Chronic Kidney Disease Stages: Recognising the Signs Early
Learn about the five stages of chronic kidney disease (CKD), their signs and symptoms, diagnostic tests, and management strategies. Early recognition is key to slowing progression.
Written by Dr. Siri Nallapu
Reviewed by Dr. Dhankecha Mayank Dineshbhai MBBS
Last updated on 22nd Sep, 2025
Introduction
Your kidneys are the unsung heroes of your body, working tirelessly to filter waste, balance fluids, and regulate blood pressure. But when they become damaged over time, it leads to a condition known as Chronic Kidney Disease (CKD). The insidious nature of CKD is that it often progresses silently, with signs and symptoms becoming apparent only in the later stages. This makes early recognition crucial. Understanding the signs of chronic kidney disease stages can empower you to take proactive steps for your health. This comprehensive guide will walk you through the five stages of CKD, detailing the specific symptoms associated with each, and provide actionable advice on when to seek medical help. Knowledge is your first line of defence in preserving your kidney function and overall well-being.
What is Chronic Kidney Disease (CKD)?
Chronic Kidney Disease (CKD) means your kidneys are damaged and can't filter blood the way they should. This damage typically happens gradually over months or years. The primary measure of kidney function is the glomerular filtration rate (GFR), which estimates how much blood passes through the tiny filters in your kidneys (called glomeruli) each minute. CKD is diagnosed if kidney damage is present for more than three months, indicated by a persistent decrease in GFR or the presence of markers like protein in the urine (albuminuria).
How CKD Differs from Acute Kidney Injury
It's vital to distinguish CKD from Acute Kidney Injury (AKI). AKI is a sudden episode of kidney failure or damage that happens within a few hours or days. It is often reversible if treated promptly. CKD, on the other hand, is a long-term, progressive condition. While its progression can be slowed, the damage is usually permanent. A key difference lies in the duration and onset of symptoms.
The 5 Stages of Chronic Kidney Disease: A Breakdown
The stages of CKD are based on your eGFR value, which is calculated from a blood test for creatinine, along with your age, sex, and body size.
Stage 1 CKD: Kidney Damage with Normal Function
• eGFR: 90 or higher
Description: At this earliest stage, you have normal kidney function, but there is evidence of some kidney damage. This is often detected through physical signs like protein in the urine (proteinuria) or structural damage seen on an imaging test.
Signs and Symptoms in Stage 1
Most people experience no noticeable symptoms of kidney disease at this point. The damage is often identified incidentally during tests for other conditions, such as diabetes or high blood pressure. This is why screening for those with risk factors is so critical.
Stage 2 CKD: Mild Loss of Function
• eGFR: 60 to 89
Description: There is a mild loss of kidney function, along with evidence of kidney damage.
Signs and Symptoms in Stage 2
Like Stage 1, symptoms are often absent or very subtle. You might experience slightly more frequent urination, especially at night, or your urine might be foamy if protein is leaking. However, these signs are easy to dismiss or attribute to other causes.Consult a Nephrologist for Personalised Advice
Stage 3 CKD: Moderate Loss of Function
• eGFR: 30 to 59
Description: This is often when CKD begins to become more apparent. The kidneys are significantly impaired in their filtering ability, allowing waste products to build up in the blood (a condition called uraemia).
Stage 3a vs. Stage 3b: Understanding the Difference
• Stage 3a: eGFR 45-59. A mild to moderate reduction in function.
• Stage 3b: eGFR 30-44. A moderate to severe reduction.
This distinction helps doctors tailor treatment plans more precisely.
Common Signs and Symptoms of Stage 3 CKD
This is when people often start to feel unwell. Common symptoms of stage 3 kidney disease include:
• Swelling (Oedema): In the hands, feet, ankles, and around the eyes, caused by the kidneys' inability to remove extra fluid and salt.
• Fatigue: Due to a buildup of toxins and anaemia, a condition where your blood has a low red blood cell count because the kidneys aren't producing enough erythropoietin (a hormone that stimulates red blood cell production).
