It’s estimated that nearly 37 million adults in the United States suffer from chronic kidney disease. However, even with so many people being affected, many are unaware of how chronic kidney disease progresses, and what they can do to spot the signs of kidney damage early. In this article, we’ll cover everything you need to know about how chronic kidney disease develops, as well as what treatment options are available for more advanced-stage kidney failure. First, to better understand how chronic kidney disease develops, let’s take a look at what chronic kidney disease is, and what causes it.
What Is Chronic Kidney Disease?
Chronic kidney disease, also known as chronic kidney failure, involves the gradual loss of kidney function over time. The kidneys are one of many essential organs, and they are vital to maintaining a healthy, well-functioning body. They are responsible for filtering excess fluids and waste from your bloodstream, which are then excreted in your urine. Advanced stages of chronic kidney disease can cause the body to build up to dangerous levels of fluids, electrolytes, and waste, which can lead to serious health complications.
In the earlier stages of this chronic disease, you may experience little to no symptoms, which can make early detection extremely difficult. Many people do not realize they have chronic kidney disease until it is in its advanced stages.
Causes of Chronic Kidney Disease
The gradual failure of the kidneys that results in chronic kidney disease occurs when a disease or condition impairs kidney function. This impairment causes damage to the kidneys, which worsen over time, and can eventually lead to kidney failure. Several conditions can contribute to the development of chronic kidney disease. The most notable of those include:
- Type 1 or type 2 diabetes
- High blood pressure
- Glomerulonephritis (inflammation of the kidney’s filtering units)
- Interstitial nephritis (inflammation of the kidney’s tubules and surrounding structures)
- Recurrent kidney infection
- Prolonged obstruction of the urinary tract, such as an enlarged prostate or kidney stones
- Polycystic kidney disease or other inherited kidney diseases
All of these conditions can lead to chronic kidney disease or kidney failure. If you or someone you know has any of the above-mentioned conditions, talk with your doctor about your risk for chronic kidney disease. One of the first things your doctor may recommend is a test to determine whether you have chronic kidney disease, and if so, what stage.
How Chronic Kidney Disease Develops: The Stages
Chronic kidney disease is divided into five stages. These stages are based on a test known as an Estimated Glomerular Filtration Rate Test, or eGFR for short. An eGFR test is a measurement of how well your kidneys are working. Your eGFR score is an estimated number based on a blood test and your age, sex, body type, and race. All of these together help to show how well your kidneys work to filter out waste and extra fluids out of your body.
These fives stages are an important thing to understand when talking about how chronic kidney disease develops. Kidney disease isn’t something that appears out of the blue in stage 5, rather, it is a gradual process that worsens over time. In the early stages, stages 1-3, your kidneys are still able to filter waste out of your bloodstream. In the later stages, stages 4-5, your kidneys must work increasingly harder to filter your blood, and can even stop working altogether.
In the simplest term, an eGFR test measures what percentage of kidney function you have. This means a score of 90 would mean you have 90% of your kidney function, a score of 65 would mean you have 65% kidney function, and so on.
What Do the Stages of Chronic Kidney Disease Mean?
The goal of each stage of chronic kidney disease is to slow the damage to your kidneys and keep them working as long as possible. Once you undergo an eGFR test, your doctor will help explain what your results mean, what stage of kidney disease you have, and what steps you need to take moving forward.
Below we’ll take a closer look at each stage, which can help you better understand how chronic kidney disease develops.
Stage 1: eGFR Score of 90 or Greater
Stage 1 chronic kidney disease means you have mild kidney damage and an eGFR score of 90 or greater. At this stage, kidney disease doesn’t typically cause symptoms, but your doctor may recommend an eGFR test if you are at a higher risk of developing chronic kidney disease. Most of the time, a score of 90 or higher means your kidneys are healthy and working well. However, scores in this range will typically have some signs of kidney damage such as protein in your urine or physical damage to the kidneys.
During this stage of chronic kidney disease, your doctor may recommend some of the following lifestyle changes to help slow the damage to your kidneys:
- If you have diabetes, control your blood sugar
- Keep your blood pressure under control
- Eat a healthier diet
- Abstain from tobacco use
- Maintain a healthy weight
- Be active for at least 30 minutes a day, for 5 days a week
Stage 2: eGFR Score Between 60 and 89
Stage 2 chronic kidney disease means you have mild to moderate kidney damage, and an eGFR score between 60 and 89. Like stage 1, a score between 60 and 89 means you have relatively normal kidney function, although the signs of kidney disease may be more present. These can include things like darker urine, increased or decreased urination, excessive fatigue, or pain in the lower back.
