Stages of Kidney Disease

Stages of Kidney Disease

Kidney patients often refer to their disease progression using stages. To those new to kidney disease, this can be confusing.

In an ideal world, renal patients would be diagnosed at birth, or immediately after the onset of certain symptoms. Unfortunately, this is not the case. Many patients, particularly Alport syndrome patients, are diagnosed long after their kidney function has started to decline.

To make matters worse, 1 in every 3 American adults is at risk for kidney disease. To categorize renal function of the 26 million American adults with chronic kidney disease, the National Kidney Foundation (NKF) created a five-stage guideline. Read on to learn more about testing, early detection and the stages of kidney disease.

Testing and Early Detection
Many people are unaware renal disease can lack noticeable symptoms until it is too late. Therefore, it is crucial to be tested, especially if you are a high-risk patient. NKF offers free urine testing for high-risk patients. The Alport syndrome Foundation strongly encourages anyone with a family history of the disease to be tested immediately and regularly. A simple urine test can determine the amount of protein your body expels while a blood draw can determine how well your kidneys are filtering and removing wastes. The results of these quick tests can make an immeasurable impact on your future health.

Patients with Alport syndrome should have regular kidney screenings, but even family members who don’t have Alport syndrome can be at risk of developing kidney disease from other causes. Absolutely anyone over the age of 60 is advised to be tested, as are those with high blood pressure, a BMI (body mass index) over 30 and/or diabetes. According to NKF, African-Americans, Hispanics, Asians, Pacific Islanders and American Indians also have a greater risk of renal disease. Early detection of renal disease provides greater flexibility in treatment options, may prolong the time before dialysis and can allow you to make daily life changes helping to maintain current/remaining renal function.

While some patients experience little or no visible symptoms, it is important to recognize the potential warning signs of renal disease. These include, but are not limited to: overall malaise, poor appetite, lack of focus/concentration, nocturnal muscle cramping, sleep irritability and swollen feet/ankles. If initial testing indicates kidney disease, subsequent testing may occur, including more bloodwork, a kidney ultrasound or biopsy.

Once it is established you have kidney disease, your doctor will measure of how well your kidneys filter blood using a test called a Glomerular Filtration Rate (GFR). The resulting GFR will determine your particular stage on the scale of 1-5. Generally speaking, outward symptoms are experienced only during and after, stage 3, though there are some exceptions.


Symptoms and Treatment Options

Stages 1-2:
Unnoticeable external symptoms.

  • Diet changes include limiting sodium and protein intake.
  • Ingestion of fruits, veggies and whole grains is advised.
  • Control of cholesterol, blood sugar and blood pressure.
  • Exercise/staying active is recommended.
  • No smoking.
  • Regular Checkups to monitor GFR.
  • Medication such as ACE (angiotensin converting enzyme) inhibitors and ARBs (angiotensin receptor blockers) are prescribed to help slow renal decline.*

* Please note: For Alport patients, starting an ACE is recommended not at a certain stage of kidney function or GFR but when the urine protein to creatinine ratio is above 0.2 as measured in a simple urinalysis test. Regular measurement of urine protein levels is recommended beginning at one year of age in children with Alport syndrome and at least annually for all ages of patients.

Stage 3:
At this stage, symptoms of kidney disease are very apparent. These include fluid retention, changes in urine color, kidney pain and extreme fatigue.

  • Finding a nephrologist is essential at this stage. A dietician is also normally recommended.
  • Phosphorous and calcium consumption will be limited in your daily diet.
  • Maintaining all the treatment recommendations from stages 1-2 is crucial.
  • Medication such as ACE (angiotensin converting enzyme) inhibitors and ARBs (angiotensin receptor blockers) are prescribed to help slow renal decline.*

* Please note: For Alport patients, starting an ACE is recommended not at a certain stage of kidney function or GFR but when the urine protein to creatinine ratio is above 0.2 as measured in a simple urinalysis test. Regular measurement of urine protein levels is recommended least annually for all ages of patients with Alport syndrome.

 Stage 4:
In addition to the aforementioned symptoms of renal disease listed in the previous stages, patients can experience a foul, metallic taste in their mouth and bad breath due to excess urea in the blood.

  • At this stage, dialysis and/or renal transplantation are likely in the near future. Your nephrologist will review the types of dialysis with you in preparation,
  • Patients may become anemic during stage 4 as their red blood cell count drops.

Stage 5
Loss of appetite and limited urine output are common during this stage.

  • The only treatments for stage 5 are hemodialysis, peritoneal dialysis or kidney transplantation.
  • Potassium intake is closely monitored.
  • Vitamins are often prescribed.

 

Additional Resources:
Clinical Practice Recommendations – Synopsis for Families
Expert Guidelines for the Management of Alport syndrome and Thin Basement Membrane Nephropathy 
Chronic Kidney Disease on NKF website 
Prevention on NKF website
Stages of Kidney Disease on Davita website
GFR on NKF website

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