Kidney disease can cause your ankles, feet and legs to swell. The extra fluid can build up and may be painful. You can reduce this by managing your underlying conditions like diabetes and high blood pressure, staying hydrated, eating a healthy diet and getting regular foot assessments from your kidney healthcare team.
Nephrotic syndrome
Nephrotic syndrome is a combination of symptoms caused by rare kidney diseases. It happens when important proteins that help your body get rid of extra fluid are lost in your urine (albuminuria). The condition can be found in all ages, but it is most common in children between the ages of 2 and 5, and is slightly more likely to affect boys than girls. It can also happen as a result of diabetes or lupus. Some people with nephrotic syndrome may have high levels of fats in their blood (hyperlipidemia).
Your kidneys have filters called glomeruli that help your body make urine. When these glomeruli become inflamed, they can leak protein into your urine. Many of the diseases that cause nephrotic syndrome are called glomerulonephritis.
In some cases, the nephrotic syndrome gets better on its own. However, the disease that causes it can get worse over time and eventually lead to kidney failure.
Doctors can diagnose nephrotic syndrome with urine and blood tests, and sometimes with a kidney biopsy. To treat it, doctors can lower your blood pressure by limiting salt in your diet and prescribing diuretics to reduce swelling (edema). They may also prescribe medicines that treat your underlying condition, such as immunosuppressive agents, which slow the progression of the disease. They may also suggest a low-protein diet.
Edema
The kidneys are vital to balancing fluids in the body. Kidney disease or reduced function can lead to sodium (salt) retention, causing swelling in the feet and ankles. This can also happen in people with other health issues like chronic leg vein problems, heart disease or liver disease.
Edema is caused by fluid trapped in the tissues, usually the feet, ankles or legs, but sometimes the arms, hands and face. It can feel uncomfortable, and it’s a sign that you may have an underlying condition like CKD.
This symptom can be mild or severe. Pitting edema is the most common type; it happens when you press on a swollen area and the skin makes a small dent that lingers. Nonpitting edema is less common; the area feels firm and doesn’t make a dent when you push on it.
Other causes of edema include sitting or standing for long periods of time, being pregnant, having varicose veins or taking certain medications, including ibuprofen and naproxen. It can also occur due to long-term acid buildup in the body, which can affect bone and protein health. It can also be a side effect of some cancer treatments, such as chemotherapy or surgery that removes lymph nodes. It can even be the result of high blood pressure or fluid in the lungs, which is called pulmonary edema and can cause shortness of breath.
Itching
Having kidney disease means that your body doesn’t process waste and extra fluids well, so you may develop dry skin. This can especially be a problem for the feet. If you have itching that won’t go away, talk to your doctor.
If you’re not sure whether your itching is a symptom of kidney disease, ask your healthcare professional for a blood test to check the level of minerals in your body. This can help you determine if the itching is due to kidney disease, or a health condition like diabetes or liver disease.
Kidney disease can also cause nerve damage in the legs and feet, which can lead to numbness or tingling. This can make it harder to walk or move around safely, and increases the risk of injuries and infections.
To help with numbness or tingling, keep your feet as warm and dry as possible, especially in the morning and at night. Wear loose, comfortable clothing and shoes, and try not to stand for long periods of time. If you experience any foot-related problems, talk to your multi-disciplinary team, local Podiatry Department or GP as soon as possible (within 24 hours). Any delay in getting advice and treatment could lead to serious problems.
Muscle cramps
Muscle cramps are sudden, involuntary contractions of skeletal muscles, most commonly affecting the calves, feet, and thighs. They typically occur when a muscle has been overworked, and can occur at rest or during or after physical activity. Cramping may last for several seconds to a few minutes, and can be severe. Patients with muscle cramps may report recurrent episodes that disrupt sleep or daily activities.
Cramps may also be a sign of nerve damage, known as peripheral neuropathy, or a vitamin deficiency. Decreased kidney function can lead to sodium (salt) retention, which can cause the legs and feet to swell. People with diabetes, nerve damage due to aging, or illness that interferes with the liver or thyroid can also experience pain that resembles muscle cramps.
Although most muscle cramps are idiopathic, it is important to perform a thorough history and examination to identify possible treatable causes. Clinical judgment is required to evaluate the need for laboratory or imaging tests, and to provide appropriate pharmacologic therapy, including stretching techniques and fluid replacement.