Ckd Definition And Staging
Chronic kidney disease is defined as the presence of an abnormality in kidney structure or function persisting for more than 3 months.5,25 This includes 1 or more of the following: GFR less than 60 mL/min/1.73 m2 albuminuria abnormalities in urine sediment, histology, or imaging suggestive of kidney damage renal tubular disorders or history of kidney transplantation.5 If the duration of kidney disease is unclear, repeat assessments should be performed to distinguish CKD from acute kidney injury and acute kidney disease .25 Evaluation for the etiology of CKD should be guided by a patients clinical history, physical examination, and urinary findings .5,18,21
Considerations for Diagnosis, Staging, and Referral of Patients With Chronic Kidney Disease
a Other imaging modalities or urine studies may also be considered.
b A variety of scores are available, eg, .
Definition and Prognosis of Chronic Kidney Disease by GFR and Albuminuria Categories, KDIGO 2012
GFR indicates glomerular filtration rate KDIGO, Kidney Disease Improving Global Outcomes. Categories are grouped by risk of progression, which includes chronic kidney disease progression, defined by a decline in GFR category or sustained decline in estimated GFR greater than 5 mL/min/1.73 m2 per year. Green indicates low risk yellow, moderately increased risk orange: high risk and red, very high risk. Reproduced with permission from Kidney International Supplements.5
Test Results And Stages Of Ckd
Your test results can be used to determine how damaged your kidneys are, known as the stage of CKD.
This can help your doctor decide the best treatment for you and how often you should have tests to monitor your condition.
Your eGFR results is given as a stage from 1 of 5:
- stage 1 a normal eGFR above 90ml/min, but other tests have detected signs of kidney damage
- stage 2 a slightly reduced eGFR of 60 to 89ml/min, with other signs of kidney damage
- stage 3a an eGFR of 45 to 59ml/min
- stage 3b an eGFR of 30 to 44ml/min
- stage 4 an eGFR of 15 to 29ml/min
- stage 5 an eGFR below 15ml/min, meaning the kidneys have lost almost all of their function
Your ACR result is given as a stage from 1 to 3:
- A1 an ACR of less than 3mg/mmol
- A2 an ACR of 3 to 30mg/mmol
- A3 an ACR of more than 30mg/mmol
For both eGFR and ACR, a higher stage indicates more severe kidney disease.
What Are The Symptoms Of Kidney Failure
In early stages of kidney disease, many people experience few or no symptoms. Its important to note that chronic kidney disease can still cause damage even though you feel fine.
Chronic kidney disease and kidney failure can cause different symptoms for different people. If your kidneys arent working properly, you may notice one or more of the following signs:
- Fatigue
- Poor appetite or metallic taste of food
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Kidney Testing: Everything You Need To Know
If you have diabetes, your doctor will likely recommend you have one or more kidney tests to check the health of your kidneys.
If you have diabetes, you have a higher risk for chronic kidney disease. Your doctor will likely recommend you have one or more kidney tests to check the health of your kidneys. The sooner you know the health of your kidneys, the sooner you can take steps to protect them. Knowledge is powerlearn about what these tests do and what your results could mean.
Chronic kidney disease is a condition in which the kidneys become damaged over time and cannot filter blood as well as they should. Diabetes is a leading cause of CKD, which often causes no symptoms until your kidneys are badly damaged.
The good news is that if you find and treat kidney disease early, you may be able to keep CKD from getting worse and prevent other health problems such as heart disease. But the only way to know how well your kidneys are working is to get tested.
If you have diabetes, you know how important it is to prevent complications like CKD. Your doctor will want to check your kidney health, usually by testing your urine and blood.
Symptoms Of Kidney Disease
Kidney disease is called a silent disease as there are often few or no symptoms. In fact, you can lose up to 90 per cent of your kidneys functionality before experiencing any symptoms. Some signs and symptoms include:
- a change in the frequency and quantity of urine you pass, especially at night
- blood in your urine
- changes in the appearance of your urine
- puffiness around your legs and ankles
- pain in your back
- pain or burning when you pass urine
- high blood pressure.
If your kidneys begin to fail, waste products and extra fluid build up in your blood. This, and other problems, gradually leads to:
- tiredness and inability to concentrate
- generally feeling unwell
- bad breath and a metallic taste in the mouth.
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What Other Testing Might Be Required
Depending upon your pet’s clinical signs, and the results of the initial screening tests, further testing for kidney disease may include any of the following:
A urinary protein/creatinine ratio is recommended if the urine dipstick evaluation suggests that an excessive amount of protein is being lost in the urine. A urine sample is sent to a veterinary referral laboratory, and the ratio of protein to creatinine in that sample is calculated. An increased protein/creatinine ratio can indicate kidney damage.
Urine culture may be performed if the urinalysis findings are suggestive of a bacterial infection as the cause of the kidney disease.
Leptospirosis titers may be recommended if this organism is suspected of causing the kidney disease. See handout Antibody Titers for more information.
Occasionally ultrasound examination and/or kidney biopsy may be recommended to evaluate the kidneys.