• Changes in Urination: Urine may be foamy, dark, or you may urinate more or less frequently.
• Back Pain: Some people experience pain in the mid-to-lower back where the kidneys are located.
Stage 4 CKD: Severe Loss of Function
eGFR: 15 to 29
Description: Kidney function is severely reduced. This is a critical stage where preparations for kidney failure treatment (like dialysis or transplant) should begin.
Signs and Symptoms in Stage 4
All symptoms from earlier stages become more pronounced. New symptoms may appear:
• Nausea and Vomiting: Due to the buildup of waste products.
• Metallic Taste in Mouth/Uraemic Breath: Waste in the bloodstream can affect taste and cause bad breath.
• Loss of Appetite.
• Muscle Cramps and Twitching: Caused by electrolyte imbalances.
• Itchy Skin: From mineral and bone disease due to the kidneys' inability to balance calcium and phosphorus.
Stage 5 CKD: Kidney Failure (End-Stage Renal Disease - ESRD)
eGFR: Less than 15
Description: The kidneys have lost nearly all their ability to function. Waste products and fluids accumulate at dangerous levels in the body. To survive, dialysis or a kidney transplant is necessary.
Signs and Symptoms of Kidney Failure
Symptoms are severe and affect the entire body:
• Severe Shortness of Breath: From fluid buildup in the lungs.
• Confusion and Difficulty Concentrating.
• Little to No Urine Output.
• Chest Pain: Due to pericarditis (inflammation of the heart lining).
• Uncontrolled High Blood Pressure.
• Uraemic Frost: A rare, late-stage sign where urea crystals form on the skin.
Beyond the Stages: Other Key Warning Signs to Watch For
While staged by eGFR, CKD announces itself through various signals.
Changes in Urination: Colour, Frequency, and Foam
Your urine is a window into kidney health. Watch for:
• Foamy/Bubbly Urine: Suggests protein leakage (proteinuria).
• Blood in Urine (Haematuria): Can appear pink, red, or cola-coloured.
• More Frequent Urination, especially at night.
• Pressure or Difficulty while urinating.
Swelling in Legs and Ankles
When kidneys can't remove sodium effectively, it leads to fluid retention (oedema). This is one of the most common visible signs of worsening kidney function.
Persistent Fatigue and Brain Fog
This isn't just ordinary tiredness. It's a deep exhaustion caused by anaemia and the toxic buildup of impurities in the blood, which can also make it hard to think clearly.
How is CKD Diagnosed? Key Tests and Markers
Diagnosis is straightforward and relies on two simple tests. If you are experiencing any potential early signs of kidney failure, a doctor will order these.
The Role of eGFR (Estimated Glomerular Filtration Rate)
This is the key metric for determining your CKD stage. It's calculated from a blood creatinine test. A declining eGFR indicates a loss of kidney function.
The Importance of Urine Albumin-to-Creatinine Ratio (UACR)
This test measures the amount of albumin (a type of protein) in your urine. Healthy kidneys don't let albumin pass into the urine. Its presence (albuminuria) is a primary marker of kidney damage. Apollo24|7 offers convenient home collection for tests like creatinine and eGFR, making it easier to get screened.
Slowing the Progression: Management by Stage
While CKD is often progressive, its course can be significantly altered with proactive management.
• Stages 1-3: Focus is on treating the underlying cause (e.g., controlling diabetes and hypertension), adopting a kidney-friendly diet (often lower in sodium, protein, and phosphorus), staying active, and avoiding NSAIDs (like ibuprofen).
• Stages 4-5: Management becomes more intensive, involving nephrologist care, strict diet plans, medication to control complications (anaemia, bone disease), and education about treatment options for kidney failure (dialysis modalities, transplant evaluation).
If your blood pressure or blood sugar remains difficult to control, or if symptoms persist, consult a doctor online with Apollo24|7 for further evaluation and a personalised management plan.
