Hello welcome to the chronic kidney disease program at University. Of California San Diego my name is Danuta Trzebinska and I’m, a nephrologist in our clinic in this module we 39. Ll talk about symptoms of chronic kidney disease or CKD the symptoms associated with chronic kidney disease worsen. As you progress from the least severe stage stage, one to most severe stage Stage, five patients will have chronic kidney disease stage. One usually have no symptoms. The only exception is patients who are spilling a massive amount of protein in the urine because they can subsequently develop swelling in the legs or other parts of the body. Now chronic kidney disease stage, two is usually associated with no symptoms either. Just like stage one you don’t know the vast majority of patients with CKD stage. One and two are not aware of having kidney disease unless they undergo specific blood and urine testing. So, most of the time it’s incidental finding you are not even looking for it now chronic kidney disease stage three. This is the most common stage of kidney disease. This is middle road. Your GFR is between 30 and 59, since this stage is associated with moderate reduction in level of kidney function, a proportion of patients might develop some symptoms and what kind of symptoms some of those symptoms like fatigue or more frequent urination at night, are nonspecific and overlooked By patients or attributed to some other things going on in their lives, think about it. There is a very long list of causes for fatigue and kidney diseases, certainly not number one. Some patients who are in chronic kidney disease stage, three can experience swelling in the legs. Now we are moving on to stage 4 stage. 4 is associated with farther reduction in the level of kidney function is considered severe GFR is between 15 and 29. Thus, as you can expect, there will be more patients having symptoms in this stage. Symptoms can be similar to those with stage 3, but they’re just more obvious. There might be some additional symptoms like decreasing appetite or some patients will experience. Shortness of breath. Now we are moving to stage 5 chronic kidney disease, and this is the most severe stage. If you recall in stage 5, GFR is less than 15. As with other stages, various patients will experience different amounts of symptoms. There are certainly many people in this stage who continue to work full time and live a pretty much normal life. You look at them and you would never guess that they have chronic kidney disease stage 5. They ask me doc. Are you sure I feel just fine? I cannot tell in general, however, in this stage there are more symptoms than in any other previous stages. On top of previously mentioned symptoms like fatigue swelling in the legs, patients might suffer from some other symptoms like skin, itching, metallic or bitter taste in the mouth. Sometimes I ask patients, do you feel, like you swallowed a coin, now that I know what it tastes like, but it’s, just your taste is off. Sometimes, patients experience, nausea or even vomiting, and this naughty and vomiting vomiting might be most more pronounced in the morning. When you are in stage 5, you can expect further worsening in energy level and some sleep disturbances. Some patients will require. We require more sleep at night, for example, instead of your previous six seven hours, which was enough to feel refreshed now you will need nine hours to feel rested or semi rested, or maybe you’re going to have a reverse sleeping pattern. That means that you will stay up at night. You’re, just not sleepy, you cannot sleep, and then you will want to sleep all day long or some patients. They sleep at night, just fine, but they also required a nap during the day. That will tell me doc. I go to work, I can get through work, but then, when I got come home, I really need this nap and they didn’t need it. A year ago, many patients when they are in Stage five chronic kidney disease. They are in denial. All those changes are very slow. It’s not like one day you have hundred percent of kidney function and the next day you wake up and your level of kidney functions down to ten percent. So you really have to pay attention to your body, how you feel we tend to adapt. If I have less energy all right, I’m not going to run. I’m going to do less. I might sleep more. Oh, I don’t have an appetite, so I will eat less, but sometimes people don’t notice. So when you come to see us in clinic, especially when you’re in chronic kidney disease stage, five we’ll ask you very pointed questions. How much do you sleep how many hours well, how many hours did you sleep a year ago? How much do you eat well, is it up or is it down all those questions are helpful. Some patients in chronic kidney disease stage five suffer from muscle cramps. Even when measured electrolytes in the blood are normal, sodium is normal, potassium magnesium. So please do not self medicate yourself. Don’t just start taking magnesium supplements. When you get cramps, because you might overdo it, you might notice worse concentration or actually you might not notice, but somebody else around. You will notice that you’re, not as sharp as you used to be some patients might feel more cold than usual than previously. Your urine volume eyedrop, you’ll, be peeing less than you did previously and may be swelling in your legs will get worse. Sometimes, when you are in stage five chronic kidney disease, blood pressure, control becomes more difficult. We have to add another agent, and blood pressure keeps creeping up. Patients who have diabetes might have more episodes with low instead of high sugar that’s one of the findings of advanced kidney disease. To summarize, please remember that chronic kidney disease is a silent disease and some patients will have just nonspecific symptoms only which are often north or overlooked. Till kidney disease is quite advanced. Let us go through a couple of questions to check your understanding of this module. Question number one which stage of chronic kidney disease is associated with most symptoms. The correct answer is chronic kidney disease stage 5 is associated with most symptoms. This is the most advanced stage of kidney disease. If symptoms are severe enough and or some of your labs are dangerously abnormal, you might need to start either dialysis or undergo kidney transplantation in stage 5. Let’s do one more question which symptom? Would you not expect to occur in chronic kidney disease? Is it a fatigue or B, leg, swelling or C increase in appetite or D muscle cramps, let’s think about this and which symptoms? Would you not it’s a tricky question and the correct answer is C increase in appetite. If anything, there is decrease in appetite in advanced kidney disease, some people lose weight. All other symptoms often occur in patients with chronic kidney disease. So you will experience, fatigue, leg, swelling and muscle cramps. Alright, congratulations to you guys. You have completed the module on symptoms of kidney disease. Please check our website for additional educational modules on kidney health. Thank you.