The 5 Stages of Kidney Failure

The kidneys help remove waste, toxins, and surplus fluids from our bodies. Kidneys also help to regulate our blood pressure and blood chemicals as well as stimulate the formation of red blood cells and keep our bones healthy

When a kidney does not function properly, our nerves, muscles, and other tissues in the body may also not function normally.

What are the causes of kidney failure?

The two main reasons that may cause the kidneys to fail are:

• High blood pressure
• Diabetes

The kidneys may also fail due to other reasons like:

• Damages due to physical injuries
• Glomerulonephritis, when there is an inflammation of the kidney’s filtering units
• Interstitial nephritis (an inflammation of the kidney’s tubules and surrounding structures)
• Polycystic kidney disease or other inherited diseases
• Prolonged obstruction within the urinary tract due to prostate, kidney stones, or some cancers
• Recurrent kidney infection (also called pyelonephritis)
• Vesicoureteral (a condition that causes the urine to back up in the kidneys)

What are the signs and symptoms of kidney failure?

In the early stages of chronic kidney disease (CKD), a patient may not show any symptoms as kidney failure does not happen overnight. It happens gradually, and the symptoms show up as it progresses.

Some of the signs include of kidney failure include:

• Trouble sleeping
• Poor appetite
• Feeling tired or weak
• Persistent itching
• Weight loss
• Muscle cramps (especially felt in the legs)
• Swelling of the feet or ankles
• Anaemia (low blood count)

How is a kidney failure diagnosed?

Following are the two main ways that a doctor could use to check and monitor kidney disease.

• Urine test - to check the presence of albumin in the urine. Albumin is a protein that is found in your blood. A healthy kidney would not allow it to be passed into the urine. If albumin is found, it may be because the kidney is damaged.
• Blood test - to check how well the kidneys are filtering your blood. The test is called GFR, which stands for glomerular filtration rate.

What are the five stages of kidney failure?

There are five stages of kidney failure that are determined via tests, and each stage calls for a different kind of treatment.

• Stage 1 - Normal kidney function

  In stage 1, your Estimated Glomerular Filtration Rate or eGFR value is 90 or more.

  In this stage, you may not show any symptoms as the damage to your kidneys is rather mild, and they still work well. Presence of a protein may be detected in the urine.

• Stage 2 - Mild decline in kidney function

  In stage 2, your eGFR value would have gone down to between 60 and 89, and the damages are mild.

  Your kidneys may still be functioning as normal, and no symptoms may appear. Other signs that can be detected would be protein in the urine or physical damage.

• Stage 3 - Moderate decline in kidney function

  Stage 3 is when your eGFR value is between 30 and 59. In this stage, your kidneys may not work as well in filtering out waste and extra fluid out of your blood.

  This waste will start building up and may begin to cause health problems such as high blood pressure and bone diseases.

  Symptoms such as feeling tired and weak or swelling in the hands or feet may start appearing as well.

• Stage 4 - Severe decline in kidney function

  When the eGFR value drops between 15 and 29, it is classified as stage 4. This means that the body is building up more waste, toxins, and fluids.

  As a result, the patient may also face other health problems like high blood pressure, bone and heart diseases.

  He/she will likely show symptoms like swelling of your hands and feet, lower back pain, loss of appetite, and fatigue. You may also require dialysis at this stage.

• Stage 5 - Complete kidney failure or end-stage renal disease (ESRD)

  Stage 5 is life-threatening as the build-up of toxins and waste is at the critical stage. Here the eGFR reading is less than 15, and your kidneys may have stopped working (or poorly working).

  The build-up of toxins can make the patient very sick, and in order to survive, he/she may require dialysis or a kidney transplant.

  Some of the symptoms of kidney failure include swelling of the feet, severe tiredness, loss of appetite, and nausea or vomiting.

What are the treatment options for kidney failure?

At later stages of the disease, the following are the two treatment options deployed:

Dialysis

When your kidney fails, the first and immediate option to save the patient’s life is dialysis. It is a process that removes waste and fluid from the body. There are two types of dialysis:

• Hemodialysis - This is usually done three times a week at a dialysis centre. Two needles are placed in the arm, which is attached to a dialyser. The blood is then pumped through the filter and returned to the body.
• Peritoneal dialysis - In this procedure, a catheter is surgically placed into the abdomen and a dialysis solution flows through the catheter, and into the abdomen. The patients can continue their day normal but will need to drain the catheter into a bag and discard it after a few hours. This procedure has to be repeated 4 - 6 times a day.

Kidney transplant

This is a surgical procedure that involves replacing the damaged kidney with a healthy one. Kidneys can come from a living or deceased donor. The patient may not require dialysis but will have to take anti-rejection drugs for the rest of his/her life.

What is the life expectancy for someone with chronic kidney disease (CKD) before it progresses to kidney failure?

The life expectancy of someone with kidney disease depends on the stage they have been diagnosed with, age, and gender.

Generally, a person in stages 1, 2, and 3 may live longer than those in stages 4 and 5.

In general, a 40-year-old man in stage 2 can live an additional 30 years after being diagnosed, whereas a 40-year-old woman can expect to live for another 34 years. As these stages are detected early, a person may be able to live longer with all the treatments available, as not all cases may progress beyond these early stages.

In stage 4, the kidneys are significantly damaged, but the right diet and medication or dialysis may prolong your life. Patients in stage 4 may live for another 14.5 years to 16.5 years.

According to the National Kidney Foundation, on average, once a patient in stage 5 has started dialysis, he or she may live for another 5 to 10 years. Another study also shows that patients whose eGFR value is between 15-29mL may live for another ten years on average.

Make an appointment at Gleneagles Hospital

In a nutshell, chronic kidney disease has no cure, but early detection, a healthy lifestyle, and proper treatment may prolong your life once diagnosed.

If you or a loved one is at risk of chronic kidney disease, get in touch with us for an appointment with a Nephrology specialist at your nearest Gleneagles Hospital.

References

1. Tanvir Chowdhury Turin , Marcello Tonelli , Braden J. Manns,, Pietro Ravani, Sofia B. Ahmed and Brenda R. Hemmelgarn (27 Aug 2012), Chronic kidney disease and life expectancy, Available at https://pubmed.ncbi.nlm.nih.gov/22442392/ [Accessed 23 March 2022]
2. Chronic Kidney Disease Stage, Available at https://www.healthline.com/health/ckd-stages [Accessed 23 March 2022]
3. Chronic kidney disease and life expectancy, Available at https://pubmed.ncbi.nlm.nih.gov/22442392/ [Accessed 23 March 2022]
4. https://www.niddk.nih.gov/health-information/kidney-disease/kidneys-how-they-work
5. https://www.kidney.org
6. https://www.kidneyfund.org/all-about-kidneys/stages-kidney-disease
7. https://responsumhealth.com/chronic-kidney-disease/stages/stage-2/