Rapper MD

Chronic Kidney Disease

What you need to know.

Several things…

Question: What’s the big deal about chronic kidney disease?

One is that most people who have this don’t even know it. Secondly just because you make urine does not mean that your kidneys are healthy.  Why? The kidney has several functions.  For this discussion we will focus on how Nephrologists categorize kidney function and what we use to determine whether or not you need a dialysis  machine to remove your metabolic waste products-excess fluid.

Understanding Kidneys

First you must understand that the kidneys are made up of very small specialized arteries that are connected with the rest of your circulatory system.  They are called ‘glomeruli’. Since it is part of the circulatory system, this should help you to understand why diseases that affect you arteries in other areas of your body can also involve kidney damage.

{There is a simple cartoon in the Lifestyle Video section name “To The Children” that breaks down the anatomy and physiology of the kidneys in a very cute simple way.}

Five stages have been assigned to categorize chronic kidney disease processes. 

Stage 1, stage 2, stage 3a, 3b , stage 4 and the last stage is 5.  I will keep it simple and say stages one through five.  

In order to remove metabolic waste, every time your heart beats about 25% of that blood goes to your renal arteries–>on to smaller arteries until they reach –>the glomerular.  This one glomerular and one tubule is called a ‘nephron’.  

As blood passes from the glomerular through the urinary space to the tubules, this is a filtration process.  In other words  a ‘filtration rate.’ This measurement is express as an estimate in cc/min/1.73m2.  I know most people are not familiar with these terms so I simplify and say per cent (%). That is, the greater your filtration rate, the greater amount of blood is clean hence removal of metabolic toxins or waste products. 

Chronic kidney disease (CKD) stages are on lab test, estimated Glomerular Filtration Rate (eGFR):

  • Stage 1:   >90% filter rate is healthy (however if eGFR is 110% for example, this can be a problem in some situations). 
  • Stage 2:   60-89 %. I see in adults with other chronic illness like hypertension or recovering from an infection like pneumonia or when severely dehydrated.
  • Stage 3:  30-59%. Moderate disease. Like in poorly controlled high blood pressure for 5+ years.
  • Stage 4:  16-29%. Severe disease. 
  • Stage 5: eGFR is less than 15%. Horrible. Most people need a dialysis machine. No I do not wait for this number to drop further to 6% or 4%. Nor to 0%–> that is death!