Swelling of legs which is known as edema in medical terminology is a common problem faced by people. Many of us must have experienced swollen feet usually after a long workout or after a strenuous journey. “As most of us know, swelling of the legs can be a simple benign phenomenon or can be a harbinger of serious organ dysfunction,” explains Dr. Subhash Chandra, Assistant Professor of Internal Medicine at Amrita Hospital, Kochi.
Dr. Allwyn James D, MD, (Gen. Med) DM., (GE) — Consultant, Meenakshi Mission Hospital & Research Center, says, “Mild edema usually gets better on its own, especially if you keep it elevated. Speed things up. Affected organs above your heart. Medicines that help your body eliminate excess fluid in the form of urine can be used to treat more severe edema (diuretics). Furosemide is one of the most commonly prescribed diuretics. However, based on your unique medical history, your doctor will assess whether this type of medication is appropriate for you.”
But sometimes this swelling is not benign and can be a sign of a larger underlying health problem. Dr Varun Verma, Associate Director – Nephrology, Max Hospital, Patparganj said, “Swelling in the ankles can be a marker of kidney disease. It usually shows the leakage of protein in the urine. This is probably the first sign of kidney disease. Is.” However, such inflammation can also occur in patients with heart failure, CLD, or a hypothyroid state, but history and laboratories can differentiate between these conditions. “If you have this symptom I would recommend a visit to your doctor and a proper evaluation. If you have any such findings, please get your urine evaluated. I would recommend a urinalysis with urine spot protein creatinine ratio. I would also recommend a detailed kidney function test and abdominal ultrasound. I would also suggest a thyroid profile, HbA1c, liver function test as well as a 2D echo.
Harmful swelling of the legs can also be caused by certain medications, especially those used to treat high blood pressure such as the calcium channel blockers amlodipine, cilnidipine, and vasodilators such as prasozine and hydralazine. Mild lymphatic dysfunction due to congenital causes can also cause mild swelling of the legs.
Warning signs that leg swelling is inauspicious include shortness of breath associated with edema, a decrease in the amount of urine you produce, abdominal distension that accompanies edema and which is associated with yellowing of the eyes and urine. Some other dangerous signs of edema include edema in a limb that occurs after surgery or a long journey. Pain along with edema and redness of the feet that are painful to touch may indicate an infection in the feet called cellulitis, says Dr. Chandra.
Is your bloating linked to water retention?
Water retention is usually the result of consuming more water than our urine output. This scenario can occur in patients with chronic renal impairment who have decreased urine output but mistakenly consume large amounts of water, assuming they are helping their kidneys. Decreased urine output may also be due to non-compliance with medications designed to increase urine output such as diuretics that may have been prescribed by your doctor. Excessively low salt intake in the diet can also cause water retention as the kidneys require a minimal amount of salt for the excretion of water in the urine.
The link between inflammation and heart, kidney or liver dysfunction
Swelling of both legs may indicate severe heart, kidney or liver dysfunction. People who have had chest pain or a history of suffering a heart attack may later develop edema due to heart failure. This type of edema is accompanied by significant fatigue, breathlessness upon exertion, and abdominal swelling. This edema is caused by failure in the pumping mechanism of the heart causing significant back pressure and overloading of the venous circulation which in turn produces edema. Also, this swelling occurs after some time of exertion and can be seen mainly in the evening, says Dr. Chandra.
Another mechanism of edema is reduced filling of the arterial circulation due to failure of the cardiac pump which activates certain hormones in the kidneys called the renin angiotensin system. Activation of this system leads to sodium and water retention by the kidneys and eventually edema.
Edema can also be caused by kidney failure. This edema usually occurs in the morning with swelling of the face. Signs that may be related to kidney edema include low urine output, very high blood pressure, and very foamy urine, especially in the morning. Sometimes blood in the urine can also be a sign of renal causes of edema. Edema may be seen in patients with chronic renal failure, where the basic excretory function of the kidney is severely reduced so that it cannot eliminate urea and other toxic metabolites and get rid of excess water. Renal edema also occurs in a condition called nephrotic syndrome, where large amounts of protein, especially albumin, are lost in the urine. This protein maintains oncotic pressure in the blood vessels that keeps fluid within the blood vessels. With the loss of oncotic pressure, fluid leaks out of the blood vessels causing edema. A similar mechanism occurs in cirrhosis and liver failure where adequate amounts of protein are not produced by a failing liver. Edema due to liver dysfunction may be accompanied by jaundice where there is yellowing of the eyes and urine. Patients with a history of heavy alcohol use, obese individuals and those with hepatitis B and C infections are most likely to develop edema related to liver damage.
Testing to address health concerns
Patients with edema having the above symptoms undergo tests to find out if they are suffering from organ dysfunction or other problems. Routine blood checks will include a complete blood count to assess whether the patient has significant anemia because too little hemoglobin itself can lead to heart failure. Other tests include renal function tests including blood urea and serum creatinine. A urine routine may show the presence of blood or protein in the urine, as well as a 24-hour urine protein or urine protein creatinine ratio may tell us of heavy proteinuria as a possible cause.
Liver function testing is done to check for albumin and globulin levels as well as liver enzymes such as SGOT, SGPT and alkaline phosphatase which can shed light on liver injury. ECG and 2D ECHO are also performed to assess the pumping capacity of the heart, ejection fraction, structural abnormalities, regional wall motion abnormalities that contribute to cardiac edema. Blood tests for heart failure, including BNP or brain natriuretic peptide, are also done, where high levels indicate heart dysfunction. Other tests include a thyroid function test because hypothyroidism is another common cause of edema of both legs.
Unilateral swelling of one leg requires a probe like an ultrasound venous Doppler to look for thrombosis within the deep veins of the leg, a dangerous condition called DVT or deep vein thrombosis. Other tests done in unilateral swelling will include a blood count to rule out infection, especially if there is pain and redness on the swollen leg. In Kerala, unilateral swelling of the legs can also be caused by filarial infection, which leads to dysfunction of the lymphatic vessels that help carry fluid back to the chest. It guarantees tests like lymphoscintigraphy which tells us about any lymphatic dysfunction in the organs, elaborates Dr. Chandra.