Stages and Complications of Chronic Kidney Disease

Different stages of Chronic Kidney Disease(CKD)

Stage 1: The eGFR (estimated GFR) shows normal kidney function but you have some pre-existing kidney damage or disease. eGFR is 90 or more ml/min/1.73m2. This is the first stage of CKD. 

Stage 2: Mildly reduced kidney function and you are already known to have some kidney damage or disease.

Stage 3: Moderately reduced kidney function (with or without a known kidney disease. For example, an elderly person with ageing kidneys may have reduced kidney function without a specific known kidney disease.) 

Stage 3A: eGFR- 45 to 59 ml/min/1.73m2

Stage 3B: eGFR 30 -44 ml/min/1.73m2

Stage 4: Severely reduced kidney function (with or without known kidney disease). eGFR is15 to 29 ml/min/1.73m2

Stage 5: Very severely reduced kidney function. This is sometimes called end-stage kidney failure or established renal failure. eGFR ≤ 15 ml/min/1.73m2

Complications of Chronic Kidney Disease include:

Cancer: Patients with end-stage renal disease are at increased overall risk for cancer. This risk is particularly high in younger patients and gradually diminishes with age.

Fluid and electrolyte imbalance: 

• Dehydration (excessive loss of body waterwith an accompaning disruption of metabolic processes)
• Edema (abnormal accumulation of fluid in the interstitium)
• Hyperkalemia (increase in potassium levels in blood)
• Metabolic acidosis (body producing too much acid when kidneys are unable to remove enough acid from the body)

Calcium, phosphate and bone complications: 

• Hyperphosphatemia (abnormal elevated level of phosphate in blood) 
• Hypocalcemia (low serum levels of calcium)
• Secondary hyperparathyroidism (excessive secretion of parathyroid hormone causing imbalance in calcium and phosphorus metabolism leading to multiple fractures in the body)
• Renal osteodystrophy (bone mineralisation deficiency due to electrolyte and endocrine derangements, i.e. hormonal disturbances)

Haematologic complications:

• Anaemia (decrease in hemoglobin content)
• Bleeding diathesis (an unusual susceptibility to bleeding due to hypocoagulation (decreased blood clotting) 

Cardiopulmonary complications: 

• Hypertension
• Congestive heart failure (inability to maintain sufficient pump action for blood flow)
• Cardiomyopathy (measurable detoriation of the function of the myocardium, heart muscle tissue)
• Pulmonary edema (abnormal accumulation of fluid in the lung area)
• Uremic pericarditis (a form of pericarditis i.e. inflammation of pericardium, the sac containing the heart)

Gastrointestinal complications:

• Nausea and vomiting
• Bleeding
• Esophagitis (inflammation of esophagus)
• Gastritis (inflammation of lining of stomach) 
• Colitis (inflammation of colon)

Neuromuscular complications:

• Myopathy (muscular weakness that occurs due to combination of poor nutrition, hyperparathyroidism, vitamin D deficiency and disorders of electrolyte metabolism, mainly seen in association with CKD) 
• Peripheral neuropathy (damage or disease affecting peripheral nerves)
• Encephalopathy (disease of the brain)

Dermatologic complications:

• Sallow colour due to urochrome (end product of haemoglobin breakdown) deposition under skin as impaired kidneys fail to remove excess urochromes from the body 
• Pruritis (itching of the skin)
• Dermatitis (inflammation of skin)