Undiagnosed Kidney Disease?

[BigSamlkpt]

Any help you could give me with the following problem
would be GREATLY  appreciated, my friends. Two years
ago I began experiencing a diffuse set of symptoms:
cognitive dysfunction/confusion, deathly fatigue, and depression/
irritability, along with headaches. The first symptom,
cognitive dysfunction, is often difficult to describe:
variously labelled as "brain fog" or "altered mentation,"
for me it means that I can't think straight, can't think through
a problem, have to remind myself where I am. The second
symptom, deathly fatigue, is so crippling; it's like my body
can't move anymore, and I feel genuinely close to death every
time it comes. The reason I'm writing this in the Kidney Disease
Forum is that I have some suspicion it might be related to my
kidneys. I've asked for, and received, extensive bloodwork
from my doctor indicating elevated liver enzymes (AST and
ALT) on three different tests. Also, all of these symptoms are
HEAVILY influenced by caffeine, one way or another. Sometimes
all the symptoms disappear right away with caffeine; and then
they come back harder. I know, it sounds strange. Also, I've
had visual disturbances (i.e., depth perception) and slowed
speech, so I know how strange this sounds. I can't afford to
go to a neuropsychiatrist right now - it's pretty clear that I'm
evidencing a disease that has neuropsychiatric symptoms -
and I was wondering if any of you might know if this is related
to the kidneys. Again, I'll repeat the three central symptoms:
cognitive dysfunction/confusion, deathly fatigue, and depression/
irritability, along with raised liver enzymes and some high
blood pressure, not low blood pressure. Thanks! I'm sorry
for how complicated this is; I've lived with these "complications"
for two years off and on, though, and so anyone that can make
my life less complicated please do. At this point in my life,
at 24, I feel like an old man, and I honestly need a chorus of
advice-givers. Thanks.

[freeatlast2008]

How is your diet?  Have you looked into the possibility of hypoglycemia?  

Check out:
http://www.mayoclinic.com/health/hypoglycemia/DS00198

Vicki

[BigSamlkpt]

Dr. Lacuesta,

I rarely drink alcohol, I've taken a mood stabilizer (Lamictal) for about two
months, which itself does not have to be blood-tested - that's why it's
very marketable, and myriad anti-depressants, including Lexapro, Prozac,
and Wellbutrin. The Wellbutrin has no effect whatsoever, and within a
week of taking Lexapro or Prozac I start to get more confused than
usual and feel very twitchy and sick. I've tried both several times, at
introductory doses. And no, my kidney function has never been evaluated,
so far as I know, except for the fact that they did a test on my Est Glom
Filtrate Rate, and I'm not sure what relation that has to the kidney. I've
had a streak of clear for the last three or four days that is remarkable, but I
know it'll go back, even though I don't want it to. But when it strikes, it
strikes bigtime. I'm having another Liver Profile done this week, per doctor's
orders. The Lamictal was taken three months ago, and the blood liver
enzymes are consistently elevated, but those tests have only been done
after, anyways, because I asked my doctor for a full workup. The feeling
is quite simply horrendous when it comes, and my emotions are all
messed up when it does come, and I can't think straight, like I've said
before. And this is hard to prove or persuade a doctor, but all of the
symptoms occur concurrently, not discretely. Sorry, I have no idea.
Thank you ;).

- Sam

[Vanessa Lacuesta]

Hi,

Thank you for your post. I would like to commend you for being very proactive about this. I know you are going through a lot. Your symptoms appear to be disconnected and nonspecific. Disconnected because they can not be readily explained by a single disease entity. Nonspecific because they may be explained by several disease conditions .So this is where the challenge lies.

The elevated liver enzymes appear to be the objective finding that we have right now. This may be worth following through.

Are you an alcohol drinker?

Do you take medications or supplements?

Was your kidney function evaluated?

