Kidney disease does not develop in exactly the same way in every person. Some people have mild kidney damage that remains stable for years, while others experience a gradual reduction in kidney filtration.

When discussing different stages of kidney disease, doctors commonly refer to the stages of chronic kidney disease (CKD).

Modern CKD classification is based on three important elements:

• Cause of kidney disease

• GFR category

• Albuminuria category

This is often described as CGA classification.

The estimated glomerular filtration rate, or eGFR, helps estimate how effectively the kidneys are filtering blood. Urine albumin provides additional information about kidney damage and future risk.

At Prabhakar Bhurke Clinic, Dr. Sandip Prabhakar Bhurke, super specialist nephrologist and transplant physician, provides individualized evaluation and management for patients with kidney disease at different stages.

How Are Kidney Disease Stages Determined?

The stages of CKD are primarily divided according to eGFR.

CKD category	eGFR range	General meaning
G1	≥90	Normal or high filtration
G2	60–89	Mildly decreased filtration
G3a	45–59	Mild to moderately decreased
G3b	30–44	Moderately to severely decreased
G4	15–29	Severely decreased
G5	<15	Kidney failure range

These categories are part of the KDIGO CKD classification system.

However, an eGFR number alone does not always establish CKD.

For example, an eGFR of 60–89 does not automatically mean a person has CKD. There generally needs to be evidence of kidney damage or another qualifying abnormality that persists for at least three months.

Stage 1 Kidney Disease: G1

What does Stage 1 mean?

Stage 1 CKD corresponds to an eGFR of 90 or higher, but there must also be evidence of kidney damage or another qualifying abnormality persisting for at least three months.

Possible evidence may include:

• Albumin in urine

• Persistent blood in urine from a kidney-related cause

• Structural abnormalities on imaging

• Certain inherited or congenital kidney abnormalities

• Other markers of kidney damage

A person with G1 CKD may have normal or near-normal filtration but still have evidence that the kidneys are affected.

Are there symptoms in Stage 1?

Often, there are no obvious symptoms.

This is one reason kidney disease can go undetected for some time.

Urine testing and kidney-function testing may identify abnormalities before a person notices any significant change.

What is the treatment?

Treatment focuses on the underlying cause and reducing the risk of further kidney damage.

Depending on the individual situation, this may include:

• Blood-pressure management

• Diabetes control

• Management of albuminuria

• Appropriate kidney-protective medicines

• Avoiding unnecessary kidney-harming medicines

• Regular monitoring

Stage 2 Kidney Disease: G2

What does Stage 2 mean?

G2 corresponds to an eGFR of 60–89 mL/min/1.73 m² with evidence of kidney damage or another qualifying abnormality.

An eGFR in this range by itself does not automatically mean CKD.

What symptoms can occur?

Many people still have no obvious symptoms.

Some may have findings such as:

• Protein or albumin in urine

• Blood in urine

• High blood pressure

• Abnormal kidney imaging

The specific findings depend on the cause.

Why is Stage 2 important?

Identifying the cause early can provide an opportunity to manage risk factors and monitor whether kidney function remains stable.

Regular testing may include eGFR and urine albumin assessment. Albuminuria is an important marker of kidney damage and is also associated with kidney disease progression risk.

Stage 3 Kidney Disease: G3a and G3b

Stage 3 is divided into two categories because kidney filtration is moderately reduced.

Stage 3a: eGFR 45–59

This represents mildly to moderately decreased kidney filtration.

Stage 3b: eGFR 30–44

This represents moderately to severely decreased kidney filtration.

Can Stage 3 kidney disease cause symptoms?

Some people remain relatively symptom-free, while others may develop:

• Fatigue

• Swelling

• Changes in urination

• High blood pressure

• Anemia

• Muscle cramps

• Changes in appetite

• Sleep problems

Symptoms are not a reliable way to determine CKD stage.

Laboratory monitoring is important because kidney disease can progress without dramatic symptoms.

What is considered during Stage 3 treatment?

Management may involve:

• Identifying the cause of CKD

• Monitoring eGFR

• Monitoring urine albumin

• Blood-pressure management

• Diabetes management

• Medication review

• Electrolyte monitoring

• Anemia assessment

• Cardiovascular risk management

• Individualized dietary advice

The treatment plan depends on the cause and other health conditions.

Stage 4 Kidney Disease: G4

What does Stage 4 mean?

Stage 4 CKD corresponds to an eGFR of 15–29 mL/min/1.73 m².

This indicates severely reduced kidney filtration.

At this stage, complications become more likely and closer nephrology follow-up may be required.

What symptoms may occur?

Possible symptoms include:

• Significant fatigue

• Swelling

• Changes in urine output

• Nausea

• Reduced appetite

• Itching

• Muscle cramps

• Breathlessness

• Sleep disturbance

• Difficulty concentrating

Not everyone with Stage 4 CKD experiences all of these symptoms.

