Chronic Kidney Disease Stages 3 to 4 – Advanced chronic renal insufficiency
In Stage 3 and 4 of Chronic kidney disease, some symptoms might start showing up. Initially puffiness will be observed around eyes, as if the under eyes are bulging out. Ankle and feet swelling occurs subsequently, sometimes so much swelling happens that it is difficult to walk. Patients might sleep a lot during the day, and generally feel tired and drained out. Back pain is usually felt as a dull ache anywhere in the mid-to-lower portion of the back, on one side or the other. There could be changes in appetite and mood swings as digestion is slowed and varying degrees of gastroparesis (inactive stomach muscles) may occur. Persistent high blood pressure may be observed.
Serum creatinine will be above 5. Changes in urination in terms of amount, colour and frequency may be observed. Urine may look clear at this point, rather than abnormal. This is because little is actually being filtered into it by the kidneys. Previously high proteinuria and/or hematuria may actually improve.
Due to irrational behaviour of the kidney, sugar and pressure may not be under control for prolonged period. Patient must be subjected to higher dosage of medication, in consultation with the doctors.
In this stage, it is important to plan out the subsequent course of action, in consultation with kidney doctor (nephrologist). Blood tests must be performed at more frequent intervals. In case there is high potassium in blood, patient should be closely monitored by family members as chances of hyperkalemia increases, requiring immediate medical attention or hospitalization. There could be phases of pass out as well, wherein patient loses consciousness and may fall down. At this stage, doctor might ask to perform a procedure called AV Fistula to create access for dialysis. There are instances when patient do not require dialysis at all if kidney transplant is resorted to. However, an access site in the non dominant arm is always suggested. Once AV Fistula is done, the arm should be exercised by squeezing sponge balls as many times a day as possible to strengthen the veins.
Consult the doctor for water intake limits and strictly adhere to the same. Understand that body is unable to flush out toxins so water intake is limited. It is advised that dietitian be re-consulted for a revised meal plan at this stage as protein intake will be significantly reduced.