The different stages of kidney failure increase in severity as kidney function falters. Stages 1 through 5 are indicators of the extent to which the disease is progressing. Simply because an individual is experiencing a particular level, or stage, of sickness does not mean he is dying. Rather, the stages present doctors with a reference point as to the treatment necessary to help patients regain health and avoid a terminal prognosis.
The term chronic kidney disease (CKD) refers to the five stages of kidney disease. An individual with a diagnosis of CKD falls within one of these five stages of increasing severity. CKD progresses gradually, usually over the course of months and years. Stage 5, also known as endstage kidney disease or renal failure, is a near-complete shutdown of kidney function. At that point, the body is completely reliant on dialysis to mechanically cleanse the kidneys of waste.
Glomerular filtration rate (GFR) is the test used by physicians to determine what level of kidney failure a patient is experiencing. GFR monitors the amount of blood that flows per minute through the millions of tiny filters inside the kidneys. In an article written for "Kidney Beginnings: The Magazine," Dr. Stephen Z. Fadem says "when measuring GFR, a marker substance such as creatinine is used. Creatinine is a metabolite from muscle. As new muscle builds, old muscle cells are torn down and release this metabolite into the blood, where it is eliminated by the kidneys and excreted into the urine."
A high level of creatinine indicates the kidneys are not functioning properly. The higher that level rises dictates whether or not a patient is diagnosed as being in a higher stage of CKD.
Kidney function is normal with no significant symptoms of CKD in Stage 1. However, some factor points to CKD as being present. This usually is a urinalysis showing an increase in protein--an indicator the kidneys are not removing waste properly. There may also be a genetic trait or kidney abnormalities that are cause for caution. Medical treatment includes observation, testing and control of blood pressure. The GFR is 90 or above.
As heart disease is the primary cause of death for those with CKD, physicians will monitor associated risk factors including hypertension, cholesterol levels and diabetes treatment.
In Stage 2, kidney function is somewhat reduced and testing will have shown other areas of concern. Treatment consists of observation, blood pressure control and management of other risk factors like diabetes, diet, smoking and lack of exercise. The GFR falls between 60 and 89.
Advancement to this stage indicates moderately reduced kidney function. Stage 3 is actually divided into two sections--3A and 3B. The first shows a GFR between 45 and 59, while stage 3B is reached when GFR sinks to between 30 and 44. Treatment continues to be focused on observation, control of blood pressure and even stricter management of additional risk factors.
GFR has sunk to a level between 15 and 29, indicating severe loss of kidney function. Treatment focuses on planning for endstage renal failure, including preparation for dialysis and exploration of transplant options.
This is very severe, or endstage, kidney failure. GFR registers below 15 and dialysis must start immediately. Many patients live long and maintain a relatively vigorous and energetic lifestyle, even with the need for dialysis.
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