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If you have an annual physical, your MD should be checking your bloodwork, which shows changes in kidney activity. He will also do a urinalysis to check the concentration and chemistry for abnormalities.
For us, Grandpa's kidney failure was not diagnosed until he started hallucinating. He was not fond of doctors and avoided them, so early detection was evaded, as was proper treatment. The damage was permanent and he died a few years after diagnosis.
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Blood and urine tests are the best way to monitor pending renal failure.
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