What does treatment involve?

Treatment focuses on preserving remaining kidney function and managing complications.

Doctors may monitor:

• Potassium

• Bicarbonate

• Hemoglobin

• Calcium

• Phosphorus

• Blood pressure

• Urine albumin

• Nutritional status

Stage 4 is also an appropriate time for discussions about future kidney replacement options when progression is a concern.

These may include:

• Hemodialysis

• Peritoneal dialysis

• Kidney transplantation

• Conservative kidney management in selected patients

Discussing these options early does not mean dialysis must begin immediately.

Stage 5 Kidney Disease: G5

What is Stage 5?

Stage 5 corresponds to an eGFR below 15 mL/min/1.73 m² and is classified as the kidney failure range.

Kidney filtration is severely reduced at this stage.

What symptoms can occur?

Possible manifestations include:

• Severe fatigue

• Loss of appetite

• Nausea or vomiting

• Swelling

• Breathlessness

• Itching

• Muscle cramps

• Changes in urine production

• Sleep or concentration problems

• Symptoms related to fluid, electrolyte or acid-base abnormalities

However, symptoms differ considerably between patients.

Does Stage 5 automatically mean dialysis?

No.

Dialysis is not started simply because a person has crossed a particular creatinine or eGFR number.

The nephrologist considers symptoms, complications, fluid status, electrolyte abnormalities, acid-base disturbances, nutritional status and the overall clinical condition.

Kidney replacement therapy may include hemodialysis, peritoneal dialysis or transplantation when clinically appropriate.

Why Albuminuria Matters Alongside Kidney Stage

Looking only at eGFR does not provide the complete picture.

Doctors also assess albuminuria, which means increased albumin in the urine.

The commonly used UACR categories are:

Albuminuria category	UACR
A1	<30 mg/g
A2	30–299 mg/g
A3	≥300 mg/g

Higher persistent albuminuria is associated with greater risk of kidney disease progression and cardiovascular complications.

This means that two people with the same eGFR can have different overall risk profiles depending on their albuminuria and underlying cause.

Why the Cause of Kidney Disease Matters

The stage tells doctors about kidney function, but it does not explain why the kidneys are affected.

Possible causes include:

• Diabetes

• High blood pressure

• Glomerular diseases

• Polycystic kidney disease

• Recurrent urinary obstruction

• Kidney stones

• Autoimmune disorders

• Inherited kidney diseases

• Previous kidney injury

• Certain medications or toxins

Finding the cause can influence treatment and monitoring.

Can Kidney Disease Stay at the Same Stage?

Yes.

CKD does not inevitably progress from Stage 1 to Stage 5.

Some people remain stable for prolonged periods, while others experience declining kidney function.

Risk of progression is influenced by factors such as:

• Underlying kidney disease

• eGFR trend

• Albuminuria

• Diabetes

• Blood-pressure control

• Cardiovascular disease

• Recurrent acute kidney injury

• Medication-related kidney injury

NIDDK notes that some people with CKD progress to kidney failure more rapidly, while others never reach kidney failure. Monitoring eGFR and urine albumin helps identify changes over time.

What Tests Are Used Across the Different Kidney Stages?

Kidney evaluation may include several types of testing.

Blood Tests

Common measurements include:

• Serum creatinine

• eGFR

• Urea

• Sodium

• Potassium

• Bicarbonate

• Hemoglobin

• Calcium

• Phosphorus

Urine Tests

Depending on the condition:

• Urinalysis

• UACR

• Urine protein measurement

• Urine culture when infection is suspected

Blood Pressure

Blood-pressure monitoring is important because hypertension can contribute to kidney damage and can also occur as CKD progresses.

Imaging

Ultrasound or other imaging may be used to investigate:

• Kidney size

• Obstruction

• Stones

• Cysts

• Structural abnormalities

Kidney Biopsy

A biopsy may be recommended in selected patients when determining the specific kidney disease would change treatment.

How Is Kidney Disease Managed at Different Stages?

Treatment is not identical at every stage.

Earlier CKD

The focus may include:

• Finding the cause

• Controlling blood pressure

• Managing diabetes

• Reducing albuminuria when appropriate

• Maintaining a kidney-friendly lifestyle

• Avoiding unnecessary nephrotoxic medicines

• Regular monitoring

Moderate CKD

Additional attention may be needed for:

• Anemia

• Electrolytes

• Acid-base balance

• Bone and mineral abnormalities

• Cardiovascular risk

• Medication dosing

Advanced CKD

Treatment may increasingly involve:

• Managing complications

• Dietary and fluid planning

• Preparing for possible kidney replacement therapy

• Dialysis education

• Transplant evaluation when appropriate

• Conservative kidney management discussions for selected patients

Does Kidney Disease Always Cause Symptoms?

No.

Early CKD may have few or no noticeable symptoms. Testing can sometimes identify kidney disease before a person feels unwell.

