What are the stages of kidney disease?

The kidneys are a pair of bean-shaped organs responsible for eliminating waste from our body. Kidneys also ensure fluid and mineral balance, are involved in red blood cell production, vitamin D metabolism etc. Kidney disease can be acute (sudden) or chronic (gradually, over a period of time).

Acute kidney failure happens suddenly or within a few hours or days. Acute kidney failure is not permanent but it needs immediate medical attention.

Chronic kidney disease happens gradually over a period of time and in progressive stages. Even if one kidney is damaged, the other kidney carry out all the functions. In some cases, the kidney disease is diagnosed only when it reaches the advanced stage, which can later lead to kidney failure, if left untreated.

Signs and symptoms of CKD

• Increased urination
• Blood in urine
• Fatigue
• Uncontrollable high blood pressure
• Loss in appetite
• Nausea and Vomiting
• Anaemia
• Oedema
• Sleeping problem
• Persistent itching
• Muscle cramps
• Shortness of breath

Kidney disease is a progressive disease, hence gets worse as time passes. Right at the onset of symptoms, we suggest you to visit the Nephrologist. The Nephrologist will initially ask you few questions related to your family history, blood pressure, diabetes etc.

Diagnosis

• Clinical Examination: On your visit to the doctor, you will be examined thoroughly. Heart and lung will be checked for any fluid retention etc.
• Blood and Urine Test: Blood test reports reveal electrolytes, creatinine and blood urea levels. Urine tests is performed to check for any abnormalities.
• Imaging: Imaging tests include an ultrasound, CT Scan or MRI for evaluating the structural details of kidneys.
• Biopsy: A kidney biopsy may be recommended to find the cause of the problem.

What are the stages of chronic Kidney disease?

Chronic Kidney disease is broadly classified into 5 stages, based on eGFR blood test (an estimated glomerular filtration rate) which is used to assess kidney function:

• Stage 1 normal or high (eGFR value > 90): You may not even know that you are suffering from CKD stage 1 due to normal functioning of kidneys (though not 100%). There is absence of any signs or symptoms of kidney disease. Regular check-up has to be done to monitor whether the damage is progressing.
• Stage 2 Mild CKD (eGFR value = 60-89): In stage 2 there is a mild decrease in the eGFR rate and the symptoms may not be felt by you as the kidney is functional, though not 100%. However, it is recommended to visit a Nephrologist to ensure that the condition doesn’t worsen.Symptoms for Stage 1 and Stage 2
  • Higher value of creatinine or urea in the blood.
  • Presence of blood or protein in the urine.
  • Imaging test report (like MRI, CT Scan or ultrasound etc.) showing kidney damage.
  • Family history of Polycystic Kidney Disease

  Treatment for Stage 1 and Stage 2

  • Healthy diet is must. Eat low saturated fat, whole grains, fresh fruits and vegetables, keep check of protein, salt and sugar intake.
  • Keep track and control of blood pressure and sugar level.
  • Regular visit to doctor and test for serum creatinine to measure GFR.
  • Take medicine as prescribed by doctor.
  • Exercise regularly.
  • Stop smoking.
• Stage 3 Moderate CKD (eGFR value = 30-59): When kidneys are moderately damaged and not functioning properly, it is considered as Stage 3 of CKD. Stage 3 can further be classified as Stage 3A Moderate CKD (eGFR value = 45-59) and Stage 3B Moderate CKD (eGFR value = 30-44).Symptoms for Stage 3
  • Fatigue
  • Swelling in feet and hand
  • Back pain (as kidney pain is felt in the back)
  • Sleeping problem
  • Urination change (changes in colour of urine and quantity)

  Treatment for Stage 3

  • As stage 3 progresses, you should visit Nephrologist immediately, who shall further conduct a detailed investigation, to offer the best treatment.
  • You should also meet a dietician who will recommend a customised meal plan based on your kidney condition and investigation reports. Diet plan usually depends upon the stage of kidney disease; for patient with end-stage kidney disease are advised to avoid food that can cause build-up in the blood due to certain chemicals or nutrients. The intake of food consisting sodium, potassium and phosphorous is limited, as kidneys cannot adequately remove the same, hence the chances of higher levels of these minerals can be detected in blood. Generally, a kidney-friendly diet includes limiting sodium and potassium to 2,000 mg/day and phosphorus to 1,000 mg/day. For Chronic kidney disease Stage 1 – 4 are often asked to restrict the quantity of protein intake, as kidneys will not be able to filter waste product of protein metabolism.
  • Medicine to control diabetes and high blood pressure is prescribed.
  • Quit smoking and regular exercise is advised.
• Stage 4 Severe CKD (eGFR value = 15-29): Stage 4 is considered as advanced kidney damage. Waste product builds up in the blood due to decline in kidney functioning and this condition is known as uremia. Stage 4 of CKD involves further health problems like bone disease, anemia, heart problem or other cardio vascular disease.Symptoms for Stage 4
  • Fatigue and shortness of breath
  • Fluid retention
  • Kidney pain felt in the back
  • Nausea or vomiting
  • Numbness or tingling sensation in toe or fingers
  • Loss of appetite
• Stage 5 End Stage CKD (eGFR value < 15): Stage 5 of CKD is an indication that the kidney is close to failure or has already failed. Symptoms for Stage 5
  • Urinating more or less than normal
  • Breathing and sleeping problem
  • Back pain
  • Muscle cramps
  • Loss of appetite
  • Persistent Itching
  • Change in skin colour
  • Nausea or vomiting

  Treatment for Stage 4 and Stage 5

  • Hemodialysis: Hemodialysis is a process in which a dialysis machine is connected to the body to clean the blood (removes the waste and extra fluid) through a filter called a dialyzer and returns the purified blood through tubes to the body. It can be done at your home with some assistance.
  • Peritoneal dialysis: In this treatment dialysate (cleaning solution) is used to remove the waste and extra fluid from your body through the lining of the abdomen (peritoneum).
  • Kidney transplant: Kidney transplant is the most preferred treatment and you don’t have to wait till kidney fails.

Conclusion

Chronic Kidney Disease is very common and it progresses gradually. Hence, early detection, medication and change of lifestyle can slow down its progress. An untreated kidney disease can lead to complete kidney failure; dialysis or kidney transplant are the effective treatment options available. Kidney disease can occur in anyone, but without treatment such damage gets worse and becomes life-threatening.