About chronic kidney disease (CKD)

With chronic kidney disease, the kidneys dont usually fail all at once. Instead, kidney disease often
progresses slowly over a period of years. This is good news because if CKD is caught
early, medicines and lifestyle changes may help slow its progress and keep you feeling your best for as
long as possible.
Five stages of chronic kidney disease
To help improve the quality of care for people with kidney disease, the National Kidney Foundation
(NKF) created a guideline to help doctors identify each level of kidney disease. The NKF divided kidney
disease into five stages. When the doctor knows what stage of kidney disease a person has they can
provide the best care, as each stage calls for different tests and treatments.
Glomerular Filtration Rate (GFR)
GFR stands for glomerular (glow-MAIR-you-lure) filtration rate. A blood test checks your GFR, which
tells how well your kidneys are filtering.

It's important to know your GFR if you are at risk for kidney disease. A urine test will also be used to
check your kidneys.
GFR is reported as a number.
A GFR of 60 or higher is in the normal range.
A GFR below 60 may mean you have kidney disease.
A GFR of 15 or lower may mean kidney failure.
You can't raise your GFR, but you can try to keep it from going lower. Learn more about what you can do
to keep your kidneys healthy.
The graphic below can help you understand the meaning of your GFR result. Please remember that this
information should not take the place of talking with your health care provider.

If you have a:
GFR of 60 or higher*: Your kidney function is in the normal range. Ask your provider when your GFR
should be checked again. You still need to get your urine checked for kidney damage.
* If your lab report shows an actual number that is higher than 60, such as 75, 90, 100, consider your
result as "60 or higher" and in the normal range.
GFR below 60: This may mean kidney disease. Talk to your provider about treatment to keep your
kidney health at this level. Ask about:
medicines you should take,
medicines to stay away from,
changes to your diet,
other lifestyle changes,
whether your kidney disease is likely to get worse,
ways to treat kidney failure, and
if you should begin preparing for dialysis.
 Glomerular filtration rate (GFR) is the best measure of kidney function. The GFR is the number used to
figure out a persons stage of kidney disease. A math formula using the persons age, race, gender and
their serum creatinine is used to calculate a GFR. A doctor will order a blood test to measure the serum
creatinine level. Creatinine is a waste product that comes from muscle activity. When kidneys are
working well they remove creatinine from the blood. As kidney function slows, blood levels of creatinine
rise.
Below shows the five stages of CKD and GFR for each stage:
Stage 1 with normal or high GFR (GFR > 90 mL/min)
Stage 2 Mild CKD (GFR = 60-89 mL/min)
Stage 3A Moderate CKD (GFR = 45-59 mL/min)
Stage 3B Moderate CKD (GFR = 30-44 mL/min)
Stage 4 Severe CKD (GFR = 15-29 mL/min)
Stage 5 End Stage CKD (GFR <15 mL/min)

What is GFR?
GFR - glomerular filtration rate is the best test to measure your level of kidney function and determine
your stage of kidney disease. Your doctor can calculate it from the results of your blood creatinine test,
your age, body size and gender. Your GFR tells your doctor your stage of kidney disease and helps the
doctor plan your treatment. If your GFR number is low, your kidneys are not working as well as they
should. The earlier kidney disease is detected, the better the chance of slowing or stopping its progression.
What are the Stages of Chronic Kidney Disease (CKD)?
Stage Description (GFR)

At increased Risk factors for kidney disease (e.g., diabetes, high blood pressure, More than
risk family history, older age, ethnic group) 90

90 or
1 Kidney damage with normal kidney function
above

2 Kidney damage with mild loss of kidney function 89 to 60

3a Mild to moderate loss of kidney function 59 to 44

3b Moderate to severe loss of kidney function 44 to 30

4 Severe loss of kidney function 29 to 15

Less than
5 Kidney failure
15

Your GFR number tells you how much kidney function you have.
As kidney disease gets worse, the GFR number goes down.
What happens if my test results show I may have chronic kidney disease?
A GFR below 60 for three months or more or a GFR above 60 with kidney damage (marked by high
levels of albumin in your urine) indicates chronic kidney disease. Your doctor will want to investigate the
cause of your kidney disease and continue to check your kidney function to help plan your treatment.
Typically, a simple urine test will also be done to check for blood or albumin (a type of protein) in the
urine. When you have albumin in your urine it is called albuminuria. Blood or protein in the urine can
be an early sign of kidney disease.
 People with a high amount of albumin in their urine are at an increased risk of having chronic kidney
disease progress to kidney failure. (See chart below)

Imaging tests such as an ultrasound or CT scan to get a picture of your kidneys and urinary tract. This
tells your doctor whether your kidneys are too large or too small, whether you have a problem like a
kidney stone or tumor and whether there are any problems in the structure of your kidneys and urinary
tract.
A kidney biopsy, which is done in some cases to check for a specific type of kidney disease, see how
much kidney damage has occurred and help plan treatment. To do a biopsy, the doctor removes small
pieces of kidney tissue and looks at them under a microscope.
Your doctor may also ask you to see a kidney specialist called a nephrologist who will consult on your
case and help manage your care.
What is a normal GFR number?
In adults, the normal GFR number is more than 90. GFR declines with age, even in people without kidney
disease.See chart below for average estimated GFR based on age.
Age (years) Average estimated GFR

2029 116

3039 107

4049 99

5059 93

6069 85

70+ 75