High Blood Pressure And Kidney Disease
High blood pressure is increased pressure inside the arteries that carry blood from your heart to all parts of your body. Untreated, high blood pressure can damage your kidneys.
Also, high blood pressure can develop as a result of kidney disease or renal artery stenosis . Your kidneys control the amount of fluid in your blood vessels and produce a hormone called renin that helps to control blood pressure.
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Diagnosing Chronic Kidney Disease In Children
At Hassenfeld Childrens Hospital at NYU Langone, nephrologists who specialize in treating children with kidney conditions are experienced in diagnosing and managing chronic kidney disease.
The kidneys are a pair of small, bean-shaped organs located in the back, below the rib cage. Their main job is to filter waste and excess fluids from the blood and eliminate them through urine. These organs also maintain the proper balance of fluids and minerals needed for nerve and muscle health.
The kidneys have several other functions. They make erythropoietin, a hormone that helps produce red blood cells, and renin, an enzyme that regulates blood pressure. The kidneys also convert vitamin D into a hormone that the body uses to maintain bone metabolism, a process in which the body removes old bone tissue and replaces it with new bone.
Chronic kidney disease is a progressive, irreversible condition that reduces the kidneys ability to perform these functions. There are many possible causes of this condition. Depending on the cause and how its managed, chronic kidney disease may progress slowly or quickly.
Congenital kidney problems, in which the kidneys and urinary system dont develop normally, are the most common cause of chronic kidney disease in children. Often, these problems cause an obstruction in urine flow and repeated urinary tract infections, which can further injure the kidneys.
When Should I Call The Doctor
A nephrologist receives special training in kidney evaluation and treatment. You may benefit from a kidney specialists expert opinion if:
- You have trouble keeping your blood pressure levels in a normal range, even with medication.
- Your blood sugar levels fluctuate widely.
Last reviewed by a Cleveland Clinic medical professional on 01/10/2018.
References
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Slowing Down The Progression Of Kidney Disease
Early diagnosis is very important in making your condition more manageable. You can slow down the progression of your kidney disease if you have complete knowledge of stages of kidney disease. Here are some of the steps that will help improve your life expectancy with kidney disease if diagnosing it early.
1. Control the Blood Pressure
You can slow the rate of your kidney disease by maintaining good blood pressure. This is especially beneficial for people with diabetes and protein in their urine. Work with your physician to learn how you can keep your blood pressure below 130/85 to slow the rate of kidney disease. People with diabetes should strive to keep their blood pressure below 125/75. Exercising, losing weight, eating less, meditation and lowering your salt intake will also help keep your blood pressure in check. Your doctor may prescribe ACE inhibitors to help keep your blood pressure within the desired level. Meantime, be sure to take your medication as prescribed by your doctor to control the rate of damage to your kidneys.
2. Control the Blood Glucose
3. Adjust Diet and Lifestyle
With proper knowledge about different stages of kidney disease, you can learn what types of changes you need to make to your diet and lifestyle to slow the progression of your disease. Eat food loaded with antioxidants and anti-inflammatory vitamins. Use fish oil but limit your phosphorus and protein intake if your kidney disease is at an advanced stage.
4. Repair the Damage
Risk Factors And Medical History
Your risk of increases as you age. Having or also raises your risk. So does having close relatives who’ve had .
Other conditions that could affect your kidneys include:
-
Diseases that cause inflammation or damage to the kidneys, such as
-
Inherited diseases, such as , which causes large cysts to form in the kidneys
-
Diseases that affect the immune system, such as
-
Conditions that cause blockages in the urinary tract, such as , tumors or an gland
If you have any of these risk factors, your doctor may routinely screen you for kidney disease. That lets your doctor find it as early as possible and slow down its progress.
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What You Need To Know
You have two kidneys, located near the middle of your back, just below the rib cage. Each is about the size of your fist. Tiny structures called nephrons are inside each kidney and they filter the blood. There are about a million of them.
The kidneys are responsible for removing wastes, toxins and extra water from the body balancing important salts and minerals in the blood and releasing hormones to help control blood pressure, manage anemia and help maintain strong bones. The waste and extra water removed by the kidneys become urine. The urine flows through tubes called ureters. It goes to your bladder, which stores the urine until you go to the bathroom.
When the kidneys are damaged, they can’t filter blood as they should. The result can be a build-up of wastes in your body, as well as other problems that can harm your health.
One in three American adults is at high risk for developing kidney disease today. Yet most arent able to identify the signs and symptoms. One in nine American adults has kidney disease and most dont know it.
At first, kidney disease is silent. Symptoms often dont appear until the kidneys are badly damaged. Many people don’t have any symptoms until their kidney disease is advanced. Blood and urine tests are the only way to know if you have kidney disease.
Know Your Kidney Numbers: Two Simple Tests
Did you know one in three American adults is at risk for kidney disease? Anyone can get kidney disease at any time. If kidney disease is found and treated early, you can help slow or even stop it from getting worse. Most people with early kidney disease do not have symptoms. That is why it is important to be tested. Know your kidney numbers!
