Chronic kidney disease: Symptoms, Stages, Causes, Risk factors and Complications

Chronic kidney disease is a slow and progressive loss of kidney function over a period of several years, which will eventually lead to permanent kidney failure .

Updated: August 17, 2018

Chronic kidney disease is a slow and progressive loss of kidney function over a period of several years, which will eventually lead to permanent kidney failure.
It is also known as chronic renal failure, chronic renal disease, or chronic kidney failure. It often goes undetected and undiagnosed until the disease is well advanced.
The function of your kidneys is to filter wastes and excess fluids from your blood, which are then excreted in your urine. When chronic kidney disease occurs, your kidneys will not be able to perform its task properly. As kidney failure advances and the function of organ is severely impaired, dangerous levels of waste, electrolytes and fluid can rapidly build up in the body.
In the early stages of chronic kidney disease, you may have few signs or symptoms which include blood in urine, high blood pressure, and fatigue. Diagnosis can be confirmed after blood tests, kidney scans, or biopsy. As there is no cure for chronic kidney disease, treatment is focused on reducing symptoms. Treatment is aimed at stopping or slowing down the progression of the disease, which is usually done by controlling its underlying cause. The causes could be diabetes and specific kidney diseases, which includes polycystic kidney disease. Chronic kidney disease can progress to end-stage kidney failure, which is fatal without artificial filtering called dialysis or a kidney transplant.

Symptoms of chronic kidney disease:

Chronic kidney failure is a slow and gradually progressive disease. Even if one kidney stops functioning, the other can carry out normal functions. Because of this signs and symptoms are noticeable until the disease is fairly well advanced and the condition has become severe. By this time most of the damage is irreversible.
In the late stages of CKD, as you are nearing kidney failure (ESRD), you may notice symptoms that are caused by waste and extra fluid building up in your body.
The most common signs and symptoms of chronic kidney disease include:

  • anemia
  • blood in urine
  • dark urine
  • decreased mental alertness
  • decreased urine output
  • edema in which you can have swollen feet, hands, and ankles (face if edema is severe)
  • fatigue or tiredness
  • hypertension or high blood pressure
  • insomnia
  • itchy skin, can become persistent
  • loss of appetite
  • erectile dysfunction
  • more frequent urination, especially at night
  • muscle cramps
  • muscle twitches
  • nausea
  • pain on the side or mid to lower back
  • panting or shortness of breath
  • protein in urine
  • sudden change in body weight
  • unexplained headaches
  • If your kidneys stop working suddenly (acute kidney failure), you may notice one or more of the following symptoms:
  • Abdominal (belly) pain
  • Back pain
  • Diarrhea
  • Fever
  • Nosebleeds
  • Rash
  • Vomiting

Having one or more of any of the symptoms above may be a sign of serious kidney problems. You should contact your doctor right away if you notice any of these symptoms. It is important to have your kidney functions regularly checked if you are at high risk of developing kidney disease. Early detection can significantly help prevent serious kidney damage.

Stages of chronic kidney disease:

Kidney disease stages are classified based on changes in the GFR (glomerular filtration rate) rate. An estimated GFR greater than 90 means the kidneys are healthy and working well. The stages include:

Stage 1:

GFR rate is normal. However, evidence of kidney disease has been detected. In Stage 1 kidney disease there is mild kidney damage, and usually no symptoms. You have other signs of kidney damage even though your estimated GFR is normal. Signs of kidney damage could be protein in your urine or physical damage to the kidneys.
Ways to slow kidney damage in Stage 1 kidney disease include:

  • Control your blood sugar if you have diabetes.
  • Keep a healthy blood pressure.
  • Eat a healthy diet.
  • Do not smoke or use tobacco.
  • Exercise 30 minutes a day, 5 days a week.
  • Keep a healthy weight.

Ask your doctor if there are medicines you can take to protect your kidneys.
Make an appointment to see a nephrologist, even if you already have a general doctor.

Stage 2:

GFR rate is lower than 90 milliliters, and evidence of kidney disease has been detected. There is mild kidney damage, and usually no symptoms. You have other signs of kidney damage even though your eGFR is normal. Signs of kidney damage could be protein in your urine or physical damage to the kidneys. Ways to slow kidney damage in Stage 2 kidney disease are same for stage 1.

Stage 3:

GFR rate is lower than 60 milliliters, regardless of whether evidence of kidney disease has been detected. Kidneys are moderately damaged and are not working as well as they should. Stage 3 kidney disease is separated into two stages as Stage 3A and Stage 3B. In stage 3A, eGFR is between 45 and 59 where as in stage 3B, eGFR is between 30 and 44.
Swelling in the hands and feet, back pain, urinating more or less than normal are the most common sign in this stage. You are more likely to have health complications as a result of waste building up in your body. Common complications from kidney disease are high blood pressure, anemia, and bone disease.
Follow the same steps for living a healthy lifestyle as in Stages 1 to keep your kidney disease from getting worse. In addition, for stage 3, you need the below things to do:

  • Visit a nephrologist to make a treatment plan that is right for you. Your nephrologist will tell you how often you will need to have your kidneys checked.
  • Consult a dietitian, who will help you follow a diet that will keep you healthy.
  • Ask your doctor about special kinds of blood pressure medicines called ACE inhibitors and ARBs if you have diabetes or high blood pressure. Sometimes these medicines can help keep kidney disease from getting worse.

