• A high creatinine can indicate reduced kidney filtration, but may also rise with dehydration, large muscle mass, vigorous exercise, some drugs, or high meat intake. eGFR is more informative than creatinine alone. The MedlinePlus creatinine guide explains its role in kidney-function assessment.
• A high uric acid level can occur in gout, kidney impairment, dehydration, obesity/metabolic syndrome, alcohol use, purine-rich diets, certain diuretics, or high cell breakdown. Not everyone with high uric acid develops gout. MedlinePlus uric-acid information notes that excess urate may cause gout or kidney disease.

• Creatinine 1.67 may mean reduced kidney function, but the significance depends on age, sex, previous creatinine, and especially eGFR.
• Hemoglobin 10.3 indicates anemia.
• Platelets 106,000 are low. It is usually not an emergency by itself, but it raises bleeding risk and should be investigated.

• Avoid ibuprofen, diclofenac, naproxen, and similar pain medicines because they can worsen kidney function and bleeding risk.
• Avoid aspirin unless a doctor has specifically prescribed it.
• Reduce salt intake and avoid very salty foods.
• Do not force excessive water intake or severely restrict fluids unless advised.
• Bring all current medicines and previous lab reports to the appointment.

First-line tests

1. Kidney tests
   • Serum creatinine, eGFR, urea/BUN
   • Electrolytes: sodium, potassium, bicarbonate
   • Calcium and phosphate
   • Repeat test compared with any prior creatinine result
2. Urine tests
   • Urine routine with microscopy: protein, blood, infection, casts
   • Urine albumin-to-creatinine ratio (ACR) or urine protein-to-creatinine ratio (PCR)
   • Urine culture if there are urinary symptoms or infection is suspected
   Heavy protein loss in urine, with low serum albumin, can cause generalized edema. Nephrotic syndrome is characterized by edema, significant proteinuria, and hypoalbuminemia.
3. Blood protein and liver tests
   • Liver function tests: AST, ALT, ALP, bilirubin
   • Serum albumin and total protein
   • PT/INR if liver disease is a possibility
   • Abdominal ultrasound if liver disease, ascites, or enlarged liver/spleen is suspected
4. Heart assessment
   • Blood pressure, pulse, oxygen saturation, clinical examination
   • ECG
   • BNP or NT-proBNP
   • Echocardiogram if breathlessness, raised BNP, abnormal ECG, chest symptoms, or clinical concern for heart failure
   • Chest X-ray if breathlessness, cough, crackles, or suspected fluid in lungs
   Elevated BNP or NT-proBNP can support heart failure in the right clinical setting. The AAFP edema evaluation guidance recommends an initial panel including BNP, kidney/electrolyte testing, liver tests, TSH, and a urine protein/creatinine ratio.
5. Blood-count assessment
   • Repeat CBC with platelet count
   • Peripheral blood smear
   • Reticulocyte count
   • Iron profile: ferritin, serum iron, TIBC/transferrin saturation
   • Vitamin B12 and folate
   • LDH, bilirubin, and haptoglobin if the doctor suspects red-cell destruction
   This is important because both anemia and low platelets need confirmation and an explanation, especially alongside impaired kidney function.
6. Thyroid test
   • TSH, with free T4 if abnormal
7. Diabetes and inflammation screening, if appropriate
   • Fasting glucose or HbA1c
   • CRP and ESR if inflammatory, infectious, or autoimmune disease is suspected

Tests based on the pattern of swelling

• One leg suddenly more swollen, painful, red, or warm: urgent venous Doppler ultrasound to exclude DVT. Do not massage the leg.
• Both legs swollen for weeks/months with varicose veins or skin darkening: venous duplex Doppler for chronic venous insufficiency.
• Swelling with abdominal distension: abdominal ultrasound, liver panel, albumin, urine protein assessment.
• Swelling with reduced urine, frothy urine, high BP, or blood in urine: urgent nephrology review, urine microscopy and kidney ultrasound.

Bring to the doctor