During this stage of chronic kidney disease, your doctor will typically recommend the same mitigation efforts as for stage 1. They may also ask you to follow up with a nephrologist (kidney doctor) if you have not already done so.
Stage 3: eGFR Score Between 30 and 59
Stage 3 chronic kidney disease is the first stage in which kidney function is described as “not normal.” This stage means you have noticeable damage to your kidneys and an eGFR score between 30 and 59.
Stage 3 is divided into two stages: stage 3a and stage 3b. Stage 3a means you have an eGFR score between 45 and 59, and stage 3b means you have a score between 30 and 44. Although these stages of kidney disease are quite advanced, many people in this stage will not have any symptoms.
That said, some symptoms of stage 3 chronic kidney disease may include:
- Swelling in your hands and feet
- Back pain
- Urinating more or less than usual
At this stage of kidney disease, you may also experience several health complications as waste builds up in your body. These can include:
- High blood pressure
- Bone disease
During this stage of chronic kidney disease, your doctor will recommend you see a nephrologist, who will make a treatment plan that is right for you and tell you how often you will need to have your kidneys checked. They may also recommend high blood pressure medications if you have diabetes or high blood pressure.
Stage 4: eGFR Score Between 15 and 29
Stage 4 chronic kidney disease means your kidneys are moderately or severely damaged, and you have an eGFR score between 15 and 29. This stage of kidney disease should be taken very seriously, as it is the last stage before kidney failure.
At stage 4, most people will display symptoms of severe kidney damage. These may include things like:
- Fluid retention
- Changes in urination (foamy; dark orange, brown, tea-colored or red if it contains blood; and urinating more or less than normal)
- Pain in the lower back
- Sleep problems
- Bad breath due to urea buildup in the blood
- Nerve problems such as numbness or tingling in the toes or fingers
At stage 4 chronic kidney disease, it’s necessary to see a nephrologist. They will help you make a plan to get your kidneys checked regularly, and can also prepare you for kidney failure. Once your kidneys have failed, you will need to start dialysis or have a kidney transplant to live.
Stage 5: eGFR Score of 15 or Below
Stage 5 chronic kidney disease is the most advanced stage of kidney disease. At this stage, your eGFR score is below 15, and your kidneys have failed or are close to failing. If your kidneys fail, waste builds up in your blood, which can make you very sick.
Symptoms of stage 5 chronic kidney disease include:
- Muscle cramps
- Nausea or vomiting
- Swelling in the hands or feet
- Back pain
- Making little or no urine
- Changes in skin color
- Tingling in the hands or feet
If you are diagnosed with stage 5 chronic kidney disease, you will need to see a nephrologist immediately. The doctor will help you decide which treatment is best for you—hemodialysis (HD), peritoneal dialysis (PD), or kidney transplant—and will recommend dialysis access.
Treatment for Chronic Kidney Disease
Based on what stage of chronic kidney disease you have, and what the cause is, treatment can vary. Oftentimes, chronic kidney disease has no cure. Treatment for chronic kidney disease usually consists of measures to help control your symptoms, reduce complications, and slow the progression of the disease. If the damage to your kidneys becomes severe, you may require treatment for end-stage (stages 4-5) kidney disease.
For the earlier stages of chronic kidney disease, treating the cause (if possible) is often the first avenue doctors will pursue. Treatment options will vary depending on the cause. However, kidney damage can continue to worsen even when an underlying condition, such as diabetes or high blood pressure, has been controlled.
As the damage progresses, treatment for chronic kidney disease shifts towards treating the complications associated with kidney damage. These can include things like high blood pressure, swelling, anemia, high cholesterol, or the buildup of waste in your blood. All of these complications can typically be treated with medications, therapies, or a combination of the two.
Lastly, should the damage become severe, treatment for chronic kidney disease may ultimately require dialysis or a kidney transplant. Both of these treatments require constant medical care, and for those in need of a transplant, the wait times can be as long as three years.
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