This is particularly important for people at increased risk, including those with:

• Diabetes

• High blood pressure

• Cardiovascular disease

• Family history of kidney failure

NIDDK identifies urine albumin and eGFR as key markers used to detect and monitor CKD.

When Should You See a Nephrologist?

Specialist evaluation may be appropriate when there is:

• Persistent albuminuria

• Reduced eGFR

• Rapid decline in kidney function

• Persistent blood in urine suspected to be kidney-related

• Difficult-to-control hypertension

• Recurrent kidney stones or obstruction

• Electrolyte abnormalities

• Suspected glomerular disease

• Advanced CKD

• Kidney failure

A nephrologist can assess the cause, stage, progression risk and appropriate treatment plan.

Kidney Disease Stage Evaluation at Prabhakar Bhurke Clinic

At Prabhakar Bhurke Clinic, Dr. Sandip Prabhakar Bhurke, super specialist nephrologist and transplant physician, provides individualized evaluation for patients with abnormal kidney-function results and different stages of CKD.

Depending on the patient's situation, care may include:

• CKD stage assessment

• Creatinine and eGFR review

• Urine albumin and protein evaluation

• Blood-pressure management

• Diabetes-related kidney care

• Electrolyte and acid-base assessment

• Evaluation of kidney stones or urinary obstruction

• Management of CKD complications

• Dialysis planning when appropriate

• Kidney transplant-related assessment

• Long-term kidney-function monitoring

The treatment plan is based on the underlying kidney disease, current kidney function, albuminuria, complications and overall health.

Frequently Asked Questions

How many stages of chronic kidney disease are there?

CKD is commonly described using G1 through G5 categories based on eGFR. G3 is divided into G3a and G3b. Albuminuria is classified separately as A1, A2 or A3.

Which stage of kidney disease is considered kidney failure?

G5, with an eGFR below 15 mL/min/1.73 m², is the kidney failure category. However, an eGFR number alone does not determine when dialysis should begin.

Can Stage 1 kidney disease have no symptoms?

Yes. Early CKD may have no obvious symptoms, particularly when kidney function is still preserved.

Is Stage 2 kidney disease serious?

Stage 2 means an eGFR of 60–89 with evidence of kidney damage or another qualifying abnormality. An eGFR in this range alone does not establish CKD.

What is the difference between Stage 3a and Stage 3b?

Stage 3a corresponds to an eGFR of 45–59, while Stage 3b corresponds to 30–44 mL/min/1.73 m².

What does Stage 4 kidney disease mean?

Stage 4 corresponds to an eGFR of 15–29 and indicates severely decreased kidney filtration. It is generally a stage where closer monitoring and planning for possible future kidney replacement therapy may be appropriate.

Does Stage 5 always require dialysis?

Not automatically. The need for dialysis depends on the person's symptoms, complications, fluid status, laboratory abnormalities and overall clinical condition.

Can kidney disease move backward from one stage to another?

eGFR can fluctuate because of acute illness, dehydration, medications and other factors. An apparent change in stage should therefore be interpreted using repeat measurements and the clinical context rather than assuming permanent progression from one test.

What is more important: eGFR or urine protein?

Both provide important information. eGFR describes kidney filtration, while urine albumin helps identify kidney damage and contributes to risk assessment.

Conclusion

Understanding the different stages of kidney disease helps explain how kidney function is classified and monitored.

CKD is commonly categorized from G1 through G5, based primarily on eGFR, while albuminuria provides additional information about kidney damage and risk. G1 and G2 require evidence of kidney damage or another qualifying abnormality rather than an eGFR value alone.

Early kidney disease may have few symptoms, making appropriate blood and urine testing important for people at risk. As CKD becomes more advanced, doctors monitor complications and may discuss dialysis, transplantation or conservative kidney management when appropriate.

A kidney-stage label should never be interpreted in isolation. The underlying cause, eGFR trend, albuminuria, blood pressure, diabetes, complications and overall health all contribute to the treatment plan.

For individualized kidney evaluation and CKD management, consult Dr. Sandip Prabhakar Bhurke at Prabhakar Bhurke Clinic.

Medical Disclaimer

This article is intended for general educational and informational purposes only and should not be considered a substitute for medical diagnosis, treatment or individualized medical advice. CKD staging depends on appropriate interpretation of eGFR, evidence of kidney damage, albuminuria, duration of abnormalities and the underlying clinical condition. An isolated eGFR result does not necessarily establish chronic kidney disease, and symptoms cannot reliably determine CKD stage. Do not start, stop or change medicines, supplements, diet or fluid intake based solely on this article. Seek prompt medical attention for very little or no urine, severe breathlessness, chest pain, confusion, rapidly worsening swelling or sudden deterioration in health. Consult Dr. Sandip Prabhakar Bhurke or another qualified nephrologist for personalized evaluation and treatment.