Kidney School™—a program of Medical Education Institute, Inc.

Module 1—Kidneys: How They Work, How They Fail, What You Can Do

The National Kidney Foundation (NKF) has divided CKD into 5 stages based on the level of filtering the kidneys can do (called glomerular filtration rate, or GFR). This chart was adapted from the Kidney Disease Improving Global Outcomes (KDIGO) Guidelines. When there is protein in the urine, the chance of CKD getting worse is much higher.

Stages of CKD
Stage Description GFR* What to Do
1 Kidney damage with normal or increased GFR ≥90
  • Diagnose & treat the problem and/or other illnesses to slow the rate of CKD progression
  • Reduce heart disease risk
2 Kidney damage with mildly reduced GFR 60-89
  • Estimate the rate of CKD progression
3a Mildly to moderately reduced GFR 45-59
  • Assess and treat complications
3b Moderately to severely reduced GFR 30-44
  • Assess and treat complications
4 Severely reduced GFR 15-29
  • Prepare for kidney replacement therapy
5 Kidney failure <15
  • Kidney replacement therapy

Most CKD cannot be cured. The good news is that if a kidney problem is found early, there may be ways to help you feel better and to slow down the disease. Some ways your doctor might suggest include:

  • Avoiding certain pain pills – overuse of some over-the-counter pain pills with ibuprofen, naproxen, acetaminophen, or pain medicines with caffeine in them can damage kidneys.
  • Blood pressure control – high blood pressure can cause or speed up CKD. Medicines called ACE inhibitors or angiotensin receptor blockers (ARBs) can help protect kidney function. Eating less salt can help, too.
  • Eating changes – some doctors believe a low protein diet can help slow kidney disease.
  • Anemia treatment – anemia (a shortage of red blood cells) starts very early in kidney failure and can make you very tired.
  • Cut back or quit smoking – smoking tobacco can make kidney problems worse.

Your doctor only recommends; you must make the daily choices to follow up.


Nancy: Kidney Disease

"My kidneys failed from glomerulonephritis, maybe from a strep germ. The times in junior high and high school were probably more difficult than today. There was not much awareness about healthy eating. There were no prepared foods without salt. We cooked everything from scratch. A low sodium diet (or salt-free diet, as we used to call it) is essential, in most cases, to be a healthy dialysis patient. It was difficult to watch my diet when I was young, but I tried very hard. My kidneys began to fail when I was 11 years old. I didn't start dialysis until I was 19."

Warning Signs of CKD

Many people who have CKD don't know it, because the early signs can be very subtle:

  • Changes in your urine – like foamy urine, blood in the urine, more or less urine than usual, or getting up at night to urinate
  • Fatigue – low energy and feelings of overwhelming tiredness can be due to kidney failure (or many other things)
  • Itching – the build-up of wastes in the blood can cause severe itching
  • Swelling in the hands and/or feet – failing kidneys don't remove extra fluid, which builds up in the body
  • Shortness of breath – extra fluid can build up in the lungs, or anemia can cause shortness of breath
  • Pain above the waist in the back – the pain is not made worse by movement

If you or someone you know has these symptoms, or you are worried about kidney problems, see a doctor for blood and urine tests.

Page 6 of 21 | Further reading