The five stages of kidney disease are commonly used to describe the severity of chronic kidney disease (CKD) according to estimated glomerular filtration rate, or eGFR.

CKD is not diagnosed from one abnormal blood test alone. Kidney abnormalities generally need to be present for at least three months to meet the definition of chronic kidney disease. Current KDIGO classification considers the cause of kidney disease, GFR category and albuminuria, rather than eGFR alone.

The five broad GFR categories are:

CKD stage	eGFR range	General meaning
Stage 1	90 or higher	Normal or high filtration with evidence of kidney damage
Stage 2	60–89	Mildly decreased filtration with evidence of kidney damage
Stage 3	30–59	Moderately decreased kidney function
Stage 4	15–29	Severely decreased kidney function
Stage 5	Below 15	Kidney failure range

KDIGO further divides Stage 3 into G3a (45–59) and G3b (30–44). Stage 1 and Stage 2 require evidence of kidney damage because an eGFR of 90 or 60–89 by itself does not establish CKD.

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

Understanding Kidney Disease Through eGFR

The kidneys continuously filter blood and remove waste and excess fluid.

The eGFR is an estimate of how well the kidneys are filtering blood. It is calculated using laboratory measurements such as serum creatinine and an appropriate estimating equation. eGFR is useful for classifying CKD, but it is an estimate rather than a direct measurement of kidney function.

A single eGFR result should therefore be interpreted in context.

Doctors may compare multiple results to determine whether kidney function is:

• Stable

• Slowly changing

• Declining significantly

• Temporarily reduced because of an acute illness

The trend can provide more information than one isolated value.

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Stage 1 Kidney Disease: eGFR 90 or Higher

Stage 1 represents normal or high eGFR, but there must be another marker of kidney damage for CKD to be diagnosed.

Possible markers include:

• Persistent albumin in urine

• Persistent blood in urine from a kidney-related cause

• Structural kidney abnormalities

• Certain abnormalities found on imaging

• Other evidence of kidney damage

Therefore, an eGFR above 90 does not automatically mean a person has Stage 1 CKD.

Are There Symptoms in Stage 1?

Many people have no noticeable symptoms.

Early CKD can remain silent, which is why testing can be particularly important for people with risk factors such as:

• Diabetes

• High blood pressure

• Cardiovascular disease

• Family history of kidney disease

• Previous kidney injury

NIDDK notes that testing may be the only way to identify kidney disease in some people.

How Is Stage 1 Managed?

Treatment focuses on the underlying kidney problem and reducing future risk.

Depending on the cause, management may include:

• Blood-pressure control

• Diabetes management

• Monitoring urine albumin

• Kidney-protective treatment when appropriate

• Avoiding unnecessary kidney-harming medicines

• Healthy lifestyle measures

• Regular kidney-function monitoring

The goal is to preserve kidney function for as long as possible.

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Stage 2 Kidney Disease: eGFR 60 to 89

Stage 2 indicates mildly decreased eGFR, but CKD again requires evidence of kidney damage that persists for at least three months.

A person with an eGFR of 60–89 and no evidence of kidney damage does not automatically have Stage 2 CKD.

What Can Cause Stage 2 CKD?

Possible causes include:

• Diabetes

• High blood pressure

• Glomerular diseases

• Inherited kidney disorders

• Previous kidney injury

• Structural kidney abnormalities

• Other chronic kidney conditions

Are Stage 2 Symptoms Obvious?

Usually, there may be few or no symptoms.

Some people may have:

• Protein or albumin in urine

• Blood in urine

• High blood pressure

• Abnormal kidney-function tests

The absence of symptoms does not necessarily mean that kidney disease is absent or inactive.

Can Stage 2 Kidney Disease Be Controlled?

Many patients can remain stable when the underlying cause and risk factors are appropriately managed.

Regular monitoring of eGFR and urine albumin can help doctors identify changes over time.

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Stage 3 Kidney Disease: eGFR 30 to 59

Stage 3 represents a more significant reduction in kidney filtration.

It is divided into:

• Stage 3a: eGFR 45–59

• Stage 3b: eGFR 30–44

This distinction can help describe the degree of kidney-function reduction more precisely.

What Symptoms Can Occur in Stage 3?

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

• Fatigue

• Swelling

• Changes in urination

• High blood pressure

• Muscle cramps

• Anemia

• Changes in appetite

• Sleep problems

Symptoms vary according to the cause of CKD and the complications present.

What Is Important During Stage 3?

This stage deserves careful monitoring because the risks of CKD complications increase as kidney function decreases.

Doctors may monitor:

• eGFR

• Creatinine

• Urine albumin

• Blood pressure

• Potassium

• Bicarbonate

• Hemoglobin

• Calcium and phosphorus

The exact testing schedule depends on the patient's condition.

Can Stage 3 Kidney Disease Progress?

It can, but progression is not inevitable.

