Hot climate damage

Kidney and urinary tract
1

I'm a 74yr old male who's been living thru exceptionally hot season (daily 42°C) in SE Asia for over a month. Lots of sweating, drinking lots of water, and trying to replace lost electrolytes with fish sauce on food.  No aircon; simply relied on fan for sweat cooling.  

Survived several weeks OK, but then suddenly, just before I was booked to fly back to UK, I developed swollen feet and legs,  gaining 10kg on my normal 64kg.   Oedema.

Local doctor said too danagerous to fly, initially for fear of thrombosis, but thrombosis then quickly ruled out after an expensive lower body ultrasound.

Blood test shows high creatinine level indicating kidney problem.

Local doctor been giving Lasix diuretic injections & tabs for 5 days with legs & feet  overweight improving from 10kg to 5kg.

Meanwhile poor appetite,  listless, and not yet feeling up to undertaking flight and complicated journey back to UK.

Looks like kidney problem but don't know exactly what's wrong or how to treat it without lengthy expensive local hospital diagnosis at a time when I'm trying to return to UK as quickly as possible.

In case I'm suffering from potassium deficiency, I'm eating more bananas, onions, beans, cucumber, pineapple and potatoes, and have cut out tea, coffee and salt.  On the other hand I've read my symptoms could have been caused by excess sodium (too much fish sauce?) so no idea at all about sodium balance.

So I'm looking for short-term suggestions for getting better enough to be able to undertake my journey back to UK where I hope to get full and proper diagnosis and treatment.

 

2

I would have thought if your symptoms were due to "excess sodium", that would have shown up alongside the blood test result for creatinine levels, that is if the test was requested in the first place.  If not, then do request it now.  You also need to know what your eGFR reading is which will further confirm how well your kidneys are working.  However, with the heat and subsequent sweating involved, I would have thought that you sodium levels were being depleted anyway.

As for any advice we can offer, it sounds as though you are already doing everything that you can to help with regard to your diet.  Once you lose the remainder of the weight gain which has obviously led to the oedema, it is quite possible that your creatinine levels will normalise.  In the absence of other symptoms,  I would have thought that as long as you don some flight support socks that there shouldn't be any major problem with your return flight.  Good luck and let us know how you get on.  

3

Your response much appreciated, Mrs O. Thanks!

Yes, sodium level should have been included in the tests but unfortunately the local clinic here in their wisdom only ordered creatinine; nothing else. There was a urine test too, but the clinic don't seem keen to share results. I'm tempted to go to an independent shop and have new blood & urine tests done; it will be a week since my previous one when my ceatanine was measured as 2mg/dl (well out of limits) at the time when my weight gain was peaking at +10kg. I'm thinking it would be useful to see what the creatinine is now my weightgain is down to +2kg.

So without going crazy on a whole lot of tests because each one is going to cost, what else should I include? Yes there's cretinine & GFR & sodium. What about BUN? What about potassium? I'm no medical expert so would welcome suggestions.

Still suffering poor appetite, listlessness, rubbing shoes, and generally such lack of energy that I don't feel up to travelling and looking after myself in UK yet, so I think there must be some other underlying factor besides the oedema. Might of corse be partly down to side effects of the strong Lasix diuretic treatment I'm on, but just dunno.

Anyway, welcome any further thoughts.

4

I'm no medical expert either, I'm afraid.  Can only advise from my limited experience.  With you latest mention of poor appetitite, lack of energey etc, it definitely sounds as though something is going on but without the relevant tests, not even an expert medic can help.  Another couple of useful tests would be the CRP and ESR which both test for inflammation in the body.  Other than that, I'm sorry that I can't help further.  Perhaps someone else looking in might be more qualified.  

5

Thanks again to Mrs O for her helpful comments. We've both been delving into the realms of blood testing details where normally a trusted qualified medical practitioner would be doing the recommending, but the problem is partly my fault for not completely trusting the local clinic doctor who has been administering Lasix diuretic to me.

Doctors are used to handling everything, starting with comprehensive diagnostic tests, and following up with whatever total treatment is required, possibly in hospital.

In my case, though, all I'm looking for is to get well enough to travel and fly back to UK, where hopefully I'll be able to get those comprehensive tests done. This concept of splitting the job and getting a temporary fix is difficult for the local clinic doctor here to appreciate. He is intent on suggesting expensive diagnotic tests to rule out possible causes because he's used to younger patients with medical insurance where cost isn't an issue. I'm 74 and my insurance ran out when I was 70 because I was too old.

So that's why I'm looking for cheap shortcut blood and urine tests as a compromise to get me safely home to UK asap with at least some knowledge of what lies ahead.

Maybe I shouldn't worry so much and given a careful diet, kidneys have a reasonable chance of repairing themselves. What does anyone think?

6

Never wise to go away without holiday insurance cover, whatever age.  Whether or not your kidneys can improve depends on the underlying cause but I do hope you will be one of the lucky ones.  Hope you get back home safely and soon.

7

That's generally good advice, but no, to the best of my knowledge, holiday insurance isn't an option in my case because it's limited to max 3 month stays, and my stays are over 6 months. Had this all happened earlier in my stay I'd have been happy to fork out big money for the full works treatment locally, but it doesn't make the same sense to do that when I'm just about to leave.

8

Oh dear, I do understand.  Just get home safely, and let us know all is well.

9

Thanks again for your supportive reply Mrs O. Although I'm much better, haven't really established the underlying cause yet. Here's an update:

Continued with Lasix diuretic treatment till my 10kg overweight became 2.5kg underweight and then stopped. Didn't feel so good at that point and there was still some residual swelling in my feet, but weight stopped falling at -3kg and feet swelling slowly reduced. Meanwhile my creatinine level fell from its previous 2.0 to 1.41; almost within limits.

