Chronic Kidney Disease Stage 3: assessment, management, risk factors and tips to prevent it

Kidneys_

Image courtesy of Becky Striepe at Flickr.com

Stage 3 CKD is something that has to be taken seriously. In a previous post in this same blog, we talked about the 5 stages of Chronic Kidney Disease. We understood that stage 1 and stage 2 are not that serious and that the illness can be managed with diets and good habits. We also learned that Chronic Kidney disease in these two stages is invisible and that is very hard to detect unless other tests are done. We also learned that stage 3 is divided into two stages and that is here where the thing gets really serious (especially in stage 3B) and that it will be most likely that the patient needs treatment, medications, special diets and future dialysis and specific kidney treatments. Stage 4 and 5 are the last stages where the kidney is already working under 50% and the patient will need a transplant and a serious and well-managed treatment combined with diets and medications and we learned that stage 5 is already terminal and the patient has to be managed very carefully.

Today we are going to take a look at stage 3A within a Chronic Kidney Disease, the way it should be assessed and managed, the risk factors every patient has and some tips to prevent the progression of stage 3 in CKD.

Assessment and management of Stage 3 CKD

Most Stage 3 CKD patients are not at high risk and can be managed with primary care. The objective becomes to identify the patients that are in risk of passing on to stage 3B  and its associated risks.

The most important symptoms or pointers in stage 3A of patients at risk are: When the patient´s proteinuria is ACR>70 or PCR>100; the patient has a declining GFR and he or she is at a young age. After these pointers, doctors have to ask themselves if the patient is functioning well, if the patient has a history of this illness and if there has been any urinary abnormalities or other specific indicators.

The first value that has to be determined is the creatinine levels to see if they are elevated. Then compare them with previous tests and values. If previous tests don’t exist, there has to be a 14-day gap to take another test and compare values and it has to take them to the lab as deteriorating renal function needs rapid assessment.

As for the clinical assessment, the tests focus on heart failure or direct assessment of bladder enlargement. This can be done by imaging which can indicate the level of obstruction that doctor suspect. Here urine tests become ever more important because they can indicate the amount of proteinuria by ACR/PCR that can be seen in the body and this is a reliable indicator of progressive renal disease.

Management of Stage 3 CKD

In this stage, there is always a big cardiovascular risk. The idea is that the person starts having a healthier lifestyle and quit bad habits such as smoking, and starts a discipline in their exercise and eating habits. There should also be a cholesterol lowering therapy or approach if there are already any macrovascular disease symptoms. In this stage of CKD, the patients tend to be over 60 or 70 years old and most of them do not go onto stage 4. However, there should be a close assessment and control over diseases such as heart attacks, strokes, and narrowing of other arteries.

Stage 3 CKD risk factors

When we talk about risk factors we are mainly talking about cardiovascular events. The patient has to be monitored on his or her proteinuria, hematuria, and declining GFR levels and they must be closely managed. This is an accurate indicator that the CKD is progressing. The idea of understanding these risk factors is that doctors can accurately attack the kidney disease either by reducing the risk of having cardiovascular complications or by prescribing treatments that slow down or stop the progression of CKD.

Tips to prevent stage 3 CKD

Basically, there are three ways a person can prevent the body reaching stage 3 CKD: the first one is to have a kidney-friendly diet; the next one is to have a very good discipline when it comes to medications, and the third one is to exercise.

As for a kidney-friendly diet the idea is to eat the correct amount of calories, cut down on  phosphorus-rich foods because it is very hard for the kidney to process this type of food and avoid high-potassium foods (if  there is a possibility of a dietician it is a good idea because people can understand the amount of  potassium they can take.

Medications include drugs to prevent risk factors such as blood sugar levels and blood pressure.

Exercising and non-smoking become very important at this stage just to prevent the progression of CKD and to help the patient live his life as normal as possible.

