What is the cause of my edema and neuropathy in my feet, given my history of having a single kidney, hepatic steatosis (fatty liver), cholelithiasis (gallbladder stones), and splenomegaly (enlarged spleen) at 63 years old?

Edema and Neuropathy in Your Feet: Likely Causes and Next Steps

Your foot edema and neuropathy are most likely caused by undiagnosed diabetes, which your constellation of findings—single kidney, fatty liver, gallbladder stones, and enlarged spleen—strongly suggests as part of metabolic syndrome. 1

Why Diabetes is the Most Probable Cause

Your clinical picture points directly to Type 2 diabetes with metabolic syndrome:

• Hepatic steatosis (fatty liver), splenomegaly, and cholelithiasis cluster together in metabolic syndrome, which shares the same underlying insulin resistance that causes Type 2 diabetes 1
• Peripheral neuropathy in a 63-year-old male with these metabolic features makes diabetic peripheral neuropathy the leading diagnosis until proven otherwise 2, 1
• Foot edema combined with neuropathy suggests you may have both diabetic neuropathy and either fluid retention from kidney dysfunction (given your single kidney) or early cardiac autonomic neuropathy 2

Critical Immediate Actions Required

1. Confirm or Rule Out Diabetes

You need urgent testing for diabetes 1:

• Hemoglobin A1c (most reliable)
• Fasting glucose
• Random glucose if symptomatic

2. Rule Out Other Treatable Causes

Diabetic neuropathy is a diagnosis of exclusion—even if you have diabetes, other causes must be ruled out 3, 1:

• Thyroid function tests (TSH, free T4) - hypothyroidism causes neuropathy 3
• Vitamin B12 level - deficiency mimics diabetic neuropathy 1
• Serum protein electrophoresis - monoclonal proteins cause neuropathy and require hematologic treatment 3
• Kidney function tests (creatinine, eGFR) - your single kidney may be contributing to edema and neuropathy 1
• Liver function tests - advanced liver disease can cause neuropathy 1

3. Assess Your Immediate Foot Ulceration Risk

You are at high risk for foot ulceration and amputation if you have loss of protective sensation 2, 1:

Your doctor must perform these specific tests immediately 2:

• 10-g monofilament test at multiple plantar sites on both feet—inability to feel this at any site confirms loss of protective sensation and places you in a high-risk category requiring screening every 3-6 months 2, 1
• 128-Hz tuning fork on the dorsum of your great toes to test vibration sense (large nerve fiber function) 2, 1
• Pinprick or temperature sensation testing (small nerve fiber function) 2, 1
• Ankle reflexes (typically absent in diabetic neuropathy) 1
• Foot pulse examination (dorsalis pedis and posterior tibial arteries)—up to 50% of diabetic foot complications involve peripheral arterial disease 2, 1
• Inspection for foot deformities (bunions, hammertoes, prominent metatarsal heads, calluses, skin breaks, color changes) 2

Understanding Your Edema

The edema has several possible causes that need evaluation:

Most likely causes:

• Reduced kidney function from your single kidney—this needs urgent assessment with creatinine, eGFR, and urinalysis 1
• Cardiac autonomic neuropathy from diabetes—look for resting heart rate >100 bpm, which often coexists with peripheral neuropathy 2, 1
• Venous insufficiency or dependent edema from reduced mobility due to neuropathy 4
• Medication side effects if you're on any medications (calcium channel blockers, NSAIDs, certain diabetes medications) 5

Control of edema is necessary to achieve maximum healing potential if you develop any foot wounds 4.

Immediate Foot Protection Measures

You must start these protective measures immediately, even before diagnosis is confirmed 2, 1:

• Never walk barefoot, even indoors—minor trauma causes ulceration in neuropathic feet 1
• Inspect your feet daily using a mirror to see the bottom—look for cuts, blisters, redness, swelling, or warmth 1
• Check inside shoes before wearing for foreign objects 1
• Test bath water with your elbow, not your foot, to avoid burns 1
• Wear properly fitted shoes with adequate depth and cushioning—avoid tight or pointed shoes 2
• Report any skin breaks, color changes, swelling, or warmth immediately to your doctor 1

What Happens If This Is Diabetic Neuropathy

If diabetes is confirmed, the management pathway is clear 2, 1:

Glycemic control:

• Tight glucose control prevents progression in Type 1 diabetes and modestly slows progression in Type 2 diabetes 2, 1
• Target A1c typically <7% (your doctor will individualize this based on your kidney function) 1

Cardiovascular risk factor management:

• Blood pressure control to <130/80 mmHg 1
• Statin therapy for cardiovascular protection 1
• Smoking cessation if applicable—smoking dramatically increases amputation risk 1

Foot care specialist referral:

• Immediate referral to podiatry for ongoing preventive care 2, 1
• Prescription therapeutic footwear with adequate cushioning to redistribute plantar pressures 2, 1
• Screening frequency based on risk category: every 3-6 months if you have neuropathy plus other risk factors 2

Monitoring for complications:

• Screen for cardiac autonomic neuropathy (resting tachycardia, orthostatic hypotension) 2, 1
• Watch for Charcot neuroarthropathy—a unilateral red, warm, swollen foot requires immediate immobilization 1, 6

Critical Warning Signs Requiring Emergency Care

Seek immediate medical attention if you develop 2, 1, 7:

• Any open sore or ulcer on your foot
• Redness, warmth, or swelling in one foot (possible Charcot foot or infection)
• Fever with foot symptoms
• Black or discolored toes
• Sudden severe pain in a previously numb foot
• Foul-smelling drainage from your foot

The Bottom Line

Your symptom combination demands urgent evaluation for diabetes and immediate foot protection measures. The triad of peripheral neuropathy, minor trauma, and foot deformity is present in >63% of diabetic foot ulcerations 2. With loss of protective sensation, you can develop limb-threatening ulcers without feeling pain 2, 6. Early recognition and aggressive preventive care can prevent the devastating complications of amputation, which occurs in 4-27% of patients with diabetic neuropathy at 5 years 2.

Schedule an appointment with your primary care physician within the next few days to begin this evaluation. Do not delay—the window of opportunity to prevent serious complications closes quickly 8.