Chronic Kidney Disease - Stages 1, 2, and 3a

Reviewed by: HU Medical Review Board | Last reviewed: December 2022 | Last updated: January 2023

Chronic kidney disease (CKD) is a health condition that often builds slowly over time. Having CKD means your kidneys do not filter waste and extra water as well as they should.1

There are 5 stages of CKD. Each stage is measured by how well tiny filters in your kidneys are working. The early stages of CKD – stages 1, 2, and 3a – are considered mild to moderate kidney damage.1,2

In these early stages, the kidneys have some damage but are still able to keep up with most of the body's clean-up needs. There may be no specific symptoms. But kidney function may continue to get worse over time.1,2

Stages of mild to moderate CKD

Kidney function is measured using a blood test called the GFR and a urine test. GFR, which stands for glomerular filtration rate, measures how well your kidneys are filtering waste and extra water. The urine test checks for protein in the pee.3

People whose kidneys are working normally will have a GFR result between 60 and 100, and they will have no protein in their pee. People with kidney disease have different test results.3

Stage 1

In stage 1, there is mild damage, but the kidneys are still working almost as well as normal. Your GFR score may be 90 or higher. There is some protein in your pee.4

At stage 1, there are often no symptoms even though there is damage to the kidneys. This damage cannot be reversed, but you can take steps to keep your kidneys working as well as possible for as long as possible.4

Stage 1 symptoms that you might notice include:4

  • High blood pressure
  • Swelling in the hands or feet
  • Urinary tract infections
  • Blood in the urine

Signs your doctor may notice include:4

  • Protein in your pee
  • Kidney damage that can be seen on an ultrasound, CT scan, MRI, or biopsy

Stage 2

Stage 2 is also considered mild kidney damage. Your GFR score will be between 60 and 89, and there may be protein in your pee. Your kidneys still work well enough that you may not notice any changes to your health.5

Symptoms of stage 2 are the same as those of stage 1.5

Stage 3a

Stage 3 kidney disease is sometimes broken into 2 smaller stages:1,6

  • Stage 3a means you have between 45 to 59 percent of normal kidney function
  • Stage 3b means you have between 30 and 44 percent of normal kidney function

Stage 3a means there is mild to moderate damage to the kidneys. Stage 3b means the damage is becoming more serious. Depending on the person, stage 3 is when symptoms may become noticeable.1,6

You need to begin seeing a nephrologist at stage 3 if you are not already. A nephrologist is a doctor who specializes in kidney disease. At this stage you probably need to be seen by your nephrologist every 3 months to closely monitor your CKD.6

Slowing down damage to the kidneys

While you cannot reverse kidney damage, there are many actions you can take to slow down the rate of new damage. For example, you can:4,6

  • Change to a kidney-friendly diet
  • Maintain a healthy weight
  • Keep blood pressure in a healthy range
  • Get regular exercise
  • Quit smoking
  • Avoid taking drugs that are hard on the kidneys, such as NSAID pain relievers (including aspirin and ibuprofen)

Most importantly, take your prescriptions as directed. Controlling the health conditions that lead to kidney damage is vital to slowing or limiting kidney damage. The conditions that most often harm the kidneys are:6

  • High blood pressure
  • Diabetes
  • Heart and blood vessel disease (cardiovascular disease)

If you have any of these conditions, you will need to take medicines to control your blood pressure and blood sugar. You may also need to take:6

  • Vitamin D and calcium to keep your bones strong
  • Iron to help with anemia
  • Diuretics to help reduce swelling

Other things to know

Well-meaning friends and family may tell you to drink more water to slow kidney damage. While this may be good advice for people with healthy kidneys, studies show that drinking too little or too much water makes GFR rates worse in people with CKD. Talk to your doctor about how much water you should drink.7

Learn more about the other stages of chronic kidney disease:

By providing your email address, you are agreeing to our privacy policy.