Be sure to also read this post about The Most Significant Early Symptoms Of Kidney Disease

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Understanding the 5 stages of Chronic Kidney Disease

We do not have to stress out or even define what CKD is because we have discussed it in this blog in several articles and we already know what it is all about.

Instead today we are going to take a deep look at the 5 stages of Chronic Kidney Disease that were developed or designed by the National Kidney Foundation (NKF) in order to understand better Kidney diseases and to give doctors  some sort of guideline that will help them identify the evolution of the kidney disease and know how to give the patient the best care possible for each stage.

FIVE_5 stages of Chronic Kidney Disease

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Let’s take a look at those 5 stages.

Stage 1 and 2:

Somebody that is in stage 1 or 2 of CKD has a small kidney damage and his or her glomerular filtration rate (GFR) is normal or a bit higher than 90 ml/min. in this stage, symptoms are not common and the kidneys are still working normally. If the person is to find out he or she is on stage 1 CKD it is because the person was being tested for other things and the results came out with certain amount of creatinine levels or they discovered blood or protein in the urine or there was an imaging test and the results said there was a kidney damage.

For people that are in this stage the treatment only focuses on a healthy diet including whole grains, fresh fruits and vegetables, no fats or low fat diets, control the intake of sugar and sodium, have a good weight and exercise very regularly, take vitamins recommended by doctors and definitively stop smoking and having bad habits for the body.

When it comes to stage 2, the description is just the same with the disease having no symptoms and the kidney working at a very good level. The only difference here is that the kidney already has a mild damage and it is getting a bit late to discover it or to treat it and the glomerular filtration rate is around 60-89 ml/min.

Stage 3:

Here the person has already a moderate kidney damage. This stage has two parts which are called A and B. in stage 3A the glomerular filtration rate is 45-59 mL/min, and in stage 3B the glomerular filtration rate is 30-44 mL/min.  Here the disease is already noticeable and patients start to feel the symptoms. A condition called uremia appears and secondary complications such as high blood pressure, anemia and bone disease start to appear as well.

The symptoms for this stage are the feeling of being tired all the time, high retention of fluids, extremities start to swell and the patient starts feeling that his or her breath is just not enough, urine changes color to a more reddish, brownish color or it even contains blood which will make it red, lower back pain, problems with sleep and muscle cramps.

In this stage, the kidney is working at a 50% performance and the idea is to help the patient keep their kidneys working as long as possible.

In this stage, a very controlled diet and medications are essential to make the kidney live longer. When it comes to medications ( the diet is very important even since stage 1) in this stage they become essential to control glucose levels and have a very good blood pressure in order to maintain the kidney working for as long as possible. The medications doctors prescribe in this stage are ACE (angiotensin converting enzyme) inhibitors and ARBs (angiotensin receptor blockers).

Stage 4:

Here the patient has a real problem that needs to be tackled as soon as possible and with the correct treatment. Their glomerular filtration rate is 15-30 ml/min. and treatments are now very viable options. Unfortunately, a patient with stage 4 CKD will have to get a kidney transplant in the near future. In this stage conditions like anemia, uremia, bone disease, high blood pressure, heart complications and cardiovascular diseases start to become present.

The symptoms in this stage are fatigue, hard kidney pain in the lower back, sleeping problems, nausea, vomiting, a  metallic taste in their mouth, bad breath, loss of appetite due to the flavor in their mouth, difficulty in concentrating and numbness or tingling in the toes or fingers.

In this stage, there are 3 different types of treatments which are Hemodialysis, Peritoneal dialysis and, Kidney transplant

Stage 5:

Unfortunately, at this stage, the person has no options and it is a terminal disease called end-stage renal disease (ESRD) that has a glomerular filtration rate of 15 ml/min or less. In this stage, the kidneys no longer work and don’t have the ability to do anything at all. In this stage dialysis or a kidney transplant will be needed to survive.  

It is very important to understand these five stages so patients and doctors can find out about the disease in the early stages and give patients the option of having a very good quality of life.

Be sure to also read this post about how to choose the right treatment in case of renal failure?