Chest Pain and Swallowing Difficulties in Kidney Patients

Q: Chest Pain and Swallowing Difficulties in Kidney Patients

Hello： In response to your question, the text describes that since last winter solstice, there have been three episodes of fainting accompanied by convulsions, which may indicate symptoms of epilepsy. <br>It is essential to have a neurologist arrange for an electroencephalogram (

Chest tightness/pain and abnormal swallowing sensation?

1.
I am a patient with horseshoe kidney, where my left kidney is connected to the right kidney.
The symptoms I experience include hematuria, proteinuria, and stabbing pain in the left abdomen.
After examination, I was diagnosed with left-sided kidney stones, and the treatment I received was extracorporeal shock wave lithotripsy.
Since the treatment in 1990, the size of the stones has reduced from 4x2 cm to currently only the size of my thumb (my kidney function remains within normal limits).

2.
Around 1994, I first experienced cold sweats, scalp numbness, chest tightness, and difficulty swallowing, with symptoms lasting about 30 seconds before disappearing.
Since then, similar symptoms have occurred approximately every six months to a year, but the cause remains unknown.
3.
Since 2001, similar symptoms have appeared about every three months, and I have fainted once a year for unknown reasons, accompanied by chest pain, cold sweats, scalp numbness, chest tightness, and difficulty swallowing.
I have consulted cardiology and nephrology, and have undergone urine tests, blood tests, 24-hour ECG, ultrasound, and exercise ECG, all of which returned normal results.
4.
Since last winter, the symptoms have persisted, with an increasing frequency.
I have fainted three times without knowing the cause, during which I was completely unresponsive for about one minute, experiencing eye rolling and full-body convulsions, but all hospital test results were normal.
5.
My observations: (1) Blood pressure—hypertension is below 140, while hypotension shows a tendency to be elevated, ranging between 86-100.
(2) When symptoms occur, I experience dry eyes, a thick yellow-white coating on my tongue, halitosis, as well as chest pain, cold sweats, scalp numbness, chest tightness, difficulty swallowing, and cloudy urine.
6.
My suspicion: recurrent kidney infections over a long period may be affecting heart function.
7.
My questions: (1) I want to know exactly what disease I have.
(2) Which specialty should I consult? (3) How can I communicate with the doctor so that they believe I truly have a condition? (4) Can further detailed examinations be conducted even if my test results are within normal limits? PS.
Please do not suggest that stress is the cause, as that is difficult for me to accept in relation to my work.
Thank you.

Jake, 30~39 year old female. Ask Date: 2004/03/01

Dr. Yang Jun reply Internal Medicine

Hello: In response to your question, the text describes that since last winter solstice, there have been three episodes of fainting accompanied by convulsions, which may indicate symptoms of epilepsy.
It is essential to have a neurologist arrange for an electroencephalogram (EEG) and possibly a computed tomography (CT) scan of the brain.
As for patients with horseshoe kidney, there is a higher risk of kidney stones and urinary tract infections, so regular follow-up examinations by a nephrologist are necessary.

Reply Date: 2004/03/01

More Info

Understanding the symptoms and complications associated with kidney disease, particularly in the context of your condition as a horseshoe kidney patient, is crucial for effective management and treatment. Your symptoms of hematuria (blood in urine), proteinuria (protein in urine), and left abdominal pain due to kidney stones are significant indicators of underlying renal issues. The history of your kidney stones being treated with extracorporeal shock wave lithotripsy (ESWL) is a common and effective approach, especially since your kidney function remains within normal limits.

However, the recurrent episodes of cold sweats, scalp tingling, chest tightness, and swallowing difficulties that you experience are concerning and warrant further investigation. These symptoms, particularly when they occur in conjunction with fainting spells, could suggest a variety of potential issues, including cardiovascular problems, autonomic dysfunction, or even complications related to your kidney condition.

1. Understanding Your Symptoms: The symptoms you describe, such as cold sweats and chest discomfort, could be indicative of several conditions. While you have ruled out significant cardiac issues through various tests, it is essential to consider that kidney disease can have systemic effects, including on the cardiovascular system. The kidneys play a crucial role in regulating blood pressure and fluid balance, and any dysfunction can lead to complications such as hypertension or electrolyte imbalances, which may contribute to your symptoms.

2. Recommended Specialists: Given the complexity of your symptoms, it would be beneficial to consult with a nephrologist (kidney specialist) who can provide insights into how your kidney condition may be affecting your overall health. Additionally, a cardiologist may be necessary to evaluate your heart function further, especially considering your episodes of fainting and chest pain. A neurologist could also be consulted to explore any potential neurological causes for your symptoms, particularly the tingling and fainting.

3. Communicating with Your Doctor: When discussing your symptoms with your healthcare provider, it is essential to be clear and detailed. Describe the frequency, duration, and intensity of your symptoms, and mention any patterns you have noticed, such as their correlation with physical activity or stress. Emphasize the impact these symptoms have on your daily life and express your concerns about their potential underlying causes. This information can help your doctor take your symptoms seriously and consider further diagnostic testing.

4. Further Testing: Even if your current tests show normal results, it is reasonable to request more specialized evaluations if your symptoms persist or worsen. Tests such as a Holter monitor (for continuous heart rhythm monitoring), echocardiogram (to assess heart structure and function), or even advanced imaging studies like MRI or CT scans may provide additional insights. Discussing your concerns about the adequacy of previous tests with your doctor can lead to a more tailored approach to your care.

5. Potential Causes of Your Symptoms: Your suspicion that recurrent kidney infections may be affecting your heart function is valid. Chronic kidney disease can lead to cardiovascular complications, and infections can exacerbate these issues. Additionally, symptoms like dry eyes, a thick white coating on your tongue, and foul breath could indicate systemic issues, possibly related to kidney function or other metabolic disturbances.

In conclusion, your situation is complex and requires a multidisciplinary approach to diagnosis and management. It is essential to advocate for yourself, communicate openly with your healthcare providers, and seek further evaluations to ensure that all potential causes of your symptoms are thoroughly investigated. Your health is paramount, and understanding the interplay between your kidney condition and other systemic symptoms is critical for effective treatment.

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