What You Need to Know About Chronic Kidney Disease

Have you ever wondered what happens when your kidneys can’t keep up with their essential functions? Chronic Kidney Disease (CKD) affects approximately 10% of the global population. In the United States, 1 in 7 adults are estimated to be living with CKD. As the disease is complicated with five different stages, it is important to understand its fundamentals. In this blog, we will discuss CKD in detail and tests that can be performed to assess the level of damage.

What is CKD?  

According to the Centers for Disease Control and Prevention, CKD happens when our kidneys stop functioning properly over time. Our kidneys are organs that are no larger than the size of a computer mouse, but they can filter all the blood in our body every 30 minutes. They work tirelessly to remove waste, toxins, and excess fluids. Apart from working like our ‘body’s janitors’, they also help regulate our blood pressure and keep our bones strong and healthy.

In CKD, our kidneys’ functions start to decline. This can lead to the buildup of waste products to dangerous levels and trigger several health problems. However, with proper care, the disease can be easily managed and controlled.

What are the stages of CKD?

Overall, CKD progresses in 5 stages of increasing severity. Before we dive deep into this stuff, let’s make sure we understand two things: the estimated glomerular filtration rate (eGFR) and the urine albumin-creatinine ratio (uACR).

The eGFR is like a speedometer for your kidneys, telling you how fast they’re filtering your blood. It’s measured in milliliters per minute (ml/min). On the other hand, the uACR checks for two things in your urine: albumin, which is a protein that helps your body heal and fight off germs; and creatinine, which is a leftover from your working muscles. Usually, albumin stays in your blood, but if your kidneys aren’t working right, it can sneak into your urine. So, basically, these tests help figure out if your kidneys are doing their job properly or if there’s something wrong with them.

Both these parameters need to be evaluated before one can be diagnosed with a specific stage of CKD. The stages are as follows:

Stage 1: Stage 1 CKD means your kidneys aren’t working at full power, but they are still doing okay. It is like they are running at 90% or better. Now, when we say “kidney damage,” we’re talking about stuff like having too much albumin in your urine. That’s when your uACR is 30 or higher for three months or longer. So basically, if your kidneys are sluggish for a while and your pee’s got too much albumin in it, that’s stage 1 CKD.

Stage 2: In stage 2 CKD, your kidneys are still working, but not as well as they should. They are running at about 60-89% of their full power. Moreover, just like in stage 1, they have been having issues for at least three months. Now, what matters here is your uACR level, which, again tells us how much albumin is in your pee. If it’s less than 30, you are in the clear for now. But if it’s higher, your risk of kidney problems and heart disease goes up. So basically, the higher your uACR, the more you have to watch out for your kidneys and heart.

Stage 3: Stage 3 can be divided into stages A and B.

• Stage 3a means you have mild to moderate loss of kidney function. Your kidneys are running at 45 to 59% of their full power for at least three months. This is also the first stage where just a blood test can tell if you have kidney disease.
• Stage 3b means things are a bit more serious. Your kidney function is even lower, with them operating at 30 to 44% of their full power for at least three months.

Although uACR scores are not needed to identify stage 3 CKD, their levels can also be measured to get a more comprehensive picture of your kidney health.

Stage 4: People at this stage have severe loss of kidney function. Your kidneys are functioning at 15 to 29% of their full power for at least three months. You are also at the highest risk for kidney damage and heart disease at this stage.

Stage 5: This is when things get really serious with your kidneys. This stage is also known as end-stage kidney disease (ESKD). At this stage, your kidneys are operating at 15% or less of their full power. Doctors will usually perform multiple tests on your kidneys to make sure it is not just a temporary problem. Patients in Stage 5 either need a kidney transplant or regular dialysis treatment to do the job that their kidneys can no longer do.

What tests should be conducted to diagnose CKD?

Your doctor will use a blood test to check your eGFR scores. The way to interpret these scores is:

• eGFR of 60 or more is considered normal. This means that your kidneys are operating at 60% of their full power.
• eGFR below 60 may indicate kidney disease. The specific value will also let you know which stage of CKD you are in (see above). This will help healthcare professionals make more informed decisions on ways to maintain kidney health.
• eGFR of 15 or less implies that you are in Stage 5 of CKD or have ESKD. During this stage, your doctor must discuss treatment options with you in detail. This could include dialysis or a kidney transplant.

Besides checking your eGFR levels, your doctor might also want to look at the albumin levels in your urine. They do this using two common tests:

1. Dipstick Test for Albumin: For this one, they need a sample of your urine. They will dip a special strip, kind of like a mini magic wand, into it. If there is albumin in your urine, the strip changes color. It usually turns green or blue, depending on how much of the protein is there.

2. uACR test: This test is a bit fancier. You’ll still need to give a urine sample, but this time, the doctor measures both albumin and creatinine in it. Then they compare the amounts of these two things to figure out the uACR. This ratio helps guess how much albumin would end up in your urine over a whole day. If the ratio is higher than 30 mg/g, it could be a sign of kidney trouble.

Conclusion

Even though CKD gets worse over time, there are things you can do in your everyday life to help slow it down. What you should do depends on your health right now and whether you’re more likely to get CKD (those are called risk factors). In the next part of our blog, we’ll talk more about what those risk factors are and the signs you should watch out for to catch any kidney issues before they turn into full-blown CKD. Finding kidney problems early with screening tests is super important because symptoms don’t usually show up until things have gotten pretty serious.