Chronic kidney disease refers to a situation where the kidneys are damaged or unable to perform their normal function of eliminating wastes and extra fluids from the body. This disease can develop insidiously and may show mild symptoms at its early stages. Patients can therefore rely on blood and urine tests to support the diagnosis of chronic kidney disease. Stages of chronic kidney disease help patients understand their kidney function, manage their treatment, and know what to expect.
Chronic kidney disease has five stages and is defined by the underlying cause, the estimated glomerular filtration rate (eGFR), and the amount of albumin in the urine. The estimated glomerular filtration rate means an estimated of the percentage of kidney function. A patient’s physician will mostly analyze the eGFR trends instead of the exact figures. Chronic kidney disease mostly develops when there is a persistent abnormality in kidney function for a period of at least three months. Chronic kidney disease is diagnosed if there is a decrease in the eGFR or increased albumin in the urine.
Stage 1: Normal or High Kidney Function
In this stage, the eGFR is equal to or higher than 90%. There is also an increased risk of kidney damage, which may be evident from other health problems or tests. Although there may not be any symptoms because the kidney can perform its function efficiently, the doctor may try to identify and manage any underlying causes of chronic kidney disease. The physician may also advise the patient to periodically monitor their kidney function.
Even though the kidney function may be normal or near-normal, it does not mean that the kidneys are completely healthy. The patient should therefore continue to have regular checkups to ensure that kidney function does not change.
Stage 2: Mildly Reduced Kidney Function
Stage 2 chronic kidney disease is characterized by an eGFR between 60% and 89% and abnormal kidney function results. Most patients do not show symptoms as they do not show signs of complications. The physician can therefore advise periodic testing of albumin levels in the urine, blood pressure, blood sugar levels and kidney function to determine the risk of developing complications and to monitor the progression of the disease. The patient should also take precautions to prevent chronic kidney disease from getting worse since diabetes and high blood pressure are the leading causes of chronic kidney disease among adults.
Stage 3: Moderately Reduced Kidney Function
Stage 3 chronic kidney disease is further split into two categories. In stage 3a, the eGFR is between 45% and 59%. The eGFR for stage 3b is between 30% and 44%. The physician may advise that the patient continues to have their kidney function monitored because this stage can either progress rapidly or be slow. Patients may also begin to show symptoms of the disease, although some might remain asymptomatic. These symptoms may include fatigue, puffiness, and changes in the frequency or volume of urination.
The physician can also check for other complications associated with chronic kidney disease, including anemia, mineral imbalance, hypertension, and heart conditions.
Stage 4: Severely Reduced Kidney Function
Chronic kidney disease in stage 4 can be characterized by an eGFR of 15% and 29%. In this stage, the physician will closely monitor the patient’s kidney function and other possible complications since the risk increases. Patients who are in this stage can show more severe symptoms of chronic kidney disease, including fatigue, puffiness, changes in the amount of urine, nausea, vomiting, dry or itchy skin, muscle cramps, or difficulty concentrating. However, symptoms can vary depending on individual circumstances.
The physician can advise the patient to consider kidney transplant or dialysis options. It is however important to note that not all patients with stage 4 chronic kidney disease progress to the final stage.
Stage 5: Kidney Failure
Stage 5 chronic kidney disease corresponds to an eGFR of less than 15% and is characterized by kidney failure. Most patients with kidney failure require dialysis. However, kidney transplant can also be considered depending on the patient’s condition, symptoms, test results, general wellbeing, and the physician’s advice.
Why Is the Amount of Albumin in the Urine Important?
Chronic kidney disease staging is based on the cause, GFR, and the level of albumin in the urine. The Kidney Disease Improving Global Outcomes or KDIGO recommends classifying chronic kidney disease based on Cause, GFR category, and Albuminuria category. This grouping method is referred to as the CGA classification. Albuminuria is categorized into three levels, namely:
- A1: Less than 30 mg/g of albumin – normal to mildly increased
- A2: 30 – 300 mg/g of albumin – moderately increased
- A3: More than 300 mg/g of albumin – severely increased
The levels of albuminuria support physicians to classify chronic kidney disease, determine the level of risk, and monitor the progression of the disease. It is therefore important to have regular urine tests to check the levels of albumin in the urine. Hence, the next time you visit the doctor, you should request for a kidney test instead of a routine kidney disease test.
Can Chronic Kidney Disease Progress to Kidney Failure?
Chronic kidney disease rarely progresses to kidney failure because its progression may be slow and can be stopped depending on an individual’s health status. Chronic kidney disease can only progress to kidney failure when the GFR declines drastically or if the test results worsen over time. Factors that can contribute to rapid progression of chronic kidney disease to kidney failure include the underlying cause of kidney disease, eGFR, albuminuria, diabetes, and high blood pressure.
Patients with chronic kidney disease should therefore regularly monitor their kidney function and adhere to the physician’s instructions.
How Is Chronic Kidney Disease Treated and Managed?
There is no standard treatment regimen for chronic kidney disease since it depends on the underlying cause, disease stage, and the patient’s general health. Chronic kidney disease patients should also work with their physicians to control the condition, regularly monitor their kidney function, manage their blood pressure and blood sugar levels, and minimize the risks of developing other diseases. The physician can also review the patient’s medications and recommend a suitable diet and lifestyle changes based on their disease severity, general health status, and other factors.
Patients with chronic kidney disease should not adjust their diet on their own because there is no universal diet that is suitable for all patients with chronic kidney disease. It is always important to consult a physician before making any drastic changes to your diet.
Who Should Have Kidney Function Tests Done?
Patients with diabetes, high blood pressure, or heart disease and those with a family history of kidney failure should consider getting their kidney function tested. Chronic kidney disease rarely shows symptoms when it develops, especially at the early stages. Hence, these patients should make sure they get their kidney function tested so that they can start managing the condition early.
Kidney Care at Anantam Hospital
Anantam Hospital offers comprehensive kidney care to patients who want to manage their chronic kidney disease by helping them understand their kidney testing results and managing their kidney disease. Patients can also benefit from regular consultations with a nephrologist to monitor their kidney function, determine risk factors, and develop a suitable treatment plan.
Final Remarks
Chronic kidney disease is not a disease with a uniform prognosis. Therefore, stages of chronic kidney disease from G1 to G5 give doctors a way to classify patients based on their kidney function. Doctors will analyze other factors, including the amount of albumin in the urine and the underlying cause of kidney disease. The most important point is to ensure that you get tested if you have heart disease, diabetes, high blood pressure, or a family history of kidney failure.
Medical Disclaimer: This article is meant for educational purposes only and should not be used as a substitute for advice from a qualified nephrologist. Chronic kidney disease stage and treatment options should be determined by a physician after relevant testing and evaluation.
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