Chronic Kidney Disease (2) Stages
Kidney disease is a chronic, progressive disease. As a result, there are specific symptoms associated with its progression. Many nephrologists (kidney specialists) use a standard classification system to describe these common symptoms and stages.
Many symptoms are associated with what is known as the Glomerular Filtration Rate (GFR). According to the Foundation for IgA Nephropathy, the GFR is the rate at which the kidneys filter waste and relates to a patient’s “kidney function.”
- Stage 1 – Signs of mild kidney disease but with normal or better GFR (greater than 90% kidney function)
- Stage 2 – Signs of mild kidney disease with reduced GFR (indicating 60% to 89% kidney function). Early chronic renal insufficiency:
- Physical symptoms. Usually few or no physical symptoms that you can feel (other than those you may experience if you have heavy proteinuria).
- Blood work. Blood work results will show abnormalities – mainly a slightly elevated serum creatinine. Note that there is often a time lag between elevations of serum creatinine, and some progression of the IgAN. By the time serum creatinine is elevated, the person may already have lost 50% of kidney function.
- Urinalysis. Urine will show abnormalities. Urine can be checked by dipstick in the doctor’s office (as an initial check), and followed up with a more complete urinalysis. The main urine abnormality that will suggest a kidney disease is the presence of protein and/or blood. Either will usually trigger further investigation. However, blood and/or protein in the urine don’t say anything about actual kidney function.
- Treatment. Treatment may involve some mild dietary changes (a lower protein diet may in some cases be recommended), and a blood pressure medication may be prescribed (usually of the ACE inhibitor class, the angiotensin II receptor class, or both, even if blood pressure is not really elevated much).
- Blood pressure. Some people start having high blood pressure even in early chronic renal failure. IgAN is one kidney disease that can do this.
- Anemia. Anemia may rarely occur at this stage. In this case, it is most often caused by having heavy proteinuria rather than actual chronic renal insufficiency.
- Stage 3 – Signs of moderate chronic renal insufficiency (where the GFR indicates 40% to 59% kidney function) Physical symptoms. You may still feel completely normal at this stage, or you may begin to experience one or more of the following symptoms:
- Serum creatinine. Serum creatinine will be higher (indicating less than 30% kidney function)
- Tiredness or fatigue
- Puffiness or swelling (obvious in the hands or feet and ankles, but the puffiness will often first be seen around the eyes).
- Back pain. Chronic kidney disease back pain is usually felt as a dull ache anywhere in the mid-to-lower portion of the back, on one side or the other – this is sometimes referred to as flank pain or loin pain.
- Appetite. Changes in appetite or eating pattern. Foods may start tasting “funny.”
- Urine. Changes in urination (amount, color, frequency). Urine may in fact look exceptionally clear at this point, rather than abnormal. This is because little is actually being filtered into it by your kidneys. Previously high proteinuria and/or hematuria may actually improve.
- Blood pressure. High blood pressure (also referred to as hypertension).
- Digestion. Poor digestion (varying degrees of gastroparesis, which means that digestion is slowed).
- Stage 4 – Signs of severe chronic renal insufficiency (where the GFR indicates 15% to 29% kidney function). Learn more about Stages 3 and 4 >
- Stage 5 – Signs of end stage renal failure (where the GFR indicates less than 15% kidney function). End-stage renal failure (or late chronic renal insufficiency)
The terms end-stage renal failure and end-stage renal disease are used interchangeably, and the abbreviation ESRD is commonly used. Typically, patients will have kidney function in the area of 10-15% or so. These are the common symptoms you may experience at this stage (and some people may start experiencing some of these earlier):
Renal Failure Symptoms:
- Anemia (may begin earlier than this)
- Easy bleeding and bruising
- Fatigue and drowsy feeling (more than normal or usual for you)
- Mental symptoms such as lowered mental alertness, trouble concentrating, confusion, seizures
- Nausea, vomiting, and generally less desire to eat
- Muscle cramps, muscle twitching
- Nocturia (night-time urination)
- Numb sensation in the extremities
- Itchy skin, itchy eyes
- Skin color changes (grayish complexion, sometimes yellowish-brownish tone)
- Swelling and puffiness (more than you had while in advanced renal failure, and most likely in the feet and/or ankles)
- Difficulty breathing (due to fluid in the lungs, anemia)
- High blood pressure (with IgAN, you may already have had this since the early stages)
- Decreased sexual interest
- Changes in menstrual cycle (and difficulty getting pregnant)
- Decreased urine output (however, you should be aware that some people with ESRD will continue to get rid of water as urine, but not wastes – therefore, the urine may be very clear and normal-looking, and some may have increased urine output rather than decreased)
- Poor digestion (varying degrees of gastroparesis)
For More Information: Chronic Kidney Disease Part 3