Your kidney numbers include 2 tests: ACR and GFR . GFR is a measure of kidney function and is performed through a blood test. Your GFR will determine what stage of kidney disease you have there are 5 stages. Know your stage.ACR is a urine test to see how much albumin is in your urine. Too much albumin in your urine is an early sign of kidney damage.
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What Makes Yale Medicines Approach To The Diagnosis Of Renal Disease Unique
As a pioneer in the field of renal pathology, Yale Medicine has become a national leader, known for leading-edge technology and extensive experience in its use. To make the best diagnosis on the kidney biopsy, Dr. Moeckel says, its important to have electron microscopy. That equipment is not found in every hospital or private practice physician clinic. We can do very detailed tests that nobody else can do.
He says that the electron microscope is a valuable diagnostic tool. However, Dr. Moeckel adds, “its not only about having the best technology, but you also need people who have experience using it. Our technologists have a combined experience of more than 50 years in immunofluorescence and electron microscopy.
Treatment For Kidney Disease
If detected early enough, the progress of kidney disease can be slowed and sometimes even prevented. In the early stages, changes to diet and medication can help to increase the life of your kidneys.
If kidney function is reduced to less than 10 per cent of normal, the loss of function must be replaced by dialysis or a kidney transplant. Dialysis is a treatment for kidney failure that removes waste products and extra water from the blood by filtering it through a special membrane .
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Anemia And The Role Of Erythropoietin In Ckd
Anemia is among the most common complications of CKD. In a study that included 19 CKD cohorts from across the world, 41% of the 209 311 individuals had low levels of hemoglobin .92 The initial workup of anemia should include assessment of iron stores: those who are iron deficient may benefit from oral or intravenous iron repletion. Patients with hemoglobin levels persistently below 10 g/dL despite addressing reversible causes can be referred to a nephrologist for consideration of additional medical therapy, including erythropoietin-stimulating agents however, erythropoietin-stimulating agents have been associated with increased risk of death, stroke, and venous thromboembolism, and these risks must be weighed against any potential benefits.93
Stage 3 Kidney Disease Life Expectancy
When diagnosed and managed early, stage 3 CKD has a longer life expectancy than more advanced stages of kidney disease. Estimates can vary based on age and lifestyle.
One such estimate says that the average life expectancy is 24 years in men who are 40, and 28 in women of the same age group.
Aside from overall life expectancy, its important to consider your risk of disease progression. One 10-year study of stage 3 CKD patients found that about half progressed to more advanced stages of kidney disease.
Its also possible to experience complications from CKD, such as cardiovascular disease, which can affect your overall life expectancy.
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Biopsy For Kidney Disease
A biopsy means that a small piece of tissue is taken for testing in a laboratory. Biopsies used in the investigation of kidney disease may include:
- kidney biopsy the doctor inserts a special needle into the back, under local anaesthesia, to obtain a small sample of kidney tissue. A kidney biopsy can confirm a diagnosis of chronic kidney disease.
- bladder biopsy the doctor inserts a thin tube into the bladder via the urethra. This allows the doctor to view the inside of the bladder and check for abnormalities. This procedure is called a cystoscopy. The doctor may take a biopsy of bladder tissue for examination in a laboratory.
Your doctor may arrange other tests, depending on the suspected cause of your kidney disorder.
What Is Acute Kidney Injury
Acute kidney injury , also known as acute renal failure , is a sudden episode of kidney failure or kidney damage that happens within a few hours or a few days. AKI causes a build-up of waste products in your blood and makes it hard for your kidneys to keep the right balance of fluid in your body. AKI can also affect other organs such as the brain, heart, and lungs. Acute kidney injury is common in patients who are in the hospital, in intensive care units, and especially in older adults.
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What Can I Expect If I Have Kidney Disease
If you have kidney disease you can still live a productive home and work life and enjoy time with your family and friends. To have the best outcome possible, its important for you to become an active member of your treatment team.
Early detection and appropriate treatment are important in slowing the disease process, with the goal of preventing or delaying kidney failure. You will need to keep your medical appointments, take your medications as prescribed, stick to a healthy diet and monitor your blood pressure and blood sugar.
How Is Kidney Disease Diagnosed
First your healthcare provider will take your medical history, conduct a physical exam, ask about any medication you are currently taking, ask about any symptoms you have noticed, and inquire if any of your family members have kidney disease.
Your healthcare provider will order blood tests, a urine test and will also check your blood pressure.
The blood tests will check:
- Your glomerulofiltration rate . This describes how efficiently your kidneys are filtering blood how many milliliters per minute your kidneys are filtering. Your GFR is used to determine the stage of your kidney disease.
- Your serum creatinine level, which tells how well your kidneys are removing this waste product. Creatinine is a waste product from muscle metabolism and is normally excreted in your urine. A high creatinine level in your blood means that your kidneys are not functioning well enough to get rid it in your urine.
A urine protein test will look for the presence of protein and blood in your urine. Well-functioning kidneys should not have blood or proteins in your urine. If you do, this means your kidneys are damaged.
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