Conclusion
Understanding the signs of chronic kidney disease stages is not meant to incite fear, but to foster awareness and empowerment. CKD is a manageable condition, especially when identified early. The silent nature of its initial phases underscores the importance of regular check-ups, particularly if you have risk factors. Listening to your body's signals; whether it's unexplained fatigue, persistent swelling, or changes in urination, is the first step. The next, and most crucial step, is to act on them. By partnering with your healthcare provider, you can take control of your kidney health, slow the disease's progression, and maintain a better quality of life. If you recognize any of these symptoms in yourself or a loved one, don't wait. Consult a doctor online with Apollo24|7 for further evaluation and peace of mind.
Consult a Nephrologist for Personalised Advice
Consult a Nephrologist for Personalised Advice
Dr Gayatri Pegu
Nephrologist
15 Years • MD (General Medicine) DM(Nephrology)
Guwahati
Apollo Clinic Guwahati, Assam, Guwahati
Dr Ch Sashidhar
Nephrologist
20 Years • MBBS, MD General Medicine, DNB, Nephrology
Secunderabad
Apollo Hospitals Secunderabad, Secunderabad
Dr. Pardha Saradhi
Nephrologist
9 Years • MBBS, MD-DNB (Gen. Med.), DNB (Nephro)
Hyderabad
Apollo Hospitals D R D O kanchanbagh, Hyderabad
(75+ Patients)
Dr Praveen Kumar Etta
Nephrologist
10 Years • MBBS,MD DM(SGPGI) FORMER ASST(PIMS)
Hyderabad
Apollo Spectra Ameerpet, Hyderabad
Dr. Manju Kamal
Nephrologist
12 Years • MBBS,MD(General Medicine), DNB,DM(Nephrology)
Angamaly
Apollo Hospitals Karukutty, Angamaly
Consult a Nephrologist for Personalised Advice
Dr Gayatri Pegu
Nephrologist
15 Years • MD (General Medicine) DM(Nephrology)
Guwahati
Apollo Clinic Guwahati, Assam, Guwahati
Dr Ch Sashidhar
Nephrologist
20 Years • MBBS, MD General Medicine, DNB, Nephrology
Secunderabad
Apollo Hospitals Secunderabad, Secunderabad
Dr. Pardha Saradhi
Nephrologist
9 Years • MBBS, MD-DNB (Gen. Med.), DNB (Nephro)
Hyderabad
Apollo Hospitals D R D O kanchanbagh, Hyderabad
(75+ Patients)
Dr Praveen Kumar Etta
Nephrologist
10 Years • MBBS,MD DM(SGPGI) FORMER ASST(PIMS)
Hyderabad
Apollo Spectra Ameerpet, Hyderabad
Dr. Manju Kamal
Nephrologist
12 Years • MBBS,MD(General Medicine), DNB,DM(Nephrology)
Angamaly
Apollo Hospitals Karukutty, Angamaly
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Frequently Asked Questions
1. Can you reverse chronic kidney disease?
While the damage from CKD is typically permanent, you can often slow or even stop the progression of the disease, especially if caught in the early stages. Effective management of underlying conditions like diabetes and hypertension is key to preserving remaining kidney function.
2. What is the life expectancy for someone with stage 3 kidney disease?
Life expectancy varies greatly depending on age, overall health, and how well the disease is managed. Many people live for decades with Stage 3 CKD by diligently following their treatment plan, including diet, exercise, and medication. It is a serious diagnosis, but not a immediate death sentence.
3. What foods should you avoid with kidney disease?
A kidney-friendly diet often involves limiting foods high in sodium, potassium, and phosphorus. This can include processed foods, canned soups, bananas, oranges, potatoes, tomatoes, dairy products, nuts, and dark sodas. A dietitian or your doctor can create a personalized plan for you.
4. What is the main cause of chronic kidney disease?
The two most common causes are diabetes and high blood pressure, which together account for about two-thirds of all CKD cases. These conditions damage the small blood vessels in the kidneys over time.
5. Can you have CKD with a normal eGFR?
Yes, this is Stage 1 CKD. You can have evidence of kidney damage (like protein in the urine) even while your eGFR is still normal (90 or above). This highlights why both tests; eGFR and UACR—are important for a complete picture.