Stage 4:

GRF rate is lower than 30 milliliters, regardless of whether evidence of kidney disease has been detected. Kidneys are moderately or severely damaged and are not working nearly as well as they should. Stage 4 kidney disease should be taken very seriously. It is the last stage of kidney disease before kidney failure. You are more likely to develop other health complications as a result of waste building up in your body. Common complications from kidney disease are high blood pressure, anemia, and bone disease. This is the time to start talking with your nephrologist about how to prepare for kidney failure. You will need to start dialysis or have a kidney transplant to live once your kidneys are failed. You can start planning for dialysis or kidney transplant before you reach kidney failure.

  • Preparing for dialysis: Several things need to be considered when getting ready for dialysis. You will need to choose a type of dialysis, your vascular access type, and consider your finances and employment.
  • Preparing for transplant: You may not need to start dialysis at all if you are able to find a living kidney donor. It is possible to have a transplant when your kidneys are getting close to failure.

Stage 5:

GFR rate is lower than 15 milliliters. Renal failure has occurred. Kidneys are getting very close to failure or have completely failed. Stage 5 kidney disease has severe symptoms because the kidneys have usually stopped working. If your kidneys fail, toxins and wastes build up in your blood which makes you very sick. You will need to start dialysis or have a kidney transplant to live once your kidneys are failed.

  • Preparing for dialysis: Several things need to be considered when getting ready for dialysis. You will need to choose a type of dialysis, your vascular access type, and consider your finances and employment.
  • Preparing for transplant: You may not need to start dialysis at all if you are able to find a living kidney donor. It is possible to have a transplant when your kidneys are getting close to failure.

It is important for kidney disease to be diagnosed and treated early to prevent any serious damage. Patients with diabetes should have an annual test, which measures microalbuminuria (small amounts of protein) in urine. This test can detect early diabetic nephropathy which can prevent other complications of diabetes.

Causes of chronic kidney disease:

Filtration of excess waste and fluid material is the main function of our kidneys. Kidneys can eliminate most waste materials that our body produces. However, problems can occur if the blood flow to the kidneys is affected or urine outflow is obstructed. In most cases, progressive kidney damage is the result of a chronic disease, such as:

Diabetes:

Chronic kidney disease is linked to types 1 and 2 diabetes. Excess sugar (glucose) can accumulate in the blood if the disease is not under control which will affect the filteration of kidney. This will progress towards CKD. However, Kidney disease is not common during the first 10 years of diabetes. More commonly it occurs 15 to 25 years after diagnosis of diabetes.

Hypertension (high blood pressure):

High blood pressure can damage the glomeruli which are parts of the kidney involved in filtering waste products.

Obstructed urine flow:

If urine flow is blocked due to any reason, it can back up into the kidney from the bladder which is called as vesicoureteral reflux. Blocked urine flow increases pressure on the kidneys and can affect their function. Possible causes of vesicoureteral reflux include an enlarged prostate, kidney stones, or a tumor.
Kidney diseases: Polycystic kidney disease, pyelonephritis, or glomerulonephritis can lead to CKD.

Kidney artery stenosis:

If the renal artery narrows or is blocked before it enters the kidney, it can affect the filteration.

Certain toxins:

These include fuels, solvents, such as carbon tetrachloride, lead and lead-based paint, pipes, and soldering materials. Even some types of jewelry have toxins, which can lead to chronic kidney failure.

Fetal developmental problem:

If the kidneys do not develop properly in the unborn baby while it is developing in the womb.

Systemic lupus erythematosus:

This is an autoimmune disease where body's own immune system attacks the kidneys as though they were foreign tissue.

Malaria and yellow fever:

These fevers are known to cause impaired kidney function.

Some medications:

Overuse of, for example, NSAIDs (non-steroidal anti-inflammatory drugs), such as aspirin or ibuprofen can cause CKD.

Illegal substance abuse:

Substances such as heroin or cocaine.

Injury:

A sharp blow or physical injury to the kidney(s).

Risk factors of chronic kidney disease:

The following conditions or situations are linked to a higher risk of developing kidney disease:

  • a family history of kidney disease
  • older age (chronic kidney disease is much more common among people over 60)
  • heart and blood vessel (cardiovascular) disease
  • smoking
  • obesity
  • being African-American, Native American or Asian-American
  • atherosclerosis
  • bladder obstruction
  • chronic glomerulonephritis
  • congenital kidney disease (kidney disease which is present at birth)
  • diabetes (one of the most common risk factors)
  • hypertension
  • lupus erythematosus
  • overexposure to some toxins
  • sickle cell disease
  • some medications

Complications of chronic kidney disease:

Chronic kidney disease can affect almost every part of your body. Potential complications may include:

  • Fluid retention, which could lead to swelling in your arms and legs, high blood pressure, or fluid in your lungs (pulmonary edema)
  • A sudden rise in potassium levels in your blood (hyperkalemia), which could impair the ability of your heart to function and may be life-threatening
  • Anemia can occur as your body may not have enough red blood cells
  • Heart and blood vessel (cardiovascular) disease
  • Weak bones and an increased risk of bone fractures
  • Damage to your central nervous system, which can cause difficulty concentrating, personality changes or seizures
  • Decreased immune response, which makes you more vulnerable to infection
  • Decreased sex drive, erectile dysfunction or reduced fertility
  • Pericarditis, an inflammation of the sac-like membrane that envelops your heart (pericardium)
  • Pregnancy complications that carry risks for the mother and the developing fetus

Irreversible damage to your kidneys (end-stage kidney disease), eventually requiring either dialysis or a kidney transplant for survival.


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