5 stages of kidney failure

Based on the extent of kidney damage, chronic kidney disease (CKD) is divided into five stages—from very mild to complete failure. Kidney failure means that the kidneys are functioning below 15 percent, which is not enough for a person to survive for long on their own. With treatment, the patient can live longer, however, there is no permanent cure for the last stage of kidney failure, according to experts like Nephrologist in Lahore.

What are the stages of kidney failure?

Stage one kidney failure: with normal or high glomerular filtration rate (GFR > 90 mL/min)

The first stage of kidney failure usually presents with little or no symptoms. It is mostly detected incidentally when an MRI of the abdomen or the ultrasound is performed for an unrelated disease. The reason stage one goes unnoticed by the patient is because the kidneys function well even when they are diseased. 

The symptoms of stage one kidney failure are: protein or blood in the urine, higher than normal levels of serum urea and creatinine. Stage one kidney failure is more common in people with the hereditary conditions—like polycystic kidney disease (PKD). As mentioned before, stage one kidney disease is diagnosed through imaging techniques like CT scan, MRI, contrast X-ray, or ultrasound abdomen, which shows evidence of kidney damage.  

Stage one kidney failure: with normal or high glomerular filtration rate (GFR 60-89 mL/min)

Even during the second stage of kidney failure, there are minimal symptoms. This stage presents with weakness and fatigue, sleep problems, loss of appetite, and itching. There is higher incidence of urinary tract infections, abnormal urine tests and high blood pressure in this stage. 

Like stage one, this stage also involving kidneys working well, however, there is higher level of protein in the urine with more physical damage to the kidneys. 

Stage three kidney failure: with mild kidney disease (GFR 30-59 mL/min)

Stage three is divided into two stages. In the first stage 3A, the GFR is between 45 and 59, while in the second stage 3B, the glomerular filtration rate is between 30 and 44. The kidney damage causes health problems at this stage. There is swelling in the hands and feet, with back pain and abnormal urination. The latter presents with dark orange urine, brown or tea colored urine. The urine becomes foamier because of protein in the urine; the kidneys may present more or less urine than normal. 

The secondary complications of kidney disease like high blood pressure, early bone disease due to calcinuria and anemia due to decreased erythropoietin become apparent. As the kidney function declines, there is a buildup of urea in the blood as well, a condition known as uremia. 

Stage four kidney failure: with severe kidney disease (GFR 15-29 mL/min)

This stage is presents with advanced kidney failure, with severe decrease in glomerular filtration rate. Patients of stage four renal disease need kidney transplant in the future and are on dialysis, most of the time. Stage four kidney disease puts the patient at risk for stroke and heart disease. 

As a consequence of severe renal impairment, there is buildup of toxins in the blood, causing severe symptoms. There is muscle twitching, fatigue, chest and back pain, loss of appetite, decreased mental sharpness, sleep problems, swelling in the hands and feet, weakness and less than normal urination.

Other complications of renal disease as seen in stage three also persist—like bone disease, anemia and hypertension. 

Stage five kidney failure: end stage kidney disease (GFR less than 15 mL/min)

In stage five, the kidneys are working at less than 15 percent capacity. This kidney failure leads to buildup of toxins and waste that can be life threatening. This end-stage renal disease presents with nausea and vomiting, breathing issues, fatigue, severe weakness, headaches, little or no urine, changes in skin color, and increased skin pigmentation. The consequence of high serum urea in the end stage renal disease puts the patient at risk for pericarditis, encephalopathy, skin manifestations and peripheral neuropathy. 

For survival, hemodialysis or renal transplant becomes necessary for survival. 

How to deal with renal disease?

Kidney disease, when recognized, at any stage needs regular appointment with an expert nephrologist like Nephrologist in Islamabad. Additionally, healthy diet should be followed by the patient to prevent worsening of disease and progression to the next stage. From stages 1 to 3, lifestyle modifications are a must to slow the advancement of disease. In stages 4 and 5, the patient should think about dialysis and transplant.   

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Christophe Rude
Christophe Rude
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