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5 Stages of Chronic Kidney Disease

Your kidneys are pretty durable, even when not working at 100%. Here’s how to tell you may have chronic kidney disease—and should see a doctor.

woman receiving an ultrasound of her kidneys
Updated August 21, 2023

By Brett Rosenthal, DO, Nephrologist — Virtua Nephrology

The kidneys play an important role in your health, filtering your blood to remove waste, toxins, and excess fluid. They help to regulate your blood pressure, stimulate the production of red blood cells, and keep your bones healthy.

So how do you know if your kidneys—each about the size of a fist—are not working properly? Unfortunately, in the early stages of chronic kidney disease (CKD), the gradual loss of kidney function, you may have few clues.

That’s because the body is usually able to cope with a decrease in kidney function. As you generally feel fine, it’s easy to attribute symptoms to another condition, or ignore them altogether.

Often, CKD is only diagnosed if a routine blood or urine test detects an abnormality.

Diagnosing Your CKD

Chronic kidney disease is divided into five stages. They are based on the results of an estimated glomerular filtration rate (eGFR) screening. This is a blood test that sees how much creatinine is in your blood. Creatinine is a waste product in your blood that comes from your muscles. Healthy kidneys take creatinine out of your blood and remove it from your body through urine.

If creatinine is building up in your body, it is a sign your kidneys are having problems filtering toxins and wastes.

Based on a mathematical formula that includes your creatinine level, age, gender, muscle mass, and ethnicity, your provider will come up with your eGFR and stage of your disease.

  • Stage 1: eGFR 90 or greater—kidneys working normally
  • Stage 2: eGFR 60 to 89—mild kidney damage
  • Stage 3a: eGFR 45 to 59—mild to moderate kidney damage
  • Stage 3b: eGFR 30 to 44—moderate to severe kidney damage
  • Stage 4: eGFR 15 to 29—severe kidney damage
  • Stage 5: eGFR less than 15—kidney failure

Your eGFR can change over time, and will go down as your CKD worsens. However, you can still have CKD if your eGFR is in the normal range and you have signs of kidney damage, like protein in your urine.

Your nephrologist will regularly calculate your eGFR levels, and may order other tests that look for kidney problems, such as the presence of protein or blood in your urine. Your nephrologist will answer any questions you may have about these tests.

Symptoms of CKD in Its Early Stages (1 and 2)

In stages 1 and 2 of your disease, your kidneys are healthy and still working well. The only indications you may experience are higher levels of protein in your urine (possibly due to nephrotic syndrome), symptoms of a urinary tract infection, or higher blood pressure.

CKD Symptoms at Stages 3 and 4

Most people only begin to experience symptoms once they reach stage 3. The most common initial symptoms are:

  • Swelling, or edema, in your hands, legs, feet, or ankles as the body is unable to get rid of extra fluid and salt
  • Higher blood pressure
  • Changes in urination habits, peeing more or less than normal
  • Kidney pain felt in the back

Additionally, you may have:

  • Fatigue
  • Higher protein levels in urine
  • Blood or excessive bubbles (foam) in your urine
  • Urinary tract infections
  • Sleep problems due to muscle cramps or restless legs
  • Anemia
  • Bone disease

When you reach stage 4, your condition has worsened to the point where you may need dialysis or a kidney transplant in the near future. In addition to the symptoms of stage 3, you may also experience:

  • Nausea and/or vomiting
  • A metallic taste in your mouth
  • Bad breath
  • Loss of appetite
  • Difficulty concentrating
  • Nerve problems, such as numbness in your fingers or toes

Stage 5 CKD Symptoms

At stage 5, your kidneys are close to or have completely failed. This stage is also called end-stage renal disease. Dialysis or a kidney transplant is necessary.

Symptoms you may experience include:

  • Loss of appetite
  • Nausea or vomiting
  • Headaches
  • Fatigue
  • Inability to concentrate
  • Itching
  • Making little or no urine
  • Swelling, especially around your hands, feet, ankles, and eyes
  • Muscle cramps
  • Tingling in the hands and feet
  • Changes in skin color or pigmentation
  • Back pain
  • Trouble breathing (from fluid buildup in the lungs)
  • Trouble sleeping

Managing Your CKD Symptoms

For all stages of CKD, a nephrologist, or kidney specialist, will work with you to create a plan to manage your symptoms and slow the progression of your CKD. This may include medications to manage high blood pressure, such as angiotensin-converting enzyme (ACE) inhibitors, angiotensin II receptor blockers, beta-blockers, and calcium channel blockers. If you have diabetes, you may be on medications like metformin, dulaglutide, or semaglutide.

In addition, your nephrologist will recommend a kidney- and heart-healthy diet, physical activity, maintaining a healthy weight, not smoking, and managing stress.

Depending on the stage of your CKD, your doctor may discuss dialysis or being listed for a kidney transplant.

If you experience symptoms that could be CKD, speak to your doctor. The earlier we can diagnose your condition, the more we can do to maintain your kidney health.

Make an Appointment

To schedule an appointment with a Virtua kidney specialist, call 856-325-3341 or request an appointment here

If you are unsure about your kidney health, take our quick and easy Kidney Health Risk Assessment