Risk is influenced by factors including:

• Underlying kidney disease

• Increasing albuminuria

• Diabetes

• Poorly controlled blood pressure

• Declining eGFR

• Recurrent acute kidney injury

• Other medical conditions

NIDDK identifies diabetes, high blood pressure, increasing albuminuria and declining eGFR among important factors associated with CKD progression.

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Stage 4 Kidney Disease: eGFR 15 to 29

Stage 4 represents severely decreased kidney function.

At this stage, patients require closer monitoring for complications and future kidney replacement therapy may need to be discussed.

Possible Stage 4 Symptoms

Symptoms can become more noticeable and may include:

• Persistent tiredness

• Swelling

• Nausea

• Reduced appetite

• Itching

• Muscle cramps

• Changes in urine

• Sleep difficulties

• Breathlessness

• Difficulty concentrating

However, symptom severity does not always correspond exactly to the eGFR value.

What Complications May Develop?

The kidneys perform several important functions beyond waste removal.

Advanced CKD can affect:

• Fluid balance

• Potassium

• Acid-base balance

• Hemoglobin

• Bone and mineral metabolism

• Blood pressure

• Nutrition

Treatment is therefore not limited to monitoring creatinine.

Is Dialysis Started Automatically in Stage 4?

No.

Stage 4 means severe reduction in kidney function, but it does not automatically mean that dialysis must begin immediately.

Doctors consider symptoms, complications, kidney-function trajectory and the overall clinical condition.

However, Stage 4 is an appropriate time for patients with progressive disease to discuss future treatment options with a nephrologist.

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Stage 5 Kidney Disease: eGFR Below 15

Stage 5 is the kidney failure range.

At this level of kidney function, the kidneys have severely reduced filtration capacity. KDIGO classifies G5 as eGFR below 15 mL/min/1.73 m².

What Symptoms Can Occur?

Depending on the individual, advanced kidney failure may cause:

• Severe fatigue

• Poor appetite

• Nausea or vomiting

• Itching

• Swelling

• Breathlessness

• Changes in urine output

• Muscle cramps

• Sleep problems

• Difficulty concentrating

• Other complications related to waste and fluid accumulation

Some patients may have relatively few symptoms despite very low eGFR, so laboratory and clinical assessment remain essential.

Does Stage 5 Always Mean Dialysis?

An eGFR below 15 is in the kidney failure range, but dialysis is not prescribed solely because of one eGFR number.

Doctors consider the patient's symptoms, fluid status, electrolyte and acid-base abnormalities, nutritional condition and other complications.

Kidney replacement options may include:

• Hemodialysis

• Peritoneal dialysis

• Kidney transplantation

• Conservative kidney management for selected patients

NIDDK notes that a GFR of 15 or less is called kidney failure and that many people at this level require dialysis or transplantation, while treatment decisions remain individualized.

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Why Albumin in Urine Matters Alongside the Five Stages

Looking only at eGFR does not provide the complete picture.

Albuminuria measures the amount of albumin being lost into urine and provides additional information about kidney damage and risk.

KDIGO classifies albuminuria as:

Albuminuria category	UACR
A1	Less than 30 mg/g
A2	30–299 mg/g
A3	300 mg/g or higher

CKD classification therefore uses cause + GFR category + albuminuria category, rather than relying on eGFR alone.

This is why two people with the same eGFR can have different levels of kidney-disease risk.

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What Causes Kidney Disease to Progress?

Not every person with CKD follows the same path.

Factors that may increase the risk of progression include:

• Poorly controlled diabetes

• High blood pressure

• Increasing albuminuria

• Recurrent acute kidney injury

• Certain untreated kidney diseases

• Smoking

• Obesity and metabolic risk factors

• Persistent urinary obstruction

• Inappropriate use of kidney-harming medicines

The cause of CKD should be identified whenever possible because treatment can differ substantially between conditions.

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Can Kidney Disease Be Stopped From Progressing?

There is no guaranteed way to stop every type of CKD from progressing.

However, appropriate management can reduce modifiable risks and help preserve remaining kidney function.

Depending on the diagnosis, treatment may involve:

• Blood-pressure control

• Diabetes management

• Reducing significant albuminuria

• Appropriate kidney-protective medicines

• Dietary management

• Avoiding unnecessary nephrotoxic medicines

• Treating specific kidney diseases

• Monitoring eGFR and urine albumin

The treatment plan should be individualized rather than based only on the stage number.

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What Tests Are Used to Determine Kidney Disease Stage?

Doctors commonly use a combination of blood and urine assessments.

Blood Tests

These may include:

• Serum creatinine

• eGFR

• Urea

• Sodium

• Potassium

• Bicarbonate

• Hemoglobin

• Calcium and phosphorus when appropriate

Urine Tests

Evaluation may include:

• Urinalysis

• Urine albumin

• Urine albumin-to-creatinine ratio

• Protein measurement

• Blood in urine

Imaging

Ultrasound or other imaging may be recommended when structural abnormalities, obstruction, stones, cysts or other conditions are suspected.

Additional Investigations

Depending on the cause, doctors may recommend:

• Autoimmune testing

• Infection-related testing

• Genetic evaluation

• Kidney biopsy

Not every patient requires all of these tests.

