What are the symptoms of low eGFR?
Low eGFR often has no symptoms in early stages, but as kidney function declines, you may experience fatigue, swelling, changes in urination, and other signs. Regular testing is crucial since symptoms typically appear only after significant kidney damage has occurred.
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Understanding eGFR and kidney function
Estimated glomerular filtration rate (eGFR) is a crucial measure of how well your kidneys filter waste from your blood. This calculation, based on your creatinine levels, age, sex, and race, provides insight into your kidney function. A normal eGFR is typically above 90 mL/min/1.73 m², while values below 60 indicate chronic kidney disease (CKD).
The challenge with low eGFR is that symptoms often don't appear until kidney function has significantly declined. Your kidneys are remarkably adaptable organs that can compensate for damage for years before you notice any problems. This silent progression makes regular monitoring essential for catching kidney issues early.
Early-stage symptoms: Often silent but subtle
In the early stages of kidney dysfunction (eGFR 60-89 mL/min/1.73 m²), most people experience no symptoms at all. However, some individuals may notice subtle changes that are easy to overlook or attribute to other causes:
Kidney Disease Stages and Associated Symptoms
| CKD Stage | eGFR Range (mL/min/1.73 m²) | Common Symptoms | Severity | |
|---|---|---|---|---|
| Stage 1 | Stage 1 | ≥90 with kidney damage | Usually none | Mild |
| Stage 2 | Stage 2 | 60-89 | Usually none or mild fatigue | Mild |
| Stage 3a | Stage 3a | 45-59 | Fatigue, mild swelling, urination changes | Moderate |
| Stage 3b | Stage 3b | 30-44 | Fatigue, swelling, back pain, urination changes | Moderate to Severe |
| Stage 4 | Stage 4 | 15-29 | Severe fatigue, nausea, swelling, itching | Severe |
| Stage 5 | Stage 5 | <15 | All symptoms plus confusion, chest pain, minimal urination | Kidney Failure |
Symptoms typically become noticeable at Stage 3 and progressively worsen. Individual experiences may vary.
- Mild fatigue or feeling more tired than usual
- Slightly increased urination frequency, especially at night
- Foamy or bubbly urine (indicating protein in urine)
- Mild puffiness around the eyes, particularly in the morning
These early signs are often dismissed as normal aging or stress-related issues. However, they can be the first indicators that your kidneys aren't filtering as efficiently as they should be.
Moderate kidney disease symptoms
As eGFR drops below 60 mL/min/1.73 m² (Stage 3 CKD), symptoms become more noticeable and can significantly impact daily life. Understanding these symptoms and their severity can help you recognize when to seek medical attention.
Fatigue and weakness
One of the most common symptoms of declining kidney function is persistent fatigue. This occurs because damaged kidneys produce less erythropoietin, a hormone that stimulates red blood cell production. The resulting anemia leaves you feeling exhausted, weak, and unable to concentrate effectively.
Fluid retention and swelling
When kidneys can't remove excess fluid efficiently, it accumulates in your body. You might notice swelling (edema) in your feet, ankles, hands, or face. This fluid retention can also cause sudden weight gain and make your shoes feel tighter than usual.
Changes in urination patterns
Kidney dysfunction often manifests through urination changes. You might experience increased frequency, especially at night (nocturia), decreased urine output, dark or tea-colored urine, or persistent foamy urine indicating protein leakage.
Advanced kidney disease symptoms
When eGFR falls below 30 mL/min/1.73 m² (Stage 4-5 CKD), symptoms become severe and life-impacting. At this stage, your kidneys are functioning at less than 30% of normal capacity, and waste products accumulate dangerously in your blood.
