in Chronic Renal Insufficiency
Foundation for IgA Nephropathy
Chronic Renal Insufficiency
Stages and Symptoms of Renal Insufficiency
nephrologist may use a classification system to describe what stage of
chronic kidney disease you are at (such as Stage I, Stage II, etc.).
Although these are not universally-used, a common example of this is
given below. It is based on clinical practice guidelines on chronic
kidney disease published in 2002 by the National Kidney Foundation
(NKF) in the U.S., as part of its Kidney Disease Outcome Quality
Stages of Chronic Kidney Disease
These guidelines are adapted from the
National Kidney Foundation's
Kidney Disease Outcomes Quality Initiative
Signs of mild kidney disease but with
normal or better GFR
greater than 90%
Mild kidney disease with reduced GFR
Moderate chronic renal insufficiency
Severe chronic renal insufficiency
End-stage renal failure
less than 15%
is given in ml/min/1.73 m2
Because there is considerable unpredictability and overlap as to when
various symptoms of chronic renal insufficiency might start appearing,
rather than limiting ourselves to these specific stages, we will
instead look at 3 broad categories as follows. Please note that if you
happen to have heavy proteinuria, even if your IgAN is at a very mild
stage in terms of chronic renal insufficiency, you may begin to
experience symptoms of what is called nephrotic syndrome. These
symptoms are due to the heavy loss of protein, and are not
strictly-speaking symptoms of "renal failure".
chronic renal insufficiency (Stages 1 to 2)
few or no physical symptoms that you can feel (other than those you may
experience if you have heavy proteinuria).
Blood work. Blood work results
will show abnormalities - mainly a slightly elevated serum creatinine.
Note that there is often a time lag between elevations of serum
creatinine, and some progression of the IgAN. By the time serum
creatinine is elevated, the person may already have lost 50% of kidney
Urinalysis. Urine will show
abnormalities. Urine can be checked by dipstick in the doctor's office
(as an initial check), and followed up with a more complete urinalysis.
The main urine abnormality that will suggest a kidney disease is the
presence of protein and/or blood. Either will usually trigger further
investigation. However, blood and/or protein in the urine doesn't say
anything about actual kidney function.
Treatment. Treatment may involve
some mild dietary changes (a lower protein diet may in some cases be
recommended), and a blood pressure medication may be
prescribed (usually of the ACE inhibitor class, the angiotensin II
receptor class, or both, even if blood pressure is not really elevated
people start having high blood pressure even in early chronic renal
failure. IgAN is one kidney disease that can do this.
rarely occur at this stage. In this case, it is most often caused by
having heavy proteinuria rather than actual chronic renal insufficiency.
chronic renal insufficiency (Stages 3 to 4)
still feel completely normal at this stage, or you may begin to
experience one or more of the following symptoms:
- Serum creatinine. Serum
creatinine will be higher (indicating less than 30% kidney function)
- Tiredness or fatigue
- Puffiness or swelling
(obvious in the hands or feet and ankles, but the puffiness will often
first be seen around the eyes).
- Back pain. Usually felt
as a dull ache anywhere in the mid-to-lower portion of the back, on one
side or the other - this is sometimes referred to as flank pain, or
- Appetite. Changes in
appetite or eating pattern. Foods may start tasting "funny".
- Urine. Changes in
urination (amount, colour, frequency). Urine may in fact look
exceptionally clear at this point, rather than abnormal. This is
because little is actually being filtered into it by your kidneys.
Previously high proteinuria and/or hematuria may actually improve.
- Blood pressure. High
blood pressure (also referred to as hypertension)
- Digestion. Poor
digestion (varying degrees of gastroparesis, which means that digestion
- Diet. Dietary changes
may be ordered (renal diet: low protein, low potassium, low phosphorus,
low sodium, higher calorie)
- High blood pressure medications.
It's common to need more than one at this stage, and often 3 or more.
- Other drugs/supplements.
May be prescribed if needed, such as vitamin D analog (calcitriol is a
common one), renal vitamins (not a regular multi-vitamin, as these
contain too much vitamin A for the typical advanced renal insufficiency
patient). Drugs for controlling heavy proteinuria if
necessary (note that heavier proteinuria does not automatically follow
with more advanced chronic renal insufficiency).
- Phosphorus binder. You
may be asked to begin taking a calcium supplement with meals as a
phosphorus binder (or a medication may be prescribed instead of or in
addition to calcium).
End-stage renal failure (or late chronic renal insufficiency)
The terms end-stage renal failure and end-stage renal disease are used
interchangeably, and the abbreviation ESRD is commonly used. Typically,
patients will have kidney function in the area of 10-15% or so. These
are the common symptoms you may experience at this stage (and some
people may start experiencing some of these earlier):
- anemia (may begin earlier than this)
- easy bleeding and bruising
- fatigue and drowsy feeling (more than normal or usual
- mental symptoms such as lowered mental alertness,
trouble concentrating, confusion, seizures
- nausea, vomiting, and generally less desire to eat
- muscle cramps, muscle twitching
- nocturia (night-time urination)
- numb sensation in the extremities
- itchy skin, itchy eyes
- skin colour changes (grayish complexion, sometimes
- swelling and puffiness (more than you had while in
advanced renal failure, and most likely in the feet and/or ankles)
- difficulty breathing (due to fluid in the lungs,
- high blood pressure (with IgAN, you may already have
had this since the early stages)
- decreased sexual interest
- changes in menstrual cycle (and difficulty getting
- decreased urine output (however, you should be aware
that some people with ESRD will continue to get rid of water as urine,
but not wastes - therefore, the urine may be very clear and
normal-looking, and some may have increased urine output rather than
- poor digestion (varying degrees of gastroparesis).
The exact time that
dialysis starts will vary slightly depending on various factors.
Consult your nephrologist.
- Kidney transplant
© 2002-2006 Foundation for IgA Nephropathy