Stages and Symptoms of Renal Insufficiency

Stages of Chronic Kidney Disease These guidelines are adapted from the National Kidney Foundation's Kidney Disease Outcomes Quality Initiative (KDOQI)
Stage	Description	GFR*
1	Signs of mild kidney disease but with normal or better GFR	greater than 90%
2	Mild kidney disease with reduced GFR	60-89%
3	Moderate chronic renal insufficiency	30-59%
4	Severe chronic renal insufficiency	15-29%
5	End-stage renal failure	less than 15%
GFR is given in ml/min/1.73 m² More information about GFR*

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".

Early chronic renal insufficiency (Stages 1 to 2)

Physical symptoms. Usually 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 function.
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 much).
Blood pressure. Some people start having high blood pressure even in early chronic renal failure. IgAN is one kidney disease that can do this.
Anemia. Anemia may rarely occur at this stage. In this case, it is most often caused by having heavy proteinuria rather than actual chronic renal insufficiency.

Advanced chronic renal insufficiency (Stages 3 to 4)

Physical symptoms

You may 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 loin pain)
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 is slowed).

Treatment

Diet. Dietary changes may be ordered (renal diet: low protein, low potassium, low phosphorus, low sodium, higher calorie)

Medication

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):

Symptoms

anemia (may begin earlier than this)
easy bleeding and bruising
headache
fatigue and drowsy feeling (more than normal or usual for you)
weakness
mental symptoms such as lowered mental alertness, trouble concentrating, confusion, seizures
nausea, vomiting, and generally less desire to eat
thirst
muscle cramps, muscle twitching
nocturia (night-time urination)
numb sensation in the extremities
diarrhea
itchy skin, itchy eyes
skin colour changes (grayish complexion, sometimes yellowish-brownish tone)
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, anemia)
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 pregnant)
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 decreased).
poor digestion (varying degrees of gastroparesis).