- Severe fatigue and weakness that interferes with daily activities
- Persistent nausea and vomiting
- Loss of appetite and unintentional weight loss
- Metallic taste in mouth and ammonia breath
- Severe itching (pruritus) due to waste buildup
- Muscle cramps and twitches
- Shortness of breath from fluid in lungs
- Chest pain if fluid builds around the heart
- High blood pressure that's difficult to control
- Sleep problems and restless leg syndrome
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Complications from low eGFR
Beyond direct symptoms, low eGFR can lead to serious complications that affect multiple body systems. Understanding these potential complications emphasizes the importance of early detection and management.
Cardiovascular complications
Kidney disease and heart disease are closely linked. Low eGFR increases your risk of high blood pressure, heart attack, stroke, and heart failure. The kidneys play a crucial role in regulating blood pressure, and when they're damaged, this system breaks down.
Bone and mineral disorders
Damaged kidneys struggle to maintain the proper balance of calcium and phosphorus, leading to weak bones, increased fracture risk, and calcium deposits in blood vessels and organs.
Anemia and blood disorders
Beyond fatigue, kidney-related anemia can cause dizziness, difficulty concentrating, rapid heartbeat, and feeling cold even in warm temperatures. This significantly impacts quality of life and work productivity.
When to seek medical attention
Don't wait for severe symptoms to appear before taking action. Seek medical evaluation if you experience any combination of the symptoms mentioned above, especially if you have risk factors for kidney disease such as diabetes, high blood pressure, family history of kidney disease, or are over age 60.
Emergency symptoms requiring immediate medical attention include severe shortness of breath, chest pain, confusion or difficulty thinking clearly, severe nausea and vomiting preventing fluid intake, or little to no urine output.
The importance of early detection
Since kidney disease often progresses silently, regular testing is your best defense. Annual screening is recommended for everyone over 60 or those with risk factors. Early detection allows for interventions that can slow progression and prevent complications.
Key tests for monitoring kidney health include serum creatinine (used to calculate eGFR), urine albumin-to-creatinine ratio, blood urea nitrogen (BUN), and comprehensive metabolic panel. Regular monitoring helps track changes over time and guides treatment decisions.
Taking action: Your next steps
If you're experiencing symptoms of low eGFR or have risk factors for kidney disease, taking proactive steps is crucial. Start by getting your kidney function tested, maintaining a kidney-friendly diet low in sodium and processed foods, staying hydrated, managing blood pressure and blood sugar, and avoiding medications that can harm kidneys without medical supervision.
Remember that kidney disease is manageable when caught early. Many people with reduced eGFR can maintain their remaining kidney function for years through proper management. The key is awareness, regular monitoring, and working closely with healthcare providers to create a personalized treatment plan.
Your kidneys work tirelessly to keep your body healthy, filtering about 50 gallons of blood daily. By understanding the symptoms of low eGFR and taking action early, you can protect these vital organs and maintain your quality of life for years to come.
References
- Levey, A. S., & Coresh, J. (2012). Chronic kidney disease. The Lancet, 379(9811), 165-180.[PubMed][DOI]
- Webster, A. C., Nagler, E. V., Morton, R. L., & Masson, P. (2017). Chronic kidney disease. The Lancet, 389(10075), 1238-1252.[PubMed][DOI]
- Inker, L. A., Astor, B. C., Fox, C. H., et al. (2014). KDOQI US commentary on the 2012 KDIGO clinical practice guideline for the evaluation and management of CKD. American Journal of Kidney Diseases, 63(5), 713-735.[PubMed][DOI]
- Chen, T. K., Knicely, D. H., & Grams, M. E. (2019). Chronic kidney disease diagnosis and management: a review. JAMA, 322(13), 1294-1304.[PubMed][DOI]
- Kidney Disease: Improving Global Outcomes (KDIGO) CKD Work Group. (2013). KDIGO 2012 clinical practice guideline for the evaluation and management of chronic kidney disease. Kidney International Supplements, 3(1), 1-150.[Link]
- Grams, M. E., & Coresh, J. (2013). Assessing risk in chronic kidney disease: a methodological review. Nature Reviews Nephrology, 9(1), 18-25.[PubMed][DOI]
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