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Stage 4 Kidney Disease: Symptoms, Causes, Diagnosis & Treatments
INS LifeGuard • May 17, 2024
Is the complexity of Stage 4 Kidney Disease leaving you feeling overwhelmed and uncertain about what steps to take next? Being diagnosed with this advanced stage of kidney disease can bring a wave of emotions and questions. In this guide, we'll provide you with all the information you need to help you understand your condition better and figure out the best way forward. In the following sections, we'll delve into the symptoms of Stage 4 Kidney Disease, explore its possible causes, discuss how it's diagnosed, and outline various treatment options available.
What is Stage 4 Kidney Disease?
Stage 4 Chronic Kidney Disease (CKD) represents severe kidney damage within the 5 stages of kidney disease, occurring just before kidney failure. At this stage, the kidneys no longer work properly, so they struggle to filter waste and control essential substances in the blood.
Individuals diagnosed with Stage 4 Kidney Disease typically have an estimated glomerular filtration rate (eGFR) ranging from 15 to 29 millilitres per minute, which indicates that they have only 15-20% kidney function remaining. Therefore, this severe loss of kidney function can result in the accumulation of waste and toxins in the body, leading to the onset of various health problems.
Symptoms
Symptoms of kidney disease often go unnoticed until the later stages, when kidney damage has already been severe. Signs indicative of Stage 4 Kidney Disease include:
- Urinating more frequently
- Dry, itchy skin
- Fatigue and shortness of breath
- Nausea and vomiting
- Swelling arms, legs, ankles or feet
- Body aches and muscle cramps
- Loss of appetite
- Mental fog
- Insomnia
- Anemia
- Azotemia (breath smells like ammonia)
- Bone disease
- Imbalanced blood levels of phosphorous, calcium, or vitamin D
Causes
Stage 4 Chronic Kidney Disease (CKD) can result from various factors and underlying conditions such as:
Diabetes
When someone has diabetes, their blood sugar levels rise because their body cannot produce sufficient insulin, a hormone that helps cells take in glucose, from the bloodstream. Without enough insulin, glucose remains in the blood, potentially harming blood vessels and organs as it circulates throughout the body. This damage can affect the kidneys' ability to filter properly, leading to reduced kidney function.
High Blood Pressure
High blood pressure, also known as hypertension, is a prevalent cause of chronic kidney disease (CKD). High blood pressure generally harms and constricts the veins and arteries of the kidneys, which impairs their ability to filter properly. As a result, the accumulation of fluid in the blood vessels can contribute to a continuous increase in blood pressure, which creates a harmful cycle that worsens kidney damage.
Other Causes
Chronic kidney disease (CKD) can also be caused by other conditions, including:
- Glomerulonephritis
- Accumulation of IgA antibodies in kidneys and blood vessels
- Alport syndrome (Rare Genetic Disorders)
- Toxicity from drugs or overexposure to heavy metals
- Lupus (Systemic Diseases)
- Renal Artery Stenosis
Diagnosis
In Stage 4 Chronic Kidney Disease (CKD), patients should visit their doctor at least every three months and undergo examinations and lab tests to assess kidney function and determine what may be causing Stage 4 CKD:
eGFR Blood Tests
Routine blood tests are performed to assess kidney function by measuring creatinine, hemoglobin, calcium, and phosphorus levels. This test reveals how effectively the kidneys are filtering waste from the blood and maintaining the body's chemical balance. For Stage 4 Kidney Disease patients, an eGFR of 15 to 29 mL/min/1.73 m² indicates severely reduced kidney function.
Urine Tests
While it's not necessary to use urine albumin-creatinine ratio (uACR) results for confirming Stage 4 CKD, it's still crucial to have your uACR checked to better understand your kidney health. This test helps healthcare providers to assess the progression of kidney disease and tailor treatment plans accordingly.
Genetic Testing
Genetic testing may be considered in certain cases, especially when there is a family history of kidney disease or suspicion of a genetic disorder contributing to Stage 4 CKD. Genetic testing can identify specific mutations or genetic variants associated with kidney disorders.
Kidney Biopsy
In some cases, a kidney biopsy may be recommended to evaluate the extent and cause of kidney damage. A small tissue sample is obtained from the kidney for microscopic examination, which can help diagnose underlying conditions contributing to CKD, such as glomerulonephritis or autoimmune disorders.
