What is the most accurate test for kidney function?

Chronic kidney disease (CKD) can be diagnosed with blood and urine tests.

In many cases, CKD is only found when a routine blood or urine test you have for another problem shows that your kidneys may not be working normally.

Who should be tested for CKD?

See your GP if you have persistent symptoms of CKD, such as:

  • weight loss or poor appetite
  • swollen ankles, feet or hands
  • shortness of breath
  • tiredness
  • blood in your pee (urine)
  • peeing more than usual, particularly at night

Your GP can look for other possible causes and arrange tests if necessary.

Because CKD often has no symptoms in the early stages, some people at a higher risk should be tested regularly.

Regular testing is recommended if you have:

  • high blood pressure
  • diabetes
  • acute kidney injury – sudden damage to the kidneys that causes them to stop working properly
  • cardiovascular disease – conditions that affect the heart, arteries and veins, such as coronary heart disease or heart failure
  • other conditions that can affect the kidneys – such as kidney stones, an enlarged prostate or lupus
  • a family history of advanced CKD or an inherited kidney disease
  • protein or blood in your urine where there's no known cause

You're also more likely to develop kidney disease if you're black or of south Asian origin.

People taking long-term medicines that can affect the kidneys, such as lithium, omeprazole or non-steroidal anti-inflammatory drugs (NSAIDs), should also be tested regularly.

Talk to your GP if you think you may need regular testing for kidney disease.

Tests for CKD

Blood test

The main test for kidney disease is a blood test. The test measures the levels of a waste product called creatinine in your blood.

Your doctor uses your blood test results, plus your age, size, gender and ethnic group to calculate how many millilitres of waste your kidneys should be able to filter in a minute.

This calculation is known as your estimated glomerular filtration rate (eGFR).

Healthy kidneys should be able to filter more than 90ml/min. You may have CKD if your rate is lower than this.

Urine test

A urine test is also done to:

  • check the levels of substances called albumin and creatinine in your urine – known as the albumin:creatinine ratio, or ACR
  • check for blood or protein in your urine

Alongside your eGFR, urine tests can help give a more accurate picture of how well your kidneys are working.

Other tests

Sometimes other tests are also used to assess the level of damage to your kidneys.

These may include:

  • an ultrasound scan, MRI scan or CT scan – to see what the kidneys look like and check whether there are any blockages
  • a kidney biopsy – a small sample of kidney tissue is removed using a needle and the cells are examined under a microscope for signs of damage

Test results and stages of CKD

Your test results can be used to determine how damaged your kidneys are, known as the stage of CKD.

This can help your doctor decide the best treatment for you and how often you should have tests to monitor your condition.

Your eGFR results is given as a stage from 1 of 5:

  • stage 1 (G1) – a normal eGFR above 90ml/min, but other tests have detected signs of kidney damage
  • stage 2  (G2) – a slightly reduced eGFR of 60 to 89ml/min, with other signs of kidney damage
  • stage 3a (G3a) – an eGFR of 45 to 59ml/min
  • stage 3b (G3b) – an eGFR of 30 to 44ml/min
  • stage 4 (G4) – an eGFR of 15 to 29ml/min
  • stage 5 (G5) – an eGFR below 15ml/min, meaning the kidneys have lost almost all of their function

Your ACR result is given as a stage from 1 to 3:

  • A1 – an ACR of less than 3mg/mmol
  • A2 – an ACR of 3 to 30mg/mmol
  • A3 – an ACR of more than 30mg/mmol

For both eGFR and ACR, a higher stage indicates more severe kidney disease.

Want to know more?

  • Kidney Research UK: stages of kidney disease
  • The Renal Association: stages of CKD
  • Kidney Care UK: kidney failure

Page last reviewed: 29 August 2019
Next review due: 29 August 2022

Overview of kidney function tests

You have two kidneys on either side of your spine that are each approximately the size of a human fist. They’re located posterior to your abdomen and below your rib cage.

Your kidneys play several vital roles in maintaining your health. One of their most important jobs is to filter waste materials from the blood and expel them from the body as urine. The kidneys also help control the levels of water and various essential minerals in the body. In addition, they’re critical to the production of:

  • vitamin D
  • red blood cells
  • hormones that regulate blood pressure

If your doctor thinks your kidneys may not be working properly, you may need kidney function tests. These are simple blood and urine tests that can identify problems with your kidneys.

You may also need kidney function testing done if you have other conditions that can harm the kidneys, such as diabetes or high blood pressure. They can help doctors monitor these conditions.

Symptoms that may indicate a problem with your kidneys include:

  • high blood pressure
  • blood in the urine
  • frequent urges to urinate
  • difficulty beginning urination
  • painful urination
  • swelling of the hands and feet due to a buildup of fluids in the body

A single symptom may not mean something serious. However, when occurring simultaneously, these symptoms suggest that your kidneys aren’t working properly. Kidney function tests can help determine the reason.

