Five Stages of Chronic Kidney Disease (CKD)

Five Stages of Chronic Kidney Disease (CKD)According to GFR, CKD is classified into five stages. And in different stages, there are different treatment goals. In this article, let’s have a quick look.

CKD stage 1: renal function is normal

If your glomerular filtration rate (GFR) is greater than 90 and serum creatinine is normal, congratulations, your kidney function is in the first stage, that is, the early stage. Most patients only have urinary protein and occult blood, and some patients may be with edema and hypertension.

This period is reversible. After treatment, most of the clinical symptoms and indicators can be restored. For some patients with mild illness and standardized treatment, inflammation of the kidney tissue can even be completely restored to normal.

During this period, the focus of treatment is to achieve complete remission of proteinuria and hypertension as far as possible: 24-hour urinary protein quantification is less than 0.5g, blood pressure is less than 130/80mmHg. And supportive treatment such as anticoagulation, lipid-lowering, diuresis and detumescence should also carried out.

CKD stage 2: kidney function declines slightly.

When GFR is 60-89, and serum creatinine is 133-177 umol/L, you are in CKD stage 2. it is also early stage. Although kidney has lost over 2/3 cells, and kidney function also declines, the residual 1/3 - 1/4 cells can still work normally and maintain the kidney function, so you won’t feel uncomfortable. As long as you follow doctor’s advice, uremia is far away from you.

During this period, the focus of treatment is proteinuria and primary disease such as Minimal Change Disease, Membranous Nephropathy, IgA Nephropathy, FSGS, etc.

CKD Stage 3: kidney function declines moderately.

When GFR is 30-59, and serum creatinine is 178 - 442 umol/L, it is CKD stage 3. Now it is not early stage any more, and the disease has progressed to a critical stage: to continue to live a normal life, or to progress to uremia. With timely and effective treatment, there is 50% of possibility to achieve clinical cure, and it won’t develop to stage 4 and stage 5. This turning point is at GFR 45, and serum creatinine 265.

In this stage, patients have weakness, renal hypertension, renal anemia, electrolyte disorder, acidosis, etc. And patients have to eat a lot of medicines. The focus of treatment is to simplify medication: while reducing urinary protein as much as possible, keep blood pressure, hemoglobin, electrolyte, carbon dioxide binding force and cardiac function stable. As to the previous use of ACEI/ARBs, steroids/immunosuppressive drugs, you need to weigh the pros and cons before use.

CKD stage 4: kidney function declines seriously.

When GFR is 15-29, and serum creatinine is 443-707 umol/L, it is CKD stage 4. And it has entered an irreversible stage.

In this stage, the treatment focuses on complications: lowering blood pressure, correcting anemia, improving acidosis, balancing electrolytes, improving cardiac function and so on so as to delay the time of entering uremia. Proteinuria is less harmful than complications. Don't use drugs with high side effects in order to reduce proteinuria.

CKD stage 5: uremia stage, and try to improve living quality.

When GFR is below 15, and serum creatinine is over 707 umol/L, it is CKD stage 5, namely uremia stage.

Some patients with severe primary disease and more complications will have uncontrollable heart failure, acidosis, hyperkalemia, and need dialysis or kidney transplantation.

The other part of patients with no obvious complications can be treated conservatively with medicine, diet and exercise. The quality of life and medical expenses are better than those of routine dialysis, and the GFR can be delayed to less than 10 times as far as possible. This period usually lasts from a few months to a year, and some patients who are well maintained do not have a GFR of 10 years later.

Complications need to be closely monitored when GFR drops to between 5 and 10, and dialysis should be started immediately if serious complications occur. When GFR drops below 5, dialysis should be started regardless of complications.

In different stages of CKD, there are different treatment strategies and goals. Which stage are you in? For more information on CKD treatment, please leave a message below or contact online doctor.


***Please seek professional medical advise for the diagnosis or treatment of any ailment, disease or medical condition. This article is not intended to be a substitute for the advice of a licensed medical professional.***

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