Treatment
For Stage 4 Kidney Disease, treatment options may include medication, procedures, and lifestyle modifications to manage symptoms and slow down the progression of kidney failure.
Dialysis
Depending on the severity of an individual's condition, dialysis may become a necessary treatment option for managing Stage 4 CKD. This procedure helps to filter waste products and excess fluids from the blood as it performs the essential functions that the damaged kidneys can no longer handle. As kidney failure progresses, dialysis can help improve quality of life and prolong survival by managing complications. This can typically be performed several times a week and can be done at a dialysis centre or at home, depending on the patient's circumstances and medical advice.
Kidney Transplant
While a kidney transplant is not often immediately necessary for those diagnosed with Stage 4 CKD, it represents a potential future treatment option as the disease progresses. As we know, kidney transplant offers the best chance for improved quality of life and long-term survival for individuals with end-stage kidney disease. Therefore, discussions about transplantation should begin during Stage 4 CKD for proper evaluation and preparation for this life-changing procedure.
Kidney-friendly Diet
If you have Stage 4 CKD, adopting a kidney-friendly diet is essential to maintain optimal kidney function. To do this, be sure to restrict the following in your diet:
- Protein
- Potassium
- Phosphorus
- Sodium
- Fluids
- Saturated fats
- Alcohol
Lifestyle Changes
If you have been diagnosed with Stage 4 Kidney Disease, this is your chance to slow down kidney failure by making positive changes in your lifestyle.
- Visit your nephrologist every three months.
- Consult with a dietitian to develop and adhere to a kidney-friendly eating regimen.
- Maintain a healthy blood pressure.
- Control blood sugar levels if you have diabetes.
- Engage in physical activity at least 30 minutes a day.
- Quit smoking.
Medications
Several medications are available to help alleviate symptoms and delay the progression of kidney failure. These medications may include:
Angiotensin-Converting Enzyme (ACE) Inhibitors
A kidney specialist may prescribe ACE inhibitors to manage blood pressure and reduce protein in urine. By slowing down kidney disease progression, these medications can help preserve kidney function and delay the need for dialysis or kidney transplant. In addition, ACE inhibitors have been shown to decrease the risk of cardiovascular problems in individuals with kidney disease.
Angiotensin Receptor Blockers (ARBs)
In individuals with diabetes or high blood pressure, ARBs (angiotensin II receptor blockers) may also be prescribed by a kidney specialist to preserve and protect kidney function. ARBs work similarly to ACE inhibitors by dilating blood vessels and reducing blood pressure.
Bone Strength Supplements
Impaired kidney function disrupts mineral metabolism, affecting vitamin D activation and calcium-phosphorus balance. This disruption hampers bone remodelling, leading to conditions like osteoporosis and other types of bone disease. To address these, Vitamin D and calcium supplements are prescribed to support bone health and minimise the risk of bone complications in individuals with chronic kidney disease.
Diuretics
In individuals with Stage 4 Kidney Disease, diuretics can be prescribed to help manage fluid retention and control blood pressure. As kidney function declines, the body may retain excess fluid and cause swelling (edema) in the legs, ankles, or abdomen. Diuretics aid in removing this excess fluid from the body, which then relieves symptoms and helps increase urination frequency.
Anemia Supplements
Anemia is a common complication of kidney disease. Therefore, in order to mitigate its progression, it is important to address these complications through Anemia supplements, such as iron supplements and erythropoiesis-stimulating agents (ESAs). Not only can these supplements help increase red blood cells production but they can also improve hemoglobin levels in individuals with Stage 4 CKD.
Takeaway
Stage 4 Kidney Disease is the last stage before kidney failure occurs. As kidney function declines, individuals may experience a range of challenging symptoms, highlighting the importance of medical intervention and preventive management strategies.
At INS LifeGuard, our personal health and safety alarm system provides an added layer of safety for individuals with Stage 4 Kidney Disease. Living with such conditions can be challenging, but our personal alarms guarantee that help is available 24/7. Whether you're experiencing sudden symptoms or need immediate medical assistance, our one-touch emergency button quickly connects you to an on-call nurse who can assess your situation and provide guidance as needed. Explore our website to learn more about the products and services we offer.
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INS LifeGuard is the only 24/7 nurse on-call personal and medical monitoring in Australia. We provide monitoring technology for both in the home and on the go and can also monitor other provider's equipment. Our services are suitable for anyone wanting support to stay independent such as the elderly, those with medical conditions and disabilities plus enhancing safety and security for lone workers.
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