[BigSamlkpt]

Dear Dr. Lacuesta - This began two years ago, in my last year of undergraduate
education. I have had about four thyroid function tests, and all have returned
normal. My symptoms defy psychological/psychosocial explanation, although
I am well aware that depressed patients often report to doctors unaware of
their own condition. I've been to two great therapists, who treated me free
of charge in grad school, just to make sure I eliminate unnecessary stressors
and retain a positive self-image, and the symptoms continue
unabated. The presence of physical symptoms is
especially striking, sometimes manifesting themselves in vague, generalized
pain and body malaise but moreover in agonizingly real neurocognitive
dysfunction, with inability to find words, and disconnectiveness/depersonalization,
something a person would feel if a truck had just run over their head. I
openly pursued a bipolar diagnosis, but the presence or absence of a
mood stabilizer had zero effect on my condition, macroscopically speaking,
which is to say that the confusion would come and go with it and without
it. I do have emotional lability which began with this, but I do
not have a family history of bipolar, and my psychiatrist was himself
very tentative. Physically, my symptoms reach outside the spectrum of psychosomatism, with the deathly fatigue that I described and the
feeling that my body is sucked dry of energy and vitality occuring outside of psychosocial influences. Also, I have sometimes discovered green stool,
and when fatigued, my right eyelid begins to close and I feel, well,
horrendous. It's a strange little malady, because as I said, it's gone
one day and here the next. Caffeine influences it somehow, I'm not
sure why. I have had a Est Glom Filtrat Rate of 108.9, but I believe
that's normal, and an Anion Gap  of 11. (I never had a chance to
discuss these test results with the nurse practicioner
who prescribed these tests for me recently, but acquired the paperwork
myself. Such is the nature of busy walk-in clinics.) In addition, my liver
enzymes tests have been consistently elevated. I have another liver enzyme
test after the 20th of this month. I am not an alcoholic and I do not consume
narcotics/opiates. The thought of this condition being psychosomatic,
for me, has been something of a palliative, but alas, it is not the case.
The confusion (brain fog) is the most difficult of symptoms, but I made
peace with it a long time ago - I have a part time job now and my
family is very supportive. I inform those closest to me when I'm having
a "clear" day and an "unclear" day, which is hopefully not too obscure.
Those who know me best know me well enough to realize it is largely
outside of my control when I sometimes forget things, look dazed and
confused, and my body just plain hurts. Interested in a diagnosis,
if you have one, but my family has  committed thousands now to
visiting two psychiatrists, two family medicine doctors and a
neurologist. They have no idea - some of them believe it's depression,
and my latest doctor has said he won't stop testing my liver. I
cannot afford to see a high-priced psychiatrist specializing in
neurological ailments, and on top of that I know that it'll be a
bear again for me to hear an M.D. shrug his/her shoulders.
I'm not interested in alternative medicine (magnetic bracelets
and crystal rub-downs) although I've been contacted here
by some good people that do that stuff. I've made peace with
it, basically, and essentially I understand it might be with me
for the rest of my life. I've done what research I can stand, and
I've been informed by others that they think it might be
CFS. It took me a long time to accept that I might have something
like that, especially when it seems inappropriate considering
how close I feel to dying at times, but an encephalopathy here
is almost guaranteed, because of the visual disturbances, the
strange and intermittent headaches, and the attenuation of
attention, memory and worst of all, fatigue/depression/confusion.
I've also made peace with dying, which might sound morose
but really isn't once you've achieved it. (Sounds like a character
in a Hemingway novel or something? lol). Anyways - thanks
for thinking about this for me. I'm a big believer in medicine,
don't worry, but sometimes even medicine doesn't have all
the answers, it appears. Oh well - Take care. Thanks again.

[Vanessa Lacuesta]

Hi,

I understand that this troubles you. I just have a few questions.

When did this start?

Have you had these symptoms for a long time ?

The symptoms that you have mentioned are nonspecific that is they may be due to a lot of factors. You have noted elevated liver enzyme levels. Are you an alcoholic beverage drinker ? Have you had any yellowing of the eyes or that of the skin?

Altered mentation, decrease in concentration and easy fatigability may suggest increased stress levels, poor nutrition, depression and other psychological disorders. These are only differentials and should not cause further worry. I suggest that you have your thyroid function assessed. Also, are there any major changes in life now that seems to increase the stress level? Any problems at work or at home? Any relationship issues?

Why do you consider a kidney problem at this point? Kidney disease may present with altered mentation but only in its severe forms . Let’s start with your thyroid function test. Also, try to share your concerns with family and friends. You need to vent out your feelings and worries as this may also provide relief. In fact, this is therapy in itself.
Eat well and sleep well.

I will expect to hear more from you.