Did you know that stage 3 kidney disease affects millions of people and is often unnoticed? Kidney disease is incredibly common, affecting more than 35 million Americans. Stage 3 kidney disease is a common and often undiagnosed condition that can have profound effects on your health. Chronic kidney disease can occur for a number of reasons and often has no symptoms.
This guide will provide you with a comprehensive look at stage 3 kidney disease, what causes it, how it affects your health, and what you can do to manage this chronic disease and slow its progression.
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What is Stage 3 Kidney Disease?
The first step to managing chronic kidney disease is to understand what constitutes chronic kidney disease, specifically stage 3 kidney disease.
Definition and Classification
The functioning of the kidney is estimated using the estimated glomerular filtration rate or eGFR. There are other ways of measuring filtration in the kidneys, but this one is the most widely used due to its low cost and availability.
Chronic kidney disease can be broken down into several stages based on the eGFR. eGFR is calculated in ml/min/1.73m2
There are many factors that can affect the eGFR, including pregnancy, muscle mass, age, liver disease, transplants, medications, hydration, and other types of kidney disease which means that abnormalities in kidney function should be interpreted with the advice of a healthcare provider.
Subdivision into 3A and 3B Stages
Stage 3 chronic kidney disease can be subdivided into stages 3A and 3B. Stage 3A is an eGFR of 45-59 ml/min/1.73m2, while stage 3B is an eGFR of 30-44 45-59 ml/min/1.73m2. Subdividing stage 3 chronic kidney disease is important because stage 3b patients are at an increased risk of some of the complications of chronic kidney disease compared to patients who are at stage 3a. These distinctions guide the frequency of monitoring for kidney disease and other conditions that may be associated.
Causes and Risk Factors
There are many conditions that increase your risk for kidney disease and many causes, but generally speaking, kidney disease is multifactorial.
Common Causes
Some of the common causes of chronic kidney disease include:
- Diabetes (both type 1 and type 2)
- Hypertension
- Inflammation of the structures in the kidneys (glomerulonephritis, interstitial nephritis, etc.)
- Polycystic kidney disease (an inherited kidney disease)
- Obstruction of the urinary tract
- Vesicoureteral reflux
- Recurrent pyelonephritis (kidney infection)
- Nephrotoxic medications
While these are some of the common causes of chronic kidney disease, this is not intended to be an exhaustive list. Other conditions such as sickle cell disease, vascular diseases, and even some cancers can also contribute to the development of chronic kidney disease.
Risk Factors
Because they can cause kidney disease, conditions such as diabetes and high blood pressure are also risk factors for kidney disease. Other risk factors include:
- Having overweight or obesity
- Family history of chronic kidney disease
- Heart disease
- Age (kidney function gradually decreases with age)
- Ethnicity
- Smoking
- Exposure to heavy metals
- Excessive alcohol use
- Metabolic syndrome
- History of kidney injury
- Infections such as HIV or hepatitis C
Other risk factors may include socioeconomic status, obstructive sleep apnea, and dental disease.
Role of Comorbidities
Conditions such as heart disease can increase the risk of kidney disease by decreasing blood supply to the kidneys. The kidneys play a role in the regulation of blood pressure so these two systems are intimately related.
Metabolic syndrome is a well-known contributing factor to chronic kidney disease, though the exact mechanisms are still being determined. It is possible that there are multiple factors by which this condition contributes.
Diabetes contributes to chronic kidney disease, especially when it is poorly controlled. Elevated blood sugars can damage the blood vessels in the body as well as the structures in the kidneys responsible for filtering blood and producing urine.
Recognizing Symptoms of Stage 3 Kidney Disease
Kidney disease often has no symptoms until its late stages, which is one of the reasons that so many people who have kidney disease don’t know it.
Early Symptoms
Some of the early symptoms of kidney disease are very similar to other diseases. These include:
- Nausea and vomiting
- Decreased appetite
- Problems sleeping
- Brain fog
- Changes in urination
- Muscle cramps
- Swelling in the feet or ankles
- Difficult to control blood pressure
- Puffiness in the face
Not all of these symptoms are present with kidney disease, and as previously mentioned, many people have no symptoms at all.
Signs of Worsening Kidney Function
As kidney disease worsens, fluid may build up around the lungs or heart, causing chest pain or shortness of breath. Additionally, electrolyte imbalances and worsening eGFR occur. Creatinine, which is a type of protein used in the blood, will increase as the kidneys are less able to filter it out.
Misdiagnosis Risks
Kidney disease has many similarities to other conditions, and because kidney disease is often associated with other conditions, these similarities can make it more difficult to diagnose. Hydration status can also contribute to misdiagnosis in kidney disease.