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Can an eGFR Change From One Stage to Another?

Yes.

eGFR can fluctuate because of:

• Acute illness

• Dehydration

• Medication effects

• Changes in creatinine

• Laboratory variation

• Other temporary factors

A single abnormal result does not necessarily mean permanent progression to another CKD stage.

Doctors often examine multiple measurements over time to understand the patient's trajectory. NIDDK emphasizes that eGFR trends can be more informative than a single point estimate.

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Does Kidney Disease Always End in Stage 5?

No.

Many people with CKD never develop kidney failure.

Some patients remain stable for many years, while others experience gradual decline.

The likelihood of progression depends on factors such as the cause of CKD, eGFR, albuminuria, diabetes, blood pressure and changes in kidney function over time.

Early identification and appropriate treatment can help address modifiable risks.

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When Should You See a Nephrologist?

Specialist kidney evaluation may be appropriate if you have:

• Persistent abnormal creatinine

• Reduced eGFR

• Significant albuminuria

• Repeated blood in urine

• Progressive loss of kidney function

• Difficult-to-control hypertension

• Recurrent kidney stones

• Repeated urinary obstruction

• Suspected glomerular disease

• Advanced CKD

• Kidney failure

A nephrologist can help determine the cause of CKD, assess progression risk and develop a monitoring and treatment plan.

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Kidney Disease Care at Prabhakar Bhurke Clinic

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

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

• CKD stage assessment

• eGFR and creatinine monitoring

• Urine albumin and protein evaluation

• Blood-pressure management

• Diabetes-related kidney care

• Evaluation of kidney stones and obstruction

• Management of CKD complications

• Medication review

• Dialysis planning when appropriate

• Kidney transplant-related evaluation

Treatment is tailored to the patient's cause of kidney disease, kidney-function trend, albuminuria and overall health.

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Frequently Asked Questions

What are the five stages of kidney disease?

The five broad CKD stages are based on GFR categories: Stage 1 is G1, Stage 2 is G2, Stage 3 includes G3a and G3b, Stage 4 is G4, and Stage 5 is G5.

Which stage of kidney disease is considered kidney failure?

Stage 5, corresponding to G5 with an eGFR below 15 mL/min/1.73 m², is the kidney failure range.

Is Stage 1 kidney disease serious?

Stage 1 involves normal or high eGFR but requires evidence of kidney damage. It may have few symptoms, but identifying and managing the underlying cause is important.

Can Stage 2 kidney disease get better?

Some abnormalities that initially appear to indicate reduced kidney function may improve if a reversible factor is involved. Established CKD, however, is defined by abnormalities persisting for at least three months and requires ongoing assessment.

What happens in Stage 3 kidney disease?

Stage 3 indicates moderately decreased kidney function and is divided into G3a and G3b. Doctors monitor kidney function and complications more closely and address factors that may accelerate progression.

Does Stage 4 kidney disease mean dialysis?

Not automatically. Stage 4 is severe CKD, but dialysis is generally considered based on the overall clinical condition and complications rather than the stage number alone.

Is Stage 5 kidney disease reversible?

Established advanced CKD is generally not simply reversible. However, potentially reversible contributors may sometimes be treated, and kidney replacement options can be considered when necessary.

Can kidney disease be present with a normal eGFR?

Yes. Kidney damage such as persistent albuminuria can be present even when eGFR is normal or high. This is why CKD classification includes both GFR and albuminuria.

How do doctors know if kidney disease is getting worse?

Doctors compare eGFR, creatinine, urine albumin and other clinical measurements over time. A trend is generally more informative than one isolated result.

Conclusion

Understanding the five stages of kidney disease can make an abnormal kidney-function report easier to interpret.

The stages broadly range from Stage 1 with evidence of kidney damage despite normal or high eGFR to Stage 5, the kidney failure range with eGFR below 15. Stage 3 is further divided into G3a and G3b.

However, the stage number is only one part of the picture. The cause of kidney disease, eGFR trend, urine albumin, blood pressure, diabetes and other health conditions all influence risk and treatment.

CKD does not automatically progress from Stage 1 through Stage 5. Some patients remain stable for long periods when the underlying condition and modifiable risk factors are appropriately managed.

If you have an abnormal creatinine, eGFR, urine albumin result or another concern about kidney function, specialist assessment can help determine the actual stage and the appropriate treatment plan.

For individualized kidney care, 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 professional medical diagnosis, treatment or individualized medical advice. CKD staging should be determined using appropriate clinical assessment, kidney-function testing and evidence of chronicity. An eGFR value alone does not diagnose every stage of CKD, particularly when eGFR is 60 or higher. Do not start, stop or change medicines, supplements, diet or fluid intake based solely on this article. Dialysis decisions should be made by a qualified nephrologist based on the patient's symptoms, laboratory findings, complications and overall medical condition. Consult Dr. Sandip Prabhakar Bhurke or another qualified nephrologist for personalized kidney-care advice.