THE STAGES OF CHRONIC

KIDNEY DISEASE
Wendy Weinstock Brown, MD, MPH
June 20, 2014
PKD National Convention
Kansas City, MO
Outline
Definition of Chronic Kidney Disease
Classification of CKD Stages
Evaluation of CKD
Why Stage CKD?
Definition of Chronic Kidney Disease
Kidney damage and/or decrease in kidney
function present for three or more months
Kidney damage can include
Abnormalities of kidney structure
Markers of damage including abnormal blood or
urine tests or imaging studies
Criteria for CKD
Markers of Kidney Damage (one or more)
Albuminuria (protein in the urine)
Urine sediment abnormalities
Abnormal serum electrolytes
Structural abnormalities found on imaging
studies
Abnormalities found on kidney biopsy
Criteria for CKD
Decreased glomerular filtration rate (GFR)
GFR provides the best overall index of kidney
function
Normal GFR in young adults is about 125
ml/min/1.73 m
Kidney failure = GFR<15 ml/min/m
Classification of CKD
CKD is classified by
Cause of disease
GFR category
Albumin category
Stages of CKD
Stage 1 signs of mild kidney disease but with
normal or GFR (>90% kidney function)
Stage 2 signs of mild kidney disease with
GFR (60-89% kidney function)
Stage 3 signs of moderate chronic kidney
disease (40-59% kidney function)
Stage 4 signs of severe CKD (15-29% kidney
function
Stage 5 less than 15% kidney function
Stages of CKD
Stage GFR GFR (ml/min/1.73m)
G1 Normal or high > 90
G2 Mildly 60-89
G3a Mildly to moderately 45-59
G3b Moderately to severely 30-44
G4 Severely 15-29
G5 Kidney failure <15
Albuminuria categories
Category Albumin excretion Albumin to Terms
rate creatinine ratio
(mg/24 hours) mg/gm
A1 <30 <30 Normal to mildly
A2 30-300 30-300 Moderately
A3 >300 >300 Severely
Prognosis of CKD by GFR and
Albuminuria categories
Why Stage CKD?
It is possible to delay progression of CKD
It is possible to control symptoms associated
with CKD
It is possible to control complications of CKD
It is preferable to prepare for renal
replacement therapy when it is clear it is
going to be necessary
ADPKD Stages 1-2
Usually few physical symptoms
Lab serum creatinine may be slightly; may have
some blood in urine or UTI
May have kidney stones
Can have aneurysms of blood vessels in brain
Treatment
-Diet: might recommend protein;
sodium (salt) if high blood pressure
-Blood pressure: ACE inhibitor or angiotensin
II Receptor blocker (ARB)
ADPKD Stages 3-4
Physical symptoms may feel completely
normal or may experience
Fatigue or tiredness
Back pain
Puffiness or swelling
Loss of appetite or food may taste funny
Blood pressure
Abdominal swelling
ADPKD Stage 5 End-stage Kidney
Failure
Anemia
Weak, tired or drowsy
Headache
Confusion, difficulty concentrating
Nausea, vomiting, appetite
Itching
Muscle cramps
Swelling and puffiness
ADPKD Stage 5 End-stage Kidney
Failure 2
Shortness of breath
blood pressure
Changes in skin color (grayish or yellow_
Changes in menstrual cycle
What can I do if I have ADPKD?
Live a healthy life-style
Control blood pressure
Exercise regularly
Avoid tobacco
Stay hydrated
Take care of yourself and see your provider
regularly
Resources
www.pkdcure.org

www.kidney.org

http://kidney.niddk.nih.gov/kudiseases/pubs
/polycystic/
QUESTIONS?