Which Specialist to See for Persistent Leg Swelling and Previous Hematuria?

Which department should I make an appointment with?

Doctor, my friend has swollen feet that are red and so swollen that they can barely fit into their shoes.
The swelling persists throughout the day, even right after waking up.
They have noticeably lost weight, and previously experienced hematuria.
They went to see a doctor for the blood in their urine, which later resolved on its own, but now they are dealing with swollen feet.
What could be the possible issue, and which specialty should they consult? Thank you!

Guai Guai, 30~39 year old female. Ask Date: 2011/03/01

Dr. Li Yilun reply Urology

Edema is a non-specific symptom, making it difficult to infer potential diseases solely based on symptoms.
Common causes of edema can arise from cardiovascular issues, such as in patients with heart failure, or may be due to renal or hepatic dysfunction.
Endocrine hormonal factors can also contribute to edema.
Therefore, it is essential to consider factors such as the patient's age and chronic diseases, as there may be numerous potential causes.
Based on your description, it is not possible to make a definitive judgment.
Therefore, please take your friend to a healthcare facility as soon as possible for an evaluation by a family medicine or internal medicine physician, who can perform a physical examination or tests to gradually determine the underlying cause or refer them to the appropriate specialist for treatment.

Reply Date: 2011/03/01

More Info

When dealing with persistent leg swelling, especially when accompanied by a history of hematuria (blood in urine), it is crucial to approach the situation with a comprehensive understanding of potential underlying conditions. Given the symptoms you've described, your friend should consider consulting with a specialist in vascular medicine or a nephrologist, depending on the specific characteristics of their symptoms and medical history.

1. Vascular Specialist:
A vascular specialist focuses on disorders of the vascular system, which includes veins and arteries. Persistent swelling in the legs can often be attributed to venous insufficiency, where the veins struggle to send blood back to the heart. This can lead to fluid accumulation in the lower extremities. Other vascular issues, such as deep vein thrombosis (DVT) or chronic venous disease, could also be responsible for the swelling. A vascular specialist can perform Doppler ultrasound studies to assess blood flow and determine if there are any blockages or abnormalities in the veins.

2. Nephrologist:
Given your friend's previous experience with hematuria, it may also be prudent to consult a nephrologist. Hematuria can indicate underlying kidney issues, such as glomerulonephritis or kidney stones, which could lead to fluid retention and swelling. A nephrologist specializes in kidney function and can conduct tests to evaluate kidney health, including blood tests, urine tests, and imaging studies. They can help determine if the swelling is related to kidney dysfunction or other systemic issues.

3. General Practitioner (GP):
If your friend is unsure where to start, visiting a general practitioner is a good first step. A GP can conduct a preliminary evaluation, review medical history, and perform basic tests. They can then refer your friend to the appropriate specialist based on their findings.

4. Possible Causes of Symptoms:
- Heart Failure: Swelling can occur if the heart is not pumping effectively, leading to fluid buildup in the legs.

- Kidney Issues: As mentioned, kidney problems can lead to fluid retention and swelling.

- Liver Disease: Conditions affecting liver function can also result in fluid accumulation in the legs.

- Medication Side Effects: Certain medications can cause swelling as a side effect, so it's essential to review any current medications with a healthcare provider.

5. Diagnostic Tests:
To determine the cause of the swelling, the following tests may be recommended:
- Blood Tests: To check kidney function, liver function, and electrolyte levels.

- Urinalysis: To evaluate for any signs of infection or kidney issues.

- Imaging Studies: Ultrasound or CT scans may be used to assess blood flow and check for any abnormalities in the kidneys or vascular system.

Conclusion:
In summary, your friend should consider seeing either a vascular specialist or a nephrologist based on their symptoms. It is essential to address both the leg swelling and the history of hematuria to identify any underlying conditions that may require treatment. Early intervention can lead to better outcomes, so encourage your friend to seek medical advice promptly.

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