Kidney Function Tests: Symptoms and Specialist Guidance

Kidney function tests

Hello Doctor: In the past few months, I have been experiencing discomfort, including chest tightness and pain, occasional shortness of breath, and unexplained nausea, although I haven't actually vomited.
My daily routine has not changed, and there has been no increase in stress.
I suddenly feel unwell every day.
In June 2020, I underwent several cardiology tests, and aside from tachycardia and mild arrhythmia, the only abnormal finding was a cortisol level of 29.4.
Recently, I visited a metabolic clinic where the doctor arranged for a 24-hour urine test.
The urine output was only 800cc, and the cortisol (Urine, 24hrs) level was 146.4 µg/day.
The doctor advised a follow-up in three months.
Could my values indicate a kidney issue? I continue to experience discomfort daily.
Which specialty should I consult to identify the problem? Should I see a neurologist, a metabolic specialist, or is it related to autonomic dysfunction, or something else? Thank you, Doctor.

You Ren Wu Yan, 40~49 year old female. Ask Date: 2020/07/06

Dr. Huang Yaoxuan reply Internal Medicine

Hello, "person with questions."
1.
In recent months, I have been experiencing discomfort, including chest tightness and pain, occasional shortness of breath, and unexplained nausea.

2.
I have noted episodes of tachycardia and mild arrhythmia.

3.
My cortisol level is abnormal at 29.4, and my 24-hour urine cortisol is 146.4 µg/day.

4.
My urine output is "only" above 800 cc.

Based on your description, I have outlined the four points above.
For points 2 and 3, I recommend that you continue to follow up with a cardiologist and an endocrinologist, as they are likely to be more specialized in these areas than I am.

Regarding point 1, the symptoms of "chest tightness and pain with occasional shortness of breath" seem to be related to cardiology (though not necessarily).
I suggest discussing these symptoms with a cardiologist to see if they are connected to the "tachycardia and mild arrhythmia."
For point 4, the urine output "appears" to have decreased.
If there is indeed a problem (meaning the body is not fully eliminating fluids), symptoms of fluid retention may occur, such as swelling in the hands and feet, rapid weight gain, and in severe cases, persistent shortness of breath.
I recommend monitoring for the aforementioned symptoms; if they do not appear, it indicates that the decrease in urine output is "normal." (Currently, it is summer, and the hot weather can increase fluid loss through the skin and respiratory tract, naturally leading to decreased urine output.)
Lastly, regarding "kidney issues," I suggest undergoing a health check-up, as most health screenings will assess kidney function, which can help determine if your kidneys are functioning well.

Wishing you peace and well-being.

Reply Date: 2020/07/06

More Info

Dear Patient,
Thank you for your inquiry regarding your health concerns and the interpretation of your kidney function tests. Based on the symptoms you have described—chest discomfort, occasional shortness of breath, nausea, and the results of your recent tests—it's important to approach this situation holistically.

Firstly, let's address the kidney function tests. The 24-hour urine collection you underwent is a valuable tool for assessing kidney function. The urine volume of 800cc is within a normal range, though it is on the lower side of average daily urine output, which typically ranges from 800cc to 2000cc. The cortisol level you mentioned (146.4 ug/day) should be interpreted in the context of your symptoms and other clinical findings. Elevated cortisol levels can indicate conditions such as Cushing's syndrome, which can have various systemic effects, including potential impacts on kidney function.

Regarding your symptoms, while they may not directly indicate kidney issues, they could be related to hormonal imbalances, particularly given the abnormal cortisol levels. Cortisol is a steroid hormone produced by the adrenal glands, and its dysregulation can lead to a range of symptoms, including fatigue, mood changes, and physical discomfort.

Given your history of heart-related symptoms and the recent findings, it would be prudent to follow up with a specialist who can provide a comprehensive evaluation. Here are a few recommendations:
1. Nephrologist (Kidney Specialist): Since you have concerns about kidney function, consulting a nephrologist would be beneficial. They can interpret your urine tests in detail, assess your kidney health, and determine if any further testing, such as blood tests for creatinine and electrolytes, is necessary.

2. Endocrinologist: Given the abnormal cortisol levels, an endocrinologist would be well-suited to evaluate your hormonal status. They can conduct further tests to determine the cause of the elevated cortisol and assess for conditions like Cushing's syndrome or adrenal insufficiency.

3. Cardiologist: Since you have experienced chest pain and shortness of breath, it may also be wise to consult a cardiologist if you haven't done so recently. They can rule out any cardiac issues that may be contributing to your symptoms.

4. Primary Care Physician: Your primary care physician can coordinate your care among these specialists and help manage any overlapping issues, ensuring a comprehensive approach to your health.

In summary, while your kidney function tests are important, they should be interpreted alongside your symptoms and other health indicators. It is crucial to address each aspect of your health—cardiac, hormonal, and renal—through appropriate specialists. Please ensure you communicate all your symptoms and concerns during your consultations, as this will aid in accurate diagnosis and treatment planning.

Take care, and I hope you find the answers and relief you seek soon.

Best regards.

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