Diagnosis and Monitoring
So, if kidney disease is often without symptoms, then how is it diagnosed? There are many tests that can help diagnose kidney disease and its potential causes.
Diagnostic Tests
The estimated glomerular filtration rate is calculated using the chronic kidney disease epidemiology collaboration (CKD-EPI) equation. This equation includes age, gender, ethnicity, and serum creatinine. Urinalysis can also help you determine if protein is present in the urine, suggesting that the kidneys are not functioning well.
Regular Monitoring
People with abnormal kidney function should be monitored at least yearly, though they may need more frequent monitoring depending on their other health conditions. If the eGFR is abnormal, additional testing, such as an ultrasound of the kidneys, may be indicated. Other imaging, such as MRI or CT scan, may be used in some cases. Sometimes, a biopsy may be necessary to determine if there are microscopic abnormalities in the kidneys.
Role of Specialists
Early in the progression of chronic kidney disease, the disease may be managed by a primary care physician. But, in some cases, a consultation with a specialist may be necessary. If the eGFR drops below 30mL/min/1.73m2, a consultation with a nephrologist may be indicated.
Management Strategies
If you’ve been diagnosed with chronic kidney disease, you may be wondering about what you can do to manage the condition. There are several strategies that may help you manage chronic kidney disease and prevent its progression.
Diet and Nutrition
Your healthcare provider can give you specific recommendations for diet based on your health conditions. However, some general guidelines for a kidney-healthy diet include:
- Limiting salt and sodium
- Controlling your protein intake based on the recommendations of your healthcare provider
- Choosing heart-healthy foods
- Limiting alcohol use
- Decreasing phosphorus in your diet
- Controlling your potassium intake, especially late in the disease process
Determining how much salt, potassium, or protein you should consume, should be done with the advice of a dietician or healthcare provider.
Medications
If you have other health conditions that can contribute to kidney disease, controlling those conditions is important. Medications may be indicated to control blood pressure or to treat diabetes. There are also classes of medications that can protect kidney function.
Lifestyle Modifications
In addition to medication and diet, there are lifestyle modifications that you can make to help with chronic kidney disease. Exercise can help control chronic health conditions as well as protect the kidneys. Smoking cessation may also protect the blood vessels of the body and be renal protective. Dehydration can have negative impacts on the kidneys, so staying well hydrated is also important.
Slowing Disease Progression
The earlier you can intervene with chronic kidney disease, the more likely you can slow the progression. Early intervention can help reduce the likelihood of developing complications.
Living with Stage 3 Kidney Disease
Receiving a diagnosis of chronic kidney disease can be life-changing, and learning to live with the diagnosis can be a challenge.
Emotional and Psychological Impact
A diagnosis of any chronic disease can have a significant emotional or psychological impact, and kidney disease is no exception. Many people with chronic kidney disease have depression or anxiety associated with their diagnosis. There may be support groups in your area or online if you would like to find others in a similar situation.
Importance of Family Support
As with any condition, family support is important for chronic kidney disease. It can help you navigate doctor appointments, tests, and treatments.
When to Seek Advanced Treatment
As kidney disease progresses, it may become necessary to seek advanced treatment.
Signs of Progression to Stage 4
As kidney disease progresses, you may develop additional signs or symptoms. Some of these include:
- Weight loss
- Decreased appetite
- Swelling
- Shortness of breath
- Fatigue
- Bloody urine
- Increased urinary frequency
- Itching
- Insomnia
- Nausea
- Muscle cramps
- Headaches
- Erectile dysfunction
If you start to develop symptoms of late-stage kidney disease, you should consult with your healthcare provider immediately.
Advanced Therapies
As kidney disease becomes more advanced, you may reach a point where dialysis or other interventions are necessary. An eGFR of <15 suggests that the kidney disease is end-stage, and dialysis may be indicated. In some cases, a kidney transplant may restore kidney function to help people get off dialysis.
Preventative Care Tips
The management strategies discussed above, may may help slow the progression of kidney disease and delay the need for more advanced therapies.
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Key Takeaways
- Chronic kidney disease may not have symptoms in its early stages
- Chronic kidney disease has many potential causes and is usually multifactorial
- Controlling other chronic conditions can help slow the progression of kidney disease
- Dietary and lifestyle modifications may also be helpful
- Advanced kidney disease often requires specialist consultation
- Advanced therapies such as dialysis or kidney transplant may be necessary for end-stage disease
Stage 3 kidney disease can be a condition that significantly affects your life. Learning to manage the condition proactively can put you back in control. If you are concerned about your kidney health, consult with your healthcare provider.
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