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), drugs (prescribed, over-the-counter, and recreational, including alcohol and tobacco), 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 starting the urinary stream is difficult
Whether it feels like the bladder does not empty completely
Whether they have had previous urinary tract infections Overview of Urinary Tract Infections (UTIs) In healthy people, urine in the bladder is sterile—no bacteria or other infectious organisms are present. The tube that carries urine from the bladder out of the body (urethra) contains no bacteria... read more , 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 drugs 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.
Doctors then examine the person. (See Overview of the Urinary Tract Overview of the Urinary Tract Normally, a person has two kidneys. The rest of the urinary tract consists of the following: Two ureters (the tubes connecting each kidney to the bladder) The bladder (an expandable muscular... read more .) 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 strike 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 Benign Prostatic Hyperplasia (BPH) Benign prostatic hyperplasia (BPH) is a noncancerous (benign) enlargement of the prostate gland that can make urination difficult. The prostate gland enlarges as men age. Men may have difficulty... read more may inhibit the flow of urine.
In women, doctors may do a pelvic examination Pelvic Examination For gynecologic care, a woman should choose a health care practitioner with whom she can comfortably discuss sensitive topics, such as sex, birth control, pregnancy, and problems related to... read more 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 Chronic Kidney Disease Chronic kidney disease is a slowly progressive (months to years) decline in the kidneys’ ability to filter metabolic waste products from the blood. Major causes are diabetes and high blood pressure... read more , they check to ensure the person is not drowsy or confused.
Doctors sometimes need to do tests or procedures to diagnose a kidney or urinary tract disorder.
After doctors complete the physical examination, they often need to examine a sample of urine Urinalysis and Urine Culture Urinalysis, the testing of urine, may be necessary in the evaluation of kidney and urinary tract disorders and can also help evaluate bodywide disorders such as diabetes or liver problems. A... read more . 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 Urinalysis and Urine Culture Urinalysis, the testing of urine, may be necessary in the evaluation of kidney and urinary tract disorders and can also help evaluate bodywide disorders such as diabetes or liver problems. A... read more ).
Doctors usually need to do imaging tests Imaging Tests of the Urinary Tract There are a variety of tests that can be used in the evaluation of a suspected kidney or urinary tract disorder. (See also Overview of the Urinary Tract.) X-rays are usually not helpful in evaluating... read more if they suspect blockage (obstruction Urinary Tract Obstruction Urinary tract obstruction is a blockage that inhibits the flow of urine through its normal path (the urinary tract), including the kidneys, ureters, bladder, and urethra. Blockage can be complete... read more ) 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 Kidney Function Tests Doctors can assess kidney function by doing tests on blood and urine samples. Creatinine, a waste product, is increased in the blood when kidney function is decreased by a large amount. Creatinine... read more ).
Sometimes doctors need to look inside the bladder (cystoscopy Cystoscopy A doctor can diagnose some disorders of the bladder and urethra (for example, bladder tumors, stones in the bladder, benign prostatic enlargement) by looking through a flexible viewing tube... read more ) or examine a sample of cells from the urine or from the kidney or prostate (biopsy Tissue and Cell Sampling Site-specific biopsies and cell sampling are also used in the evaluation of people with suspected kidney and urinary tract disorders. (See also Overview of the Urinary Tract.) A kidney biopsy... read more ).