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Diabetic. Subclinical hypothyroidism, hyperglycemia and osteoarthritis. Having eyelid drooping and swelling. Severe pain around ankles. Suggest?

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I want this to be answered by a renal expert.
My mom is 54 yr old. She has type 2 diabetes, subclinical hypothyroidism, hyperglycemia, osteoarthritis on hips, knee and ankles. Want to know about her renal health in detail.

She has left eyelid drooping and swelling around the same eye, most often these days. At times right eye shrinks. 3 months ago she had lower limbs near ankles swollen for long time with severe pain around ankles, for nearly 10 days. Today, her face especially near nose is slightly swollen/puffy. Her reports taken today are attached. Her urine test result is
Colour     Pale Yellow      
Appearance     Slightly Cloudy      
PH     5.0 (Acidic)      
Specific Gravity     1.010      
Protein     NIL      
Glucose     NIL      
Ketone     Negative      
Nitrite     Negative      
Bilirubin (Bile Pigment)      Negative      
Urobilinogen     Present in Normal Limits      
Pus Cells     6 - 8 /hpf     
Epithelial Cells     8 - 10 /hpf     
RBCS     NIL /hpf     
Casts     NIL      
Crystals     NIL      
Others     Mucus Thread Present      
Posted Thu, 26 Sep 2013 in Kidney Conditions
Answered by Dr. Aditya Bhabhe 11 hours later
Brief Answer:
No obvious signs of renal disease

Detailed Answer:
Hi there

Thank you for sending in the query.

I have gone through all the reports.

Your mother's renal parameters viz., Blood urea, creatinine, calcium and phosphorus levels are within normal limits. Her urine exam shows absent proteins and her serum protein and albumin levels are normal.

The status of her kidneys appears to be within normal limits based on all the above investigations.

The urine shows a few pus cells and we should get a urine culture done to rule out a urinary infection.

Further her blood sugar appears well controlled (as judged by the glycosylated Hb levels). Her LDL cholestrol could be better controlled (target LDL<100mg/dl). Both these things help in preventing the development of diabetic kidney disease.

I do not think that her present symptoms are caused by a kidney problem.

However patients with diabetes are always at risk of developing kidney disease. If your mother uses analgesics like combiflam, brufen etc for osteoarthritis then the risk is greater.

So I suggest that we complete the diagnostic work up for kidneys by doing the following two tests: Urine protein/creatinine ratio (UPCR) and an Ultrasound of the kidneys.

Once this is done we could repeat the parameters annually. Meanwhile she should take all the medications under the supervision of a physician.

Hope this was helpful.
Feel free to contact me if you have any further questions.

Regards and best wishes.

Dr. Aditya Bhabhe
Above answer was peer-reviewed by
Follow-up: Diabetic. Subclinical hypothyroidism, hyperglycemia and osteoarthritis. Having eyelid drooping and swelling. Severe pain around ankles. Suggest? 16 minutes later
OK.. am relieved a bit.. But, few more concerns -

1) Why this edema on the face then?
2) Her Glomerular Filtration rate based on Creatinine shows Stage 2 of CKD, as told by another doctor. What does this mean? I am concerned as her Urea and Uric acid has increased from her last test taken on 30 Jun 2013.
3) She has mucus present in urine, as in urinalysis. What is it?
4) What natural remedies, measure will help her avoid kidney problem.

Please respond to every query, in detail. FYI - she had protein trace in urine which was taken 5-6 months ago. Also, had calcium oxalate crystals in the test taken in 2009.
Answered by Dr. Aditya Bhabhe 9 hours later
Brief Answer:
See detailed answer

Detailed Answer:

I have following suggestions for your queries:

1) It is difficult to ascertain the cause of swelling without examining the patient.
I would recommend doing an Echocardiogram to look at cardiac function.
Also the thyroid function can be checked if not done recently.

2)CKD Stage II means GFR between 60-90 ml/min. GFR is calculated based on number of factors including serum creatnine. These equations are not very accurate when GFR> 60 ml/min.
So I would not worry about these numbers much.
We should do UPCR (see my first reply) or 24 hour urine protein. If these are abnormal it will indicate effect of diabetes on kidneys.

3) Mucus is a non specific finding. As I said earlier we should get a urine culture to rule out infection.

4) Measures to avoid kidney problem include diet (low salt; moderate protein: see a dietician); strict control of blood sugars, hypertension and cholesterol; and regular monitoring and follow up with a nephrologist.

Hope this helps
Above answer was peer-reviewed by
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