Your kidneys constantly filter your blood to remove waste products and control your fluid levels. If your kidneys are damaged over an extended period — at least three months — you then have chronic kidney disease (CKD). This disease is progressive, meaning it becomes worse over time and advances over five stages.

Whether it’s caused by diabetes or rare kidney diseases like IgA nephropathy or C3 glomerulopathy, the stages of kidney disease remain the same. This article covers how CKD is staged and the symptoms you may experience with each of the five stages of CKD.

What Tests Are Used To Assess Kidney Disease Stages?

The stage of kidney disease you have is based on how well your kidneys are functioning. Nephrologists (kidney doctors) use two main tests to measure your kidney function and diagnose CKD. Your estimated glomerular filtration rate (eGFR) shows your kidneys’ ability to filter your blood. A simple blood test is used to measure your eGFR. An eGFR of 90 or above is normal.

Your health care team will also run a urine test to measure your urine albumin to creatinine (uACR) ratio. This test measures whether there is any albumin (protein) in your urine. Healthy kidneys can filter out water and waste while keeping protein in your body where it belongs. When protein leaks from your kidneys into your urine, it may be a sign that there’s damage. If you have a high uACR, you’re more likely to develop CKD and, eventually, kidney failure.

Imaging tests can help your doctor take a closer look at your kidneys and assess your CKD stage. They’re used to find out what’s causing damage. Ultrasound uses sound waves that bounce off kidney tissues and form pictures. A CT scan uses X-rays at different angles to create three-dimensional (3D) pictures. MRI also uses strong magnets and radio waves to make 3D images.

Your nephrologist may also recommend a kidney biopsy to collect a sample of tissue and study it in the laboratory. This provides them with more information about what’s causing your CKD and exactly how much damage there is.

What Can You Expect With Each Stage of Kidney Disease?

As kidney function declines with each stage of CKD, you may experience additional and more severe symptoms.

Stage 1 Kidney Disease

In stage 1 CKD, your kidneys are damaged, but they’re still working well.

According to the National Kidney Foundation, stage 1 CKD is diagnosed with a normal eGFR (90 or above). However, you also need to have kidney damage as measured with a uACR of 30 or higher. You must have these test results for at least three months.

With stage 1 CKD, your kidneys can still filter out waste. You likely won’t notice any symptoms at this early stage, which can make early detection tricky. Your doctor may catch signs of stage 1 CKD at an annual visit or while looking for other health conditions. Examples include high blood pressure or kidney damage that shows up on an imaging test given for another condition.

Stage 2 Kidney Disease

With stage 2 CKD, your kidneys have a harder time filtering your blood. Your eGFR will drop to 60 to 89 as your kidney health declines, and your uACR will still be 30 or higher.

For the most part, your kidneys are still working well, and you still may not have any symptoms. Some people may experience urinary tract infections (UTIs) and swelling in their hands and feet. If you start noticing new swelling or you’re having more frequent UTIs, it’s a good idea to talk to your doctor.

Stage 3 Kidney Disease

If you have stage 3 CKD, your kidneys can no longer filter waste and fluid properly. You’ll begin experiencing noticeable symptoms that point to kidney damage. Stage 3 CKD is divided into two substages depending on kidney function and eGFR.

Stage 3a Kidney Disease

People with stage 3a CKD have an eGFR of 45 to 59 and mild to moderate kidney damage. At this point, your kidneys can still do some of their job but not as well as they used to. Your doctor will recommend treatments and lifestyle changes to stop your CKD from becoming worse. With the right treatment plan, you can prevent disease progression to the late stages of CKD.

Most people with stage 3a CKD will start having symptoms. This is because their kidneys can’t filter out toxic waste products. The kidneys also help control the body’s fluid balance and get rid of extra water in urine. Fluid buildup from CKD can lead to uncomfortable symptoms.

Stage 3 CKD can cause:

• Fatigue and weakness
• Dark, foamy urine
• Swelling in the hands and feet from extra fluid
• Muscle cramps
• Changes in how often you urinate
• Lower back pain
• Itchy skin
• Trouble sleeping, which may be due to restless legs syndrome (discomfort in your legs that makes it harder to keep them still)

Stage 3b Kidney Disease

In stage 3b CKD, you have moderate to severe kidney damage. Your eGFR drops to 30 to 44, meaning your kidneys are struggling to filter your blood properly. People with stage 3b CKD experience the same symptoms as stage 3a. At this point, it’s important to work closely with your doctor to stop your CKD from progressing to stage 4.

Stage 4 Kidney Disease

With stage 4 CKD, your kidneys are severely damaged, and your eGFR falls to between 15 and 29. Waste products continue building up in your bloodstream, leading to more severe CKD symptoms. This can lead to:

• Anemia (low red blood cell levels)
• High blood pressure
• Heart disease
• Metabolic acidosis (acid buildup in the blood)

The kidneys also help balance and remove extra minerals from your body. People with stage 4 CKD and severe kidney damage tend to have high phosphorus levels. Too much phosphorus in the blood can also pull calcium out of the bones, which can lead to bone disease. The extra calcium and phosphorus can then form hard deposits in different organs like the heart, lungs, and blood vessels.

Stage 4 CKD causes similar symptoms to stage 3. You may also start feeling nauseous or throw up. Loss of kidney function can lead to a loss of appetite over time. If you’re experiencing any of these symptoms, it may be a sign your CKD is progressing.

Stage 5 Kidney Disease

People with stage 5 CKD have kidney failure and an eGFR of less than 15. You may also hear this referred to as end-stage kidney disease or end-stage renal disease (ESRD). The kidneys no longer work well enough to filter blood on their own.

Stage 5 CKD causes severe symptoms that need to be treated, otherwise it can be life-threatening. In addition to other CKD symptoms from earlier stages, you may experience:

• Little to no urine output
• Shortness of breath
• A yellow or gray hue to your skin
• Changes to your nails

Several conditions like diabetes, high blood pressure, autoimmune conditions, and genetic kidney diseases may eventually progress to kidney failure if not treated appropriately to delay the disease course. If you’re living with a kidney disease like immunoglobulin A (IgA) nephropathy or complement 3 glomerulopathy (C3G), you may be more likely to develop stage 5 CKD. Studies show that 20 percent to 40 percent of people with IgA nephropathy progress to kidney failure within 10 to 20 years of their diagnosis. Around half of those with C3G progress to ESRD within 10 years.

The only way to treat kidney failure or stage 5 CKD is with hemodialysis (dialysis) or a kidney transplant. Your nephrologist will help you determine the best option based on your overall health and lifestyle. Regular checkups are crucial to manage your condition.

Find Your Team

At MyKidneyDiseaseCenter, the site for people with kidney disease and their loved ones, people come together to gain a new understanding of kidney disease and share their stories with others who understand life with kidney disease.

What symptoms have you noticed with different stages of chronic kidney disease? Share your experience in the comments below.