A nephrologist sees patients across all stages of kidney disease (CKD), but they become crucial from Stage 3 onward, particularly when kidney function (eGFR) drops below 60 mL/min/1.73m², with mandatory involvement in Stage 4 (eGFR 15-29) to plan for dialysis or transplant, and Stage 5 (kidney failure). Early referral, even in Stage 3, ensures optimal management to slow progression and manage complications like high blood pressure, say Kidney Health Australia and the American Kidney Fund.
Patients should be referred to a nephrologist at any stage of CKD or for urinary abnormalities, especially when the eGFR falls below 60 mL/min/1.73m2. An early referral ensures optimal management.
Chronic kidney disease is classified into five stages based on how well your kidneys filter waste from your blood. These stages range from very mild damage to kidneys to kidney failure. If you have received a chronic kidney disease diagnosis, no matter what stage it is, it's time to see a kidney specialist.
To learn what stage you have, your healthcare team performs a blood test to check how well the kidneys are working. This blood test is called the estimated glomerular filtration rate (eGFR). The eGFR measures how much blood the kidneys filter each minute, recorded as milliliters per minute (mL/min).
A GFR of 60-89 for three months or longer, along with kidney damage, is a sign of early CKD. There are often few (if any) symptoms at this stage. Stage 3: GFR of 30 to 59 — People at stage 3 have moderate CKD and may want to see a nephrologist.
The diversity of guidelines concerning referral from primary care to a specialist nephrologist determines different outcomes around the world among patients with CKD where several guidelines recommend referral when the glomerular filtration rate (GFR) is <30 mL/min/1.73 m2 regardless of age.
In the general population, approximately 38% of adults aged 70 or older have an estimated glomerular filtration rate (eGFR) < 60 ml/min/1.73 m2, with most having moderate reductions in eGFR in the 30-59 ml/min/1.73 m2 range (1).
Most people with CKD will be able to control their condition with medicine and regular check-ups. CKD only progresses to kidney failure in around 2 in 100 people with the condition. If you have CKD, even if it's mild, you're at an increased risk of developing other serious problems, such as cardiovascular disease.
Usually, when the creatinine clearance falls to 10-12 cc/minute, the patient needs dialysis.
In stage 2, there is a mild decrease in kidney function. The estimated glomerular filtration rate (eGFR), a measure of kidney function, will be between 60-89 mL/min/1.73m². Symptoms may start to appear at this stage, including fatigue, fluid retention, and changes in urination patterns.
You should see a nephrologist if you have any symptoms of kidney disease. These symptoms may include: Changes in your pee: Changes in your peeing habits or how your pee looks may indicate a problem with your kidneys. Signs may include peeing more often or less often, foamy pee or pee that's darker in color.
Blood and urine tests determine which stage of CKD you're in. The stages range from very mild (stage 1) to kidney failure (stage 5). Healthcare providers determine the stage of your kidney function according to the glomerular filtration rate (GFR).
It is generally patients with Stage 5 CKD that are considered candidates to start dialysis therapy or be considered for kidney transplantation. Once dialysis or transplantation is felt to be necessary, this is called End Stage Renal Disease (ESRD).
Seeing a doctor when you have stage 3 CKD
As stage 3 progresses, a patient should see a nephrologist (a doctor who specializes in treating kidney disease). Nephrologists examine patients and perform lab tests so they can gather information about their condition to offer the best advice for treatment.
At 40 years of age, the average life expectancy is: 24.5 years for males with stage 3a CKD. 28.7 years for females with stage 3a CKD. 14.5 years for males with stage 3b CKD.
Recognizing the warning signs of kidney failure early is crucial to prevent complications and prepare for dialysis. Symptoms like severe fatigue, swelling, and changes in urination patterns should never be ignored. Timely medical intervention can improve your quality of life and health outcomes.
Certain conditions may cause a person to have higher than normal levels of creatinine. People with only one kidney may have a normal creatinine level of about 1.8 or 1.9. Creatinine levels of 2.0 or more in infants and 5.0 or more in adults may indicate severe kidney damage.
Generally, a creatinine level above 5.0 mg/dL in adults is considered alarming, but dialysis is usually started when symptoms become severe or GFR drops below 15.
You need dialysis when you develop end stage kidney failure, usually by the time you lose about 85 to 90 percent of your kidney function and have a GFR of <15.
Stages of CKD
CKD is evaluated using two simple tests – a blood test known as the estimated glomerular filtration rate (eGFR) and a urine test known as the urine albumin-creatinine ratio (uACR). Both tests are needed to have a clear picture of your kidney health.
Medicines that may need to be avoided, adjusted, or changed include:
In Stage 3 CKD, your kidneys have mild to moderate damage and are less able to filter waste and fluid out of your blood. Waste buildup or uremia can build up in your body and lead to complications, such as high blood pressure, anemia, and problems with your bones.
GFR is considered as the best overall measure of kidney function for diagnosis and treatment of patients with CKD.