Understanding the Stages of Chronic Kidney Disease

Kidney disease is diagnosed via a test called the Estimated Glomerular Filtration Rate (eGFR). This test allows for an estimation of the volume of blood filtered by the glomeruli, tiny filters in the kidneys, over a period of time. When kidney function is compromised the glomeruli do not filter as much as normal, and the results are less than 90 ml/minute/1.73 m.

Severity of chronic kidney disease is generally defined by the level of eGFR combined with other factors, and is 1 of 5 stages:

• Stage 1 – eGFR is normal (90 and over), but there are signs of kidney damage such as kidney inflammation, blood in urine, abnormal blood work, etc. Kidney function is normal.
• Stage 2 – eGFR is between 60-89 and there is damage to the kidneys. Kidney function is mildly reduced.
• Stage 3 – eGFR is between 30-59. Kidney function is moderately reduced.
• Stage 4 – eGFR is between 15-29. Kidney function is severely reduced.
• Stage 5 – eGFR is less than 15. Kidney function is severely reduced. Also known as End Stage Renal Failure.

Symptoms of chronic kidney disease

In most case, people suffering from stage 1 to 3 of kidneys disease, are a-symptomatic, and the diagnosis is made based on the eGFR results alone. Often, people are only aware of the kidney disease because of tests they had done regarding other health conditions such as diabetes or high blood pressure. If chronic kidney disease has been diagnosed, testing will be done at regular intervals in order to allow for kidney function monitoring.

The symptoms tend to develop as kidney function lessens. At first the symptoms tend to be vague, just a general feeling of un-wellness, frequent nocturnal urination and tiredness.

As the disease progresses and an imbalance of minerals and chemicals occur causing symptoms such as confusion, nausea, swelling and bloating, cramps, weakness, anemia and weight loss. Eventually, if untreated, symptoms such as muscle damage, loss of sensation in limbs, heart failure, gastrointestinal bleeding, itchy skin and seizures may occur.

Prognosis of kidney disease

While effort should be placed on early diagnosis, delaying or halting the progression of chronic kidney disease and treatment of the symptoms and underlying conditions, in most cases kidney function declines and the kidney disease will progress regardless of treatment. The rate of decline depends on a combination of many parameters, with the cause of the kidney disease (such as diabetes, high blood pressure, drug use, infections, etc.), efficiency of the treatment, combined with general health and life style, as crucial factors.  Monitoring decline in kidney function is critical, in order to allow for timely placement of vascular access needed for long term kidney replacement therapy such as dialysis, or registering for a kidney transplant.

When end stage renal failure (stage 5 chronic kidney disease) goes untreated, survival prognosis is usually a few months or less. Treating kidney failure with dialysis combined with nutritional restrictions, adequate treatment of complications and general health care extends the patient’s life expectancy for many years, reducing symptoms and improving quality of life to a great extent. For patients refusing treatment arrangement for palliative care should be made.