About Stage 3 Chronic Kidney Disease

Overview

Stage 3 chronic kidney disease (CKD) marks moderate loss of kidney function and is classified based on the estimated glomerular filtration rate (eGFR), a test that measures creatinine levels in the blood to assess kidney health. Stage 3 is divided into two subcategories:

Stage 3a: eGFR between 45 and 59 mL/min/1.73m²
Stage 3b: eGFR between 30 and 44 mL/min/1.73m²

At this stage, the kidneys show mild to moderate damage, and some people may start experiencing symptoms like fatigue, swelling, or changes in urination. While kidney damage at this stage cannot be reversed, treatment focuses on slowing further progression and protecting remaining kidney function.

Managing underlying conditions, making lifestyle changes, and taking prescribed medications are essential to controlling stage 3 CKD. Working closely with a healthcare provider to create a personalized treatment plan is key to maintaining kidney health and overall well-being.

Causes and Risk Factors

The root causes of Stage 3 CKD are highly variable and can include factors such as drug toxicity, inflammation, obesity, oxidative stress, hyperuricemia, hypertension, dyslipidemia, autoimmune diseases, and urinary tract infections.

Non-modifiable risk factors for Stage 3 CKD are factors that cannot be changed. These include:

Age: As people get older (over age 60), their risk of developing CKD increases.
Gender: In adults, gender can be a non-modifiable risk factor for CKD. Family history: Having a family history of CKD can increase the risk.
Inherited kidney disorders: Some genetic conditions can increase the risk of developing CKD.
Ethnicity: Certain ethnicities, such as African American, Hispanic American, Asian, Pacific Islander American, and Native American, have higher rates of high blood pressure and diabetes, which are common causes of CKD.

Modifiable risk factors for Stage 3 CKD are factors that can be influenced or changed. These include:

Drug Toxicity: Certain medications or substances can cause kidney damage if used improperly or in excessive amounts.
Inflammation: Chronic inflammation in the body can contribute to kidney damage over time.
Obesity: Being overweight or obese has been associated with an increased risk of developing CKD.
Oxidative Stress: Imbalance between free radicals and antioxidants in the body can lead to oxidative stress, which may contribute to kidney damage.
Hyperuricemia: High levels of uric acid in the blood can increase the risk of kidney disease.
Hypertension (High Blood Pressure): Elevated blood pressure is a significant modifiable risk factor for CKD progression.
Dyslipidemia (Abnormal Blood Lipid Levels): High cholesterol and triglyceride levels can contribute to kidney damage.
Autoimmune Diseases: Certain autoimmune conditions can affect the kidneys and lead to CKD.
Urinary Tract Infections: Frequent or untreated urinary tract infections can cause kidney damage.
Proteinuria: Elevated levels of protein in the urine can contribute to the progression of CKD. Managing proteinuria through medication and dietary changes can help slow down kidney damage.
Metabolic disorders: Untreated metabolic disorders such as anemia, acidosis, and hyperphosphatemia can worsen CKD. Proper management of these conditions with medications and dietary adjustments is important.

It's important to note that these risk factors may vary from person to person. It is recommended to consult with a healthcare professional for personalized advice and treatment options.

Symptoms

In the early stages of Stage 3 chronic kidney disease (CKD), symptoms may not be noticeable. However, as the disease progresses or reaches higher severity, symptoms become more common. Here are the most common early symptoms of Stage 3 CKD:

Dark yellow, orange, or red urine
Urinating more or less frequently than normal
Edema (fluid retention)
Unexplained fatigue
Weakness and other anemic-like symptoms
Insomnia and other sleep issues
Lower back pain
Increased blood pressure
Dry, itchy skin

As CKD progresses to later stages or higher severity, additional symptoms may occur, such as:

Difficulty concentrating
Numbness or swelling in the hands, feet, legs, or ankles
Shortness of breath
Vomiting
Muscle aches or cramps

It's important to note that symptoms can vary from person to person. It's best to consult with a healthcare professional for an accurate diagnosis and appropriate management.

Diagnosis

To diagnose Stage 3 chronic kidney disease (CKD), doctors commonly perform the following examinations, tests, and procedures:

Medical history review: A doctor will gather information about your overall health, symptoms, and any risk factors for kidney disease.
Physical examination: A doctor will perform a physical exam to check for signs of kidney disease, such as swelling in the legs or high blood pressure.
Blood tests: Blood tests are done to measure the level of waste products and substances in the blood, such as creatinine and blood urea nitrogen (BUN). These tests help estimate the glomerular filtration rate (GFR), which indicates how well the kidneys are functioning.
Urine tests: Urine tests are done to check for the presence of protein or blood in the urine, which can be signs of kidney damage.
Imaging tests: Imaging tests like ultrasound may be used to assess the size and structure of the kidneys and detect any abnormalities.
eGFR: A blood test called an estimated glomerular filtration rate (eGFR) is taken to measure the amount of creatinine in your blood. Creatinine is an amino acid that can indicate how well your kidneys are filtering waste. An abnormally high creatinine level suggests that your kidneys are not functioning optimally. The eGFR reading determines the stage of CKD. In Stage 3A CKD, the eGFR reading falls between 45 and 59. This indicates mild to moderate kidney damage. In Stage 3B CKD, the eGFR reading falls between 30 and 44. This indicates moderate to severe loss of kidney function.

To determine the stage or severity of CKD, additional examinations, tests, and procedures may include:

Repeat blood and urine tests: Regular monitoring of blood and urine tests over time can help track changes in kidney function and determine if the disease is progressing.
Kidney biopsy: In some cases, a kidney biopsy may be recommended to examine a small sample of kidney tissue under a microscope. This can provide more detailed information about the cause and severity of kidney damage.
Additional imaging tests: Depending on individual circumstances, additional imaging tests such as CT scans or MRI scans may be performed to evaluate the kidneys further.

It's important to note that these examinations, tests, and procedures should be performed by a healthcare professional to accurately diagnose and determine the stage of CKD.

Treatment Options

The goals of treatment for Stage 3 chronic kidney disease (CKD) are to slow the decline in kidney function and prevent the disease from advancing to more severe stages.

To achieve these goals, the following treatments and lifestyle changes are recommended:

Blood pressure management: High blood pressure is both a cause and complication of CKD. Controlling blood pressure is crucial for maintaining kidney function. This may involve lifestyle changes, such as a heart-healthy diet low in sodium, regular exercise, and adequate sleep. Medications like angiotensin converting enzyme inhibitors (ACE inhibitors) and angiotensin receptor II blockers (ARBs) may be prescribed to reduce blood pressure and slow CKD progression.
Blood sugar management: If you have diabetes, managing blood sugar levels is essential to reduce the impact of diabetes on the kidneys.
Diet modifications: A Stage 3 CKD diet typically involves consuming whole foods like fruits, vegetables, grains, and reducing processed foods. Protein intake may be decreased, and high-potassium or high-sodium foods may be limited based on individual needs.
Weight management: Maintaining a healthy weight is important for overall kidney health. If weight loss occurs due to appetite loss, it's important to ensure adequate calorie and nutrient intake.

It's important to consult with your healthcare professional before making any significant changes or starting any medication. They can provide personalized advice based on your specific condition.

Medication dosing may be affected by many factors. Check with your healthcare professional about dosing for your individual situation. Other side effects can occur. Check with your healthcare professional or read the information provided with your medication for additional side effect information.