To test your kidney function, your doctor will order a set of tests that can estimate your glomerular filtration rate (GFR). Your GFR tells your doctor how quickly your kidneys are clearing waste from your body.

Urinalysis

A urinalysis screens for the presence of protein and blood in the urine. There are many possible reasons for protein in your urine, not all of which are related to disease. Infection increases urine protein, but so does a heavy physical workout. Your doctor may want to repeat this test after a few weeks to see if the results are similar.

Your doctor may also ask you to provide a 24-hour urine collection sample. This can help doctors see how fast a waste product called creatinine is clearing from your body. Creatinine is a breakdown product of muscle tissue.

Serum creatinine test

This blood test examines whether creatinine is building up in your blood. The kidneys usually completely filter creatinine from the blood. A high level of creatinine suggests a kidney problem.

According to the National Kidney Foundation (NKF), a creatinine level higher than 1.2 milligrams/deciliter (mg/dL) for women and 1.4 mg/dL for men is a sign of a kidney problem.

Blood urea nitrogen (BUN)

The blood urea nitrogen (BUN) test also checks for waste products in your blood. BUN tests measure the amount of nitrogen in the blood. Urea nitrogen is a breakdown product of protein.

However, not all elevated BUN tests are due to kidney damage. Common medications, including large doses of aspirin and some types of antibiotics, can also increase your BUN. It’s important to tell your doctor about any medications or supplements that you take regularly. You may need to stop certain drugs for a few days before the test.

A normal BUN level is between 7 and 20 mg/dL. A higher value could suggest several different health problems.

Estimated GFR

This test estimates how well your kidneys are filtering waste. The test determines the rate by looking at factors, such as:

  • test results, specifically creatinine levels
  • age
  • gender
  • race
  • height
  • weight

Any result lower than 60 milliliters/minute/1.73m2 may be a warning sign of kidney disease.

Kidney function tests usually require a 24-hour urine sample and a blood test.

24-hour urine sample

A 24-hour urine sample is a creatinine clearance test. It gives your doctor an idea of how much creatinine your body expels over a single day.

On the day that you start the test, urinate into the toilet as you normally would when you wake up.

For the rest of the day and night, urinate into a special container provided by your doctor. Keep the container capped and refrigerated during the collection process. Make sure to label the container clearly and to tell other family members why it’s in the refrigerator.

On the morning of the second day, urinate into the container when you get up. This completes the 24-hour collection process.

Follow your doctor’s instructions about where to drop the sample off. You may need to return it either to your doctor’s office or a laboratory.

Blood samples

BUN and serum creatinine tests require blood samples taken in a lab or doctor’s office.

The technician drawing the blood first ties an elastic band around your upper arm. This makes the veins stand out. The technician then cleans the area over the vein. They slip a hollow needle through your skin and into the vein. The blood will flow back into a test tube that will be sent for analysis.

You may feel a sharp pinch or prick when the needle enters your arm. The technician will place gauze and a bandage over the puncture site after the test. The area around the puncture may develop a bruise over the next few days. However, you shouldn’t feel severe or long-term pain.

Your doctor will focus on treating the underlying condition if the tests show early kidney disease. Your doctor will prescribe medications to control blood pressure if the tests indicate hypertension. They’ll also suggest lifestyle and dietary modifications.

If you have diabetes, your doctor may want you to see an endocrinologist. This type of doctor specializes in metabolic diseases and can help ensure that you have the best blood glucose control possible.

If there are other causes of your abnormal kidney function tests, such as kidney stones and excessive use of painkillers, your doctor will take appropriate measures to manage those disorders.

Abnormal test results mean you’ll probably need regular kidney function tests in the months ahead. These will help your doctor keep an eye on your condition.

What is the most important test for kidney function?

Glomerular filtration rate (GFR) - one of the most common blood tests to check for chronic kidney disease. It tells how well your kidneys are filtering. Creatinine blood and urine tests - check the levels of creatinine, a waste product that your kidneys remove from your blood.

Which test is the best indicator of kidney disease?

Urine Tests One of the earliest signs of kidney disease is when protein leaks into your urine (called proteinuria). To check for protein in your urine, a doctor will order a urine test.

What three tests can be useful in diagnosing kidney disease?

Tests for kidney disease.
Blood test: eGFR..
Blood test: Serum creatinine test..
Blood urea nitrogen (BUN) test..
Urine test..
Kidney ultrasound..
Kidney biopsy..

Which is more accurate GFR or creatinine?

Because the "good" creatinine number is different in everyone, GFR is more accurate in determining if your kidneys are ok. Your GFR will help assess your stage of kidney disease. Learn more about creatinine.