2 days after stopping Lasix, my weight started to rise and in 4 days it was just about normal. Felt much better and started to regain appetite.

All seemed well at that point, but then my weight didn't stabilise at its normal level; it continued to rise and in a couple of days when I was 1kg overweight I started to notice some leg and foot swelling again, and not feeling so good..

That was only yesterday. However I quickly started diuretic tabs again and they've quickly brought my weight and swelling down.

I'm planning another blood test tomorrow, especially to see what's happening with my creatinine level, but for the next few weeks till I can arrange my travel and get a thorough diagnosis, looks like I'll have to carefully monitor my weight and start and stop taking diuretic tabs to keep my weight nearly normal.

My last blood test showed electrolytes all normal, but a low eGFR, (48 when min should be 90), so need to keep an eye on that in tomorrow's test results. Don't really understand the significance of low eGFR, or what I might be able to do to improve it in the short term.

Any further thoughts or suggestions about the best way to cope for the next few weeks till I can travel and get a proper diagnosis in my home country, would be welcome.

10

Well it does sound as though something is going on, doesn't it.  But in the case of oedema, the hot climate you are in certainly won't be helping the situation.  However, it must at least be reassuring to know that the diuretic is available when needed and that it works.

That eGFR of 48 is low but not worryingly so.  You are in the range of Chronic Kidney Disease Stage 3 - at this level, many doctors are unconcerned.    The main thing is to get it re-tested and as long as it is remaining stable at that level then you probably have little to feel concerned about in that area.  My eGFR is slowly declining, probably due to high blood pressure, the latest test recording 41.  However, some blood pressure medications cause it to dip further - bit worrying especially as it is a sole kidney!

Good luck with those test results tomorrow.

11

Mrs O's good luck wishes for my test results have worked better than going to see any doctor! They're very good!    Better than expected!    My creatinine  has come right down to 0.98, well within limits now,  and my eGFR has risen from 48 to 76; still not quite high enough,  but not so far to go  to reach the lower limit of 90.

I didn't know whether a damaged kidney was capable of repairing itself,  but these results seem to indicate mine can and is doing just that.   Phew!    I've got my weight back to normal and looks like I can keep it close to that by watching it and  going back to a few diuretic tabs whenever I see it rise again.   

These  results do beg the question of what the underlying cause of my oedema is, though.  Blood tests have ruled out electrolyte imbalance so what other common causes are there?  Very hot weather remains on top of my personal suspect list,  but could the heat alone have triggered it?    That very hot dry period has now given way to cooler cloudy humid weater with rainstorms.  

Things aren't right yet;  my feet and ankles remain somewhat swollen. They get worse and my bodyweight rises if I don't take diuretics occasionally.  so as Mrs O points outs. something is still going on but I don't know what. 

Anyway I'm feeling a lot better than I was,  thanks partly to Mrs O's encouragement here. 

12

"eGFR has risen from 48 to 76"  Wow!  Please tell me the secret!  So it appears that whatever it is is tied up with fluid retention.  I bet once you return to cooler climes, everything will sort itself out.  When you get back home though, I'm sure you will be wise enough to get everything thoroughly checked out, including your heart.  Keep doing whatever you're doing now and stay well.

13

From what I'm gathering,  eGFR isn't the result of an independent blood analysis;  it's a calculated result which simply goes up as creatinine comes down.  So long as weight, height, age  don't substantially change.  eGFR will just follow suit in the opposite direction.   Hope I've got that right!  

In my own case, it's looking more and more as if the original damage, whatever it was, is managing to repair itself.  When I first stopped taking diuretic tabs, my weight started going up again and I had to keep going back to taking a few more tabs to bring it back to normal.  That up and down cycle repeated  several times,  but now for the last few days my weight has stabilised itself at it's normal level without any more diuretics,  so that's another encouraging sign.  

Still ffindling myself slow and doddery and weak some days though, so keep  putting off my flight back to UK till I feel more up to managing life on my own over there.  For the time being I'm basking in the relative comfort of my convalescence here,  despite the weather still being quite hot.   The original urgency I felt to get back to UK quickly and get properly diagnosed isn't so strong now, and I can even imagine me getting back there with hardly any symptoms left to diagnose. 

It does look as if some kidney problems are more capable of repairing themselves than others,  but when symtoms are raging it's hard to know which need prompt attention and which can be left to sort themselves out. 

14

Hi sleepyzz, my mum, 60 yrs old, experienced symptoms like yours, and she's diagnosed with glomerulonephritis and right now she is treated at hospital. Perhaps you could search for it

15

Ah, thanks ileaestrella.   Hmm.... glomulerulonnephritis... Wow that's a mouthful to pronounce!  

I've tried googling it but my symptoms don't seem to match it very much.  I don't have any blood in my urine,  nor does a fairly full urine analysis come up with anything obviously abnormal.  

Earlier on when it all first started, I did wonder if I might have overdone the fish sauce that I sprinkled extensively on my food as seasoning  in an attempt to replace the salts I was clearly losing wiith heavy sweating in the very  hot weather.  I see too much salt can be a cause of  glomerulonephritis,   but no,  that doesn't seem to match either because a blood test has shown my sodium, potassium and chlorine all normal. 

Having said that,  apart from simply saying it was hot weather, I'm still in the dark about what caused my oedema in the first place.   My feet and  ankles still swell up when I sit down for any length of time, and I'm still generally weak and slow  and lacking energy as if something's still not quite right.   On the other hand my body weight has been stable at its normal level  for a week now without having to take any diuretics.  

So even though that glomer????   doesn't seem to match my case,  thanks for the suggestion and it's good to have pretty much ruled that one out.