What are the stages of chronic kidney disease? Let's find out in simple terms.

Has the doctor told you that you have a kidney problem or weakness? Or have you heard that someone you know has kidney disease? It is very normal to feel a little scared and worried when you hear these words. But if we are aware of this, that fear can be reduced to a great extent. So today, let's talk about this long-term kidney disease, that is, `Chronic Kidney Disease (CKD)`, what its different stages are, and what we should do at each stage.

Why is kidney disease (CKD) divided into stages?

Simply put, CKD is a condition in which the function of the kidneys gradually decreases over time. This does not happen all at once. That is why doctors classify the disease into stages 1 to 5 to understand its severity.

Think of it like a staircase. When you're at the top of the stairs, your kidneys work best. As you go down, their function decreases.

• Early stages (stages 1-3): During these stages, your kidneys are still functioning well or at a normal level. In most cases, there are no major symptoms at this stage.
• Late stages (stages 4-5): By this stage, kidney function has significantly decreased. By the end stage, the kidneys may be almost completely dysfunctional.

How are these stages determined? What is GFR?

Okay, now let's see how the doctor can tell exactly what stage you are in. This is determined mainly by looking at the "filtration rate" of your kidneys.

The two kidneys in our body are like two water filters. The main function of the kidneys is to filter and purify the unwanted waste products, excess water and salts from the blood and excrete them as urine. There are millions of very small units inside the kidneys that perform this filtering process. We call them `(nephrons)`. The main filter in each of these nephrons is called `(glomerulus)`.

The measurement of how quickly your blood is cleaned through these filters is called the Glomerular Filtration Rate , or GFR .

When the kidneys are damaged, this filtration rate (GFR) decreases. Since it is difficult to measure this GFR directly, doctors calculate the GFR by measuring the amount of a waste product called ``creatinine'' in your blood and then using a special equation with factors like your age and gender. We call this estimated GFR or eGFR . This is the value that is listed as eGFR on your blood report.

In addition, a urine test is done to check for protein (albumin) in the urine. Sometimes, even if the eGFR is normal, protein in the urine can be an early sign of kidney damage.

CKD stages and their meaning

This is the eGFR value that is used to classify the 5 stages of CKD. You can easily understand it by looking at this table.

What symptoms can be seen at each stage?

One of the unique features of CKD is that symptoms vary depending on the stage.

Phases 1 and 2

In these early stages, most people don't have any symptoms because their kidneys are still working well. It's usually discovered incidentally when blood or urine tests are done for another condition, or when blood pressure is checked. But some people may notice things like:

• Swelling of the hands, feet, or ankles
• Frequent urinary tract infections
• Foamy urine

Phases 3a and 3b

As kidney function decreases further, the body has a harder time adjusting to it. This is when many people start to experience symptoms.

• Swelling of the legs and ankles
• Weight loss and loss of appetite
• Feeling tired and lifeless
• Muscle cramps
• Difficulty breathing
• Insomnia
• Itchy skin
• Frequent need to urinate, especially at night
• Foamy or dark urine

Stages 4 and 5

By this time, the kidneys are no longer functioning properly, and waste products from the body begin to accumulate in the blood. This can lead to serious complications. In addition to the symptoms mentioned above, the following may also occur:

• Difficulty concentrating
• Headache
• Lower abdominal pain
• Tingling in the hands and feet
• Nausea and vomiting
• Decreased or complete cessation of urination
• Bad breath
• Skin discoloration (turning gray or yellow)

What are the treatments for kidney disease?

There is no cure for CKD yet. However, treatment can control symptoms and slow down the progression of the disease. Treatment options vary depending on the stage of the disease.

Treatment for stages 1 and 2

The main goal at this time is to prevent further damage to the kidneys. Your doctor may recommend the following:

• If you smoke, stop immediately.
• Eating a healthy diet, low in salt and oil.
• Exercising regularly.
• Controlling body weight.
• If you have diabetes, control your blood sugar levels well.
• If you have high blood pressure, control it.

Treatment for stages 3a and 3b

At this stage, along with lifestyle changes, medications may also be needed to control the disease.

• Medications for high blood pressure: Even if you don't have high blood pressure, some medications can reduce damage to your kidneys.
• Cholesterol-lowering medication.
• Diabetes medications: Some medications, especially SGLT2 inhibitors, are given to protect the kidneys even in people without diabetes.
• Diuretics: Help remove extra salt and water from the body.
• Other medications: Iron tablets or other vitamins to keep bones strong and prevent anemia.

Treatment for stages 4 and 5

When the kidneys are close to failing, medication alone is no longer enough to keep the body healthy. The two main treatment options at this stage are:

• Dialysis: A machine that removes the blood from your kidneys.
• Kidney Transplant: The surgical transplantation of a healthy kidney into the body.

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