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Having feet swelling, terrible dry mouth and loss of appetite. No diabetes. What should I do?

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General & Family Physician
Practicing since : 2009
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I have the following symptoms: toe/feet swelling. terrible dry mouth, loss of appetite, lethargic, urinating every 1.5-2 hours, fall asleep but do not stay asleep. All cardio tests come back fine, no diabetes. Do have a couple of out of range lab results: GFR is 51; protein/osmality is .19. Any thoughts on what is going on and what next steps should be?
Posted Sun, 27 Oct 2013 in Kidney Conditions
Answered by Dr. Luchuo Engelbert Bain 1 hour later
Brief Answer:
Needs a rheumatologic evaluation, screen for diabetes

Detailed Answer:
Hi and thanks for the query,

I would recommend investigations to be done with respect to a rheumatological origin. The opinion of a rheumatologist could be needed at some point in the evaluation process.

Toe/foot swelling , lethargy deserves tests for rheumatoid arthritis (rheumatoid factor), erythrocyte sedimentation rate to measure the degree of inflammation, C reactive protein ti be done. Tests for lupus are also needed and other systemic diseases. Anti nuclear antibody and HLA 27 tests are important to be evaluated in this context. Dry mouth coupled with joint pain, especially in the context of reduced salivation, mouth dryness is seen in Sjogren s disease, a very rare but specific disease.

I would recommend you book an appointment with a rheumatologist. Excessive urination could deserve a fasting blood sugar test, to exclude diabetes. A complete clinical review coupled with these initial tests should be sufficient either to make an exact diagnosis, guide treatment and orient further testing.

Do feel free asking any follow up questions in case you have any concerns. Thanks and kind regards.

Bain LE, MD
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