How to control blood pressure and leg swelling with one kidney?

Question

Hello doctor,

I am 88 years old, and I survived prostate cancer 15 years ago. Two years ago, I had a cancerous kidney removed. The remaining kidney is functioning well, although it has several cysts. Since losing a kidney, I have developed high blood pressure and leg swelling.

My doctor has tried various medications to lower my blood pressure, but they pose a risk of damaging my kidneys. Currently, I am taking 25 mg of Hydralazine in the morning and at night, but headaches and rapid breathing at night limit how much I can take. I am also taking supplements. My recent home blood pressure check averages 140/80 mm Hg.

Is there anything else I can or should do to minimize my blood pressure and protect my kidneys?
How serious is the leg swelling?
Is it primarily caused by poor kidney function, poor blood circulation, or both?

I can provide photocopies of past test results, but I do not have those files to attach.

Please guide me.

Answer 1

Hello,

Welcome to icliniq.com.

I have read your query and understand your concerns.

Staying active is a positive sign, but the daily leg swelling and rapid breathing at night raise some concerns. These symptoms could indicate kidney, heart, or circulatory issues, especially in someone 88 years old.

Nighttime breathlessness, in particular, should not be overlooked, as it can signify heart failure, while kidney disease may lead to edema and shortness of breath due to fluid accumulation. While these symptoms do not necessarily signal a severe condition at this time, it is advisable to seek medical review rather than simply monitoring at home.

With a solitary kidney, there is an increased risk of high blood pressure (BP). Proper BP control is essential to protect kidney function. Guidelines advocate for a lower systolic BP target in patients with chronic kidney disease (CKD). Still, in frail older adults, less intensive BP management may be more appropriate to avoid symptoms like headache or dizziness.

Your home average of around 140/80 mmHg is not alarming, but its adequacy depends on your standing blood pressure, kidney function, urine protein, and overall symptoms. Caution is advised against aggressively escalating medication if it results in negative side effects.

Practical steps to help safeguard your kidney health include maintaining a low salt or sodium intake, avoiding painkillers, staying reasonably hydrated, and continually monitoring your blood pressure.

Pay attention to whether the swelling worsens, affects both legs, is accompanied by weight gain, or is linked to breathlessness, especially when lying flat or during the night.

It is wise to schedule a review with your doctor in the coming days to discuss tests for creatinine, potassium, and sodium; the urine albumin-to-creatinine ratio; weight trends; and a possible heart evaluation due to the nighttime breathing issues.

To better guide you, answer these questions:

Is the leg swelling present in both legs, or mainly in one?
Does it tend to worsen by evening and improve by morning?
Do you experience shortness of breath when lying flat or wake up needing to sit up?
Do you have recent results for creatinine and any protein in your urine?
Have you ever had an echocardiogram or been diagnosed with heart failure?

Sharing past test results would also be beneficial.

I hope I have addressed all of your queries and concerns. Please feel free to follow up with the answers.

Thank you.

How to control blood pressure and leg swelling with one kidney?

Manage blood pressure and leg swelling with one kidney.