Chronic Kidney disease

The kidneys are paired organs that filter and excrete waste and maintain homeostasis within the body through several means, including regulating blood pressure, maintaining an acid-base balance, and hormone synthesis.

Patients with chronic kidney disease (CKD) exhibit abnormality in the structure or function of their kidneys for three months or longer. Common causes of CKD include diabetes mellitus and hypertension. Because the kidney can initially compensate for complications due to such conditions, most patients who develop CKD are initially asymptomatic, and symptoms arise when kidney function is severely impaired. Furthermore, CKD increases the risk of developing other conditions, most notably atherosclerotic cardiovascular disease (ASCVD), resulting in the blockage of vital arteries. Unfortunately, there is no cure for CKD, but physicians can help patients slow its progression and manage symptoms. Patients at risk of developing CKD may take preventative measures, such as monitoring their lab results, especially their electrolyte and creatinine levels.

Stages of Chronic Kidney Disease

The progression of CKD is primarily classified based on two categories: the estimated glomerular filtration rate (eGFR)—a measure of kidney function based on a blood test—and albuminuria, the amount of albumin protein present in the urine. A higher eGFR and lower albuminuria are indicative of better kidney function.

Stage 1

The kidneys are in a mild form of damage, and the eGFR is greater than 90 mL/min. Symptoms indicating kidney damage are typically not present at this stage, as the kidneys can still perform effectively despite minor damage. Thus, a CKD diagnosis in this stage is typically thanks to routine bloodwork and urine tests.

Stage 2

Like stage 1, stage 2 is also typically asymptomatic; however, the eGFR is 60-89 mL/min.

Stage 3

At stage 3, the kidney has undergone moderate damage. In stages 3A and 3B, the eGFR ranges from 45 to 59 mL/min and 30 to 44 mL/min, respectively. This stage is characterized by uremia, a buildup of waste, toxins, and fluids due to poor filtration. Additionally, complications of kidney disease may arise, such as anemia, high blood pressure, and early bone disease.

Stage 4

With an eGFR at 15-30 mL/min, patients in stage 4 of CKD will likely require dialysis or a kidney transplant and develop cardiovascular complications.

Stage 5

During stage 5 of CKD, the kidneys are nearly defunct, as the eGFR is 15 mL/min or less. This stage is classified as end-stage renal disease (ESRD), and dialysis or a kidney transplant is required as the buildup of wastes and toxins becomes life-threatening.

Frequently Asked Questions

CKD may be the result of various etiologies; in the United States, 38% of CKD cases are due to diabetes mellitus, 26% are due to hypertension, and 16% are due to kidney inflammation.
Due to the kidneys’ exceptional compensatory mechanism, CKG is often unnoticed in its initial stages; however, it may be diagnosed early from routine lab work. Although later stages may precipitate general symptoms, such as fatigue, weakness, and headaches, patients with CKG may also have unique symptoms, such as a urine-like odor in the breath and crystallized yellow-white deposits on the skin.
CKD may only be diagnosed by blood and urine tests. The blood test can determine the glomerular filtration rate (GFR), a measure of kidney function. Meanwhile, the urine test can detect protein in the urine, a sign of kidney dysfunction.
The primary goals of managing CKD are slowing its progression and preventing further complications. To accomplish them, the underlying disease must be treated.
Because the kidneys are nearly defunct in the advanced stages, they cannot filter toxins at this stage. As a result, patients with CKD can accumulate dangerous levels of electrolytes and wastes in the body.
CKD can be managed by making lifestyle changes, and appropriate medications prescribed by a nephrologist can prevent its complications.
When CKD reaches stage 4, patients should consider dialysis or a kidney transplant. In stage 5, the kidneys are suffering from end-stage renal disease and will thus require renal replacement therapy (i.e., dialysis or transplantation).
Dialysis is not a cure for kidney disease. Rather, it performs the kidney’s role by removing waste and fluids from the blood. Kidneys cannot heal, so if they are damaged due to CKD, they cannot recover.
An organ transplant is often the treatment of choice for kidney failure once the patient reaches end-stage renal disease. Patients may opt for a transplant over dialysis, as frequent visits to dialysis centers may interfere with day-to-day life. A kidney transplant can treat CKD and end-stage renal disease, restore patients’ lifestyles, and increase their longevity.