Swollen feet and ankles

[Beth35]

I am not on dialysis yet.  My renal function has been gradually getting worse.  My GFR is about 20 right now.  Two weeks ago my feet, ankles and legs began to swell up BAD.  It's still chilly here in NJ so it's from heat.  When I get home from my work day my feet look like they have been beaten with a stick.  Now they are not even going down to normal by the morning.  My skin actually HURTS in those areas.  Sometimes I can barely move them around after I get home.

Do you know what could be causing this?  My last creatinine was only 2.6.  It hurts to stand or walk.  I go to my nephrologist on Monday but thought I would get some ideas. 

I really don't want to take any water pills.  I am a teacher and can't get to the bathroom much.

Any advice?

[okarol]

When did you last have labs done?

As the kidney function worsens, one can experience weight gain from excess fluids, swollen feet and ankles, and puffiness around the eyes. A common symptom is fluid retention leading to high blood pressure, swelling and shortness of breath. Patients with kidney disease, even advanced kidney disease, maintain their ability to urinate well after starting dialysis. Because of what appears to be a normal urine volume, many patients are surprised when they are told their kidneys are not working normally because they expect this to be associated with a decreased production of urine. However, even a small imbalance between salt and water intake, and the amount of salt and water excreted in the urine, can lead to progressive accumulation of fluid over time. In its early stages, this is treated with dietary sodium restriction and diuretic drugs. However, in advanced stages of kidney disease, these treatments may no longer be sufficient and dialysis may be the only effective option. Therefore, any patient with CKD who notices the development of tissue swelling, shortness of breath, or an increased difficulty with blood pressure control should promptly seek medical attention to determine the most appropriate treatment. (from: http://www.aakp.org/aakp-library/Signs-your-Kidneys-May-be-Failing/index.cfm )

[sullidog]

Sounds like fluid retention to me.
Do you urinate much?
Troy

[monrein]

How closely are you watching your salt?  And also if your doc thinks that diuretics are indicated for you then that beats the heck out of fluid buildup in the lungs which could be seriously serious.  How's your breathing?  Fluid can "hide" in many different parts of the body and this excess causes the heart to have to work overtime.  For us, the tightrope we must walk isn't easily dismantled and it's all about keeping our bodies in balance which, before kidney failure, they could do all by themselves.

Since you're not on dialysis yet, going to the bathroom may be inconvenient but dialysis itself when it comes will redefine inconvenient and time-consuming. 

Please see your doc and take good care.  Salt free isn't tasty but it sure helps us to maintain some semblance of balance.
 

[Beth35]

Yes, I automatically assumed it was my kidney function.  My labs were taken three weeks ago.  I am now getting labs done every three weeks because now that funtion is worsening I have to be careful.  What surprised me is that my doc didn't seem too concerned.  I am having my labs taken tomorrow and then will find out results on Monday.

I do pee a lot and so I just assumed it was not fluid retention due to kidney failure.  But I really don't see what else it could be. 

Uh, it just really hurts.  So I am anxious to find out what is going on.  I was told about three years ago that my kidney was failing and that I only had about three years left on my current kidney.  It has felt like an ax hanging over my head.  I am REALLY tired and now this...it SUCKS big time!

[paris]

It does sound like fluid retention.  I am predialysis and have taken water pills for several years. You need to get the excess fluid off.  I would get "elephant" legs and feet, but not with the meds.   And like Monrein said, limit all intake of salt. It just graps the fluid and keeps it on you.  Let us know what the neph says.

[RightSide]

Your kidneys are losing their ability to balance electrolytes in your bloodstream.  Healthy kidneys can dump excess sodium into the urine, but not sick kidneys.  And that excess sodium causes fluid retention.

I suggest you try to cut your sodium intake down drastically--to 1,000 mg a day.  Cut out everything that has salt in it, everything, except maybe a couple pieces of bread a day.  And it goes without saying that you shouldn't put salt or anything containing salt (like sauces or salad dressing) on your food either.

With that low a sodium intake, even your damaged kidneys may be able to excrete the excess fluid. Works for me.  My neph approves too.

[MooseMom]

The same type thing happened to me, but perhaps not as seriously.  When my GFR was 20 and creatinine about 2.6 like yours, I went through a period when my ankles suddenly started swelling.  I told everyone, but no one seemed to care.  I think what happened was that at the time, I was bleeding a lot because of fibroids and was becoming quite badly anemic.  I began losing a LOT more protein than normally I did.  Turns out my body was "stressed" by the anemia, resulting in proteinuria and swelling.  So, are you by any chance anemic or have bad periods?  Your symptoms probably are better explained by other posters on this thread, but I just wanted to let you know that for me, the same thing happened but for an entirely different reason.  Let us know what you find out on Monday.

[Beth35]

Thanks for the tips guys.  Sometimes I feel like I need to have some info. going in to suggest to the doctor when she can't seem to figure things out.  I have a fairly new doc and she doesn't just seem to "know" everything like my last doc did.

I honestly don't eat too many foods that are high in salt.  I can't really think of anything.  I may eat lunch meat once in a while but when I do, I get the low sodiam stuff.  I will have to go over my diet and check how much salt is contained in the stuff I'm eating.  Maybe I am eating things that are high in it but I just don't know it.  I know my diet has not changed in a long time.  I'm the kind of person who eats the same things all of the time.

I will let you know what the doc says.

[BRANDY]

I am also predialysis and have the same symptoms as you. I am at 22% gfr. Iwas haveing awful leg cramps with lasix ( which I took for yrs,)  and doc switched me to Bumex , which took a tole on my leg muscles and joints.  So now I have lowered my dosage of lasix ( I went back to)  and am doing better   eyes still stay swollen and legs swelling less but still have problems.    I dont eat any extra salt . I can identifiy with your legs hurting. I would ask about a dieretic  it would be better to expel the fluid than to retain it. Hope you can get some relief.  Good luck.

[Ang]

sounds  like  fluid  retention

[Beth35]

Well my kidneys are rapidly declining in function.  My creatinine went up to 3.6 and my gfr is now only 15.  I go on Monday to have another fistula put into my arm.  I was given lasix but it is not helping at all.  My doc is hoping that my fistula has time to strengthen before I need to begin dialysis, which could be in another month or so.

I am kind of depressed at the news.  It totally stinks, but I am dealing with it.  Thanks for the advice everyone. 

[MooseMom]

Well my kidneys are rapidly declining in function.  My creatinine went up to 3.6 and my gfr is now only 15.  I go on Monday to have another fistula put into my arm.  I was given lasix but it is not helping at all.  My doc is hoping that my fistula has time to strengthen before I need to begin dialysis, which could be in another month or so.

I am kind of depressed at the news.  It totally stinks, but I am dealing with it.  Thanks for the advice everyone.

I am so sorry to hear this.  It's not fair that you are having to relive this rotten part of your history.  Will you try for another transplant?  Is the swelling any better at all?  I'm dealing with my first fistula; it is only a few weeks old; I can't imagine having to have another one.  We are all here for you and wish you well.  Please let us know how things go on Monday, OK?