Stages of Chronic Kidney Disease | Stage 1 - Stage 5 Explained

When chronic kidney disease (CKD) is diagnosed early and accurately, its advance from the early stages to the later stages can be slowed and sometimes even stopped. However, far too many CKD patients do not obtain an early diagnosis or appropriate treatment.

As a result, CKD patients may suffer and sometimes die unnecessarily. A doctor’s failure to detect or treat CKD, the late detection or improper treatment of CKD, and the failure to refer a CKD patient to a specialist when it’s called for – all of these may constitute medical malpractice.

When someone suffers from chronic kidney disease, that person’s kidneys seldom fail all at once or unexpectedly. Rather, chronic kidney disease usually progresses at a slow pace over a period of years. This is actually helpful to patients because if CKD is diagnosed early, treatments and lifestyle adjustments can impair its progress and keep patients feeling healthy – and living normal lives – for years, and in some cases, for decades.

Kidneys filter the blood to remove waste products and toxins, and they secrete important hormones that we require for healthy red blood cells, strong bones, and proper blood pressure regulation. The kidneys also remove excess water and calcium from the body.

The stages of chronic kidney disease are determined by the “glomerular filtration rate.” It’s not as complicated as it sounds. Glomerular filtration is simply the process of the kidneys filtering the blood to remove excess fluids and wastes.

HOW IS THE GLOMERULAR FILTRATION RATE DETERMINED?

The glomerular filtration rate (GFR) is a measurement that indicates how well blood is being filtered by the kidneys, and it’s one of the several ways to measure kidney efficiency. The GFR is determined by a formula that considers a patient’s age, gender, and creatinine levels.

Creatinine is a chemical waste molecule that forms as a result of muscle metabolism. Creatinine moves through the blood to the kidneys, which filter out most of the creatinine, which is then expelled in the urine.

Because the human body’s muscle mass barely changes from one day to the next, creatinine production remains essentially unchanged from day to day. When the kidneys are impaired for any reason, the creatinine level in the blood rises because the efficiency of the kidneys has declined. Thus, rising creatinine levels are a generally dependable warning sign of chronic kidney disease.

Standard blood tests measure the level of creatinine in the blood. However, if test results are misinterpreted or not even recognized – due to insufficient medical training, overwork, and stress, or for any other reason – specialists may not be consulted, the appropriate treatment may not be ordered, and a CKD patient’s health can rapidly deteriorate. The failure to read test results properly or to order referrals or treatment based on those test results may constitute medical malpractice.

HOW CAN YOU KNOW IF YOU ARE A VICTIM OF MEDICAL MALPRACTICE?

If you believe that your own kidney disease has been misdiagnosed or that you have not received the proper treatment for CKD, discuss your situation promptly with an experienced medical malpractice attorney. Medical malpractice is the violation of the “reasonable standard of care” provided by most doctors, but it’s often difficult for the average person to know if he or she has been a medical malpractice victim. An experienced kidney diseases lawyer can review your case, provide candid legal advice, and explain your options, which may include a medical malpractice lawsuit.

The exact formula for determining a patient’s GFR – for those who are mathematically inclined – is 140 minus the patient’s age in years, times the patient’s weight in kilograms (or times 0.85 for women), divided by 72 times the creatinine level in milligrams per deciliter (or mg/dL). The lower the GFR number, the more inefficient the kidney function.

While a patient with a GFR of 60 for three months or longer, for example, is very likely to be a victim of kidney disease, for some categories of patients – amputees, the obese, the very young and the very old – the GFR may not be a reliable indicator of kidney health.

To improve the treatment of chronic kidney disease patients, the National Kidney Foundation (NKD) has established guidelines to help doctors and patients recognize and understand each stage of the disease. The National Kidney Foundation guidelines recognize five different stages of CKD. Each stage requires different tests and treatments.

Listed here are the stages of chronic kidney disease as spelled out by the NKD, along with the GFR numbers that are expected with each stage:

Stage 1: Early CKD (with a normal or high GFR of 90 or higher)
Stage 2: Mild CKD (GFR of 60 to 89)
Stage 3A: Mild to Moderate CKD (GFR of 45 to 59)
Stage 3B: Moderate to Severe CKD (GFR of 30 to 44)
Stage 4: Severe CKD (GFR of 15 to 29)
Stage 5: End Stage CKD (a GFR measurement below 15)

Chronic kidney disease treatment in the first four stages concentrates on maintaining kidney function for as long as possible. If chronic kidney disease progresses to the final stage – end stage renal disease or ESRD – a patient will discuss with his or her doctor treatment options that include kidney dialysis and a kidney transplant. More than 600,000 people in the United States have end stage renal disease, according to the National Kidney Foundation.

WHAT IS THE DEFINITION OF MEDICAL NEGLIGENCE?

While medical malpractice cannot cause chronic kidney disease, any failure to obtain a precise and early diagnosis and appropriate treatment for CKD can lead directly to acute renal failure. When healthcare providers do not provide the “reasonable standard of care,” they are negligent. If that negligence causes a patient to be injured, the patient is entitled by law to monetary compensation and has the right to sue for medical malpractice.

Chronic kidney disease patients who are injured by medical malpractice can be reimbursed for their lost income and any lost earning potential linked to the malpractice, any additional medical care and expenses required by the malpractice, and in some cases, patients can be additionally compensated for their malpractice-related pain and suffering.

Victims of medical negligence are entitled to compensation, but compensation isn’t just handed to victims. If you are a kidney disease patient and a victim of medical malpractice, you’ll need to work alongside an experienced kidney diseases attorney who can fight for justice on your behalf.

By: Jed Kurzban

Medical malpractice attorney Jed Kurzban graduated from the University of Alabama in 1992 and earned his Juris Doctor from the University of Miami School of Law in 1995. He is a member of the Dade County Bar Association, the Florida Bar Association, the American Association for Justice, the Academy of Florida Trial Lawyers, and the American Bar Association. Mr. Kurzban is happily married and the father of two.