney function, explain investigation findings and develop an appropriate management plan. If you have concerns about your kidney health or have been advised to see a nephrologist, arrange a consultation to discuss your next steps.
Frequently Asked Questions (FAQs) About Kidney Disease Assessment
Most kidney function blood tests do not require fasting. However, some tests may have specific preparation instructions. Your nephrologist or the clinic will let you know if any special preparation is needed.
Not necessarily. Some tests, such as blood and urine tests, can often be completed on the same day, while imaging studies or a kidney biopsy may need to be scheduled separately.
If your results indicate kidney disease, your nephrologist will explain the diagnosis, discuss its cause and severity, and recommend a personalised treatment and monitoring plan to help protect your kidney function.
If you have chronic kidney disease or are at higher risk of developing kidney problems, your nephrologist may recommend regular blood tests, urine tests, and follow-up appointments to monitor your kidney function over time.
Meet Our Doctor
Dr Alvin Ng is a senior consultant nephrologist with over two decades of experience in kidney care. Prior to setting up his own practice, Dr Ng was the Director of Peritoneal Dialysis at Changi General Hospital and executive committee member of the Singapore Society of Nephrology. He has held teaching appointments for medical students and residents and is also a recipient of various service awards, a testament to the quality of care he provides.
