Stage 2 Chronic Kidney Disease - Know It All

Introduction:

Chronicity of a particular medical condition is the major reason for the deterioration in the quality of patients' physical and mental health status. One such chronic condition that can affect various body organs and tissues simultaneously is chronic kidney disease. Chronic kidney disease can bring a major change in the affected patients’ lives as it passes through various stages to finally manifest as a failure of the renal tissues.

What Is Chronic Kidney Disease?

Chronic kidney disease manifests when the capacity of the renal tissues to filter and reabsorb materials is highly compromised. Damage to renal tissues can cause this dysfunction. As a result, the kidney's primary function (glomerular filtration) fails to happen in the patient's body. The International Classification of Diseases code (ICD-10) for chronic kidney disease is N18.

What Are the Causes of Chronic Kidney Disease?

• Diabetes (diabetic nephropathy) - Causes renal vasculature damage and rupture.

• Persistent high blood pressure.

• Inflammation of the nephron units (glomerular filtration units) - Glomerulonephritis.

• Inflammation of the surrounding tubules.

• Cysts within the kidneys (polycystic kidney disease).

• Obstructed urinary tract.

• Repeated infections.

• Systemic autoimmune diseases.

• Toxins or metal toxicity.

• Obesity.

• Smoking.

Any of these factors can work together to cause severe irreversible damage to the cells of the kidney for a long period and result in the causation of chronic kidney disease.

What Are the Stages of Chronic Kidney Disease?

Based on how well the kidney filters the blood and removes the toxins from the body, chronic kidney disease can be grouped into five stages, the last of which indicates complete failure (kidney failure). These stages are categorized based on the glomerular filtration rate and capacity of the kidneys.

• Stage 1: Normal glomerular filtration rate (over 90 milliliters per minute). Patients in this nascent stage would not experience any symptoms.

• Stage 2: A mild decrease in the filtration rate of the glomerulus will be noted in this stage (60-89 mL/min).

• Stage 3: The glomerular filtration rate of the affected patients drops to 30 to 59 mL/min.

• Stage 4: The GFR falls to 15-29 mL/min, which is a clear indication that most of the renal tissues are undergoing failure.

• Stage 5: End-stage renal disease, where GFR is less than 15 milliliters per minute, indicating near or complete renal failure.

What Is Stage 2 Chronic Kidney Disease?

As mentioned, stage 2 of chronic kidney disease is a stage in which the glomerular filtration rate of the affected patients ranges from 60 to 89 milliliters per minute. People may not complain of any apparent symptoms in this stage. However, there would be ongoing dysfunction of the kidneys, and the level of kidney damage can be elicited through various investigations. The International Classification of Diseases code (ICD-10) for stage 2 chronic kidney disease is N18.2.

What Are the Symptoms of Stage 2 Chronic Kidney Disease?

• Generalized Fatigue: When the kidney fails to perform its filtration action, there is an excessive buildup and accumulation of toxins and waste products in the body. These deposited waste materials can cause the body to feel lethargic, causing fatigue.

• Pedal Edema: Ongoing disturbances to the kidneys’ function can cause fluids to be retained in the body rather than flushed out. In the early stages, the retained fluid accumulates within the limbs, manifesting as pedal edema. In later stages, the abdominal cavity can retain the fluids, which can cause ascites.

• Changes in the frequency of urination occur when kidney damage persists. People may also complain of increased urination during the night hours (nocturia).

How to Diagnose Stage 2 Chronic Kidney Disease?

• Since the staging is based on glomerular filtration rates, the initial step is to assess the glomerular filtration rate of the affected patients. This will be done by performing a hematological test, where the drawn serum sample will be investigated for the presence and elevation of serum creatinine. Increased serum creatinine levels indicate that the kidneys are no longer functioning efficiently. In cases where precise levels of glomerular filtration rate are needed, direct creatinine clearance tests will need to be performed.

• Urine samples will be analyzed to measure protein excretion in urine (proteinuria).

• As structural abnormalities are a major cause of kidney dysfunction, an ultrasound or CT scan will be performed to elicit any structural defects within the kidneys.

• Sometimes, a kidney biopsy (a sample of the kidney tissue) is required to identify the cause of kidney damage.

• Sometimes, conventional methods, such as quantification of filtration markers like inulin, cystatin, or radioisotopes, can be used to check the urine's filtration capacity.

How to Manage Stage 2 Chronic Kidney Disease?

The primary objective in managing chronic kidney disease stage 2 is to slow down the deterioration process noted in the renal tissues. This can be achieved by modifying the ways and habits of the affected patients.

Dietary Changes:

• Do not take more than 2300 mg of sodium daily, which can cause fluid retention.

• Limit the amount of protein taken through foods to reduce the kidney’s load and functioning.

• Restrict high phosphorus and potassium-containing foods, processed foods, and high fat-containing diets.

• Only adequate amounts of water should be consumed. This is needed to balance hydration in the body and simultaneously avoid kidney overload.

Medical Management:

• Blood pressure control is paramount while managing stage 2 chronic kidney disease. Anti-hypertensive medicines should be taken to preserve the kidney function.

• People with diabetes mellitus should take medicines appropriately as it is a significant risk factor in the progression of chronic kidney disease from stage 2 to stage 3.

• A complication associated with stage 2 chronic kidney disease is the incidence of anemia. So, accordingly, iron supplements or erythropoietin stimulants should be consumed.

• Several medicines are known to be nephrotoxic, and having enough knowledge about these drugs and avoiding them also becomes a part of the medical management of stage 2 chronic kidney disease.

Modifying all the risk factors, along with family and peer support, can help slow down the damage incurred to renal tissues.

Is Stage 2 Chronic Kidney Disease Reversible?

Stage 2 chronic kidney disease is an irreversible stage, and the only thing that can be done at this stage is to halt further progression of kidney damage with a comprehensive management approach.

What Is the Life Expectancy of Stage 2 Chronic Kidney Disease?

The life expectancy of people who have stage 2 chronic kidney disease is largely dependent upon how well the condition is slowed down. Sticking to the approaches mentioned above strictly is the key to better life expectancy, as this stage is mild. It is purely in the hands of patients to adhere to the treatment guidelines at this stage so that the progression of kidney disease can be completely curbed.

Conclusion:

Stage 2 chronic kidney disease represents an early yet significant stage in the development of kidney disease. While symptoms may be minimal, the presence of kidney damage necessitates proactive management to slow disease progression and maintain kidney function.