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What Is The Effect Of Chronic Bladder Hypertrophy On Kidney Function?

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Posted on Mon, 7 Jul 2014
Question: what is the effect of chronic bladder hypertrophy on kidney function? If a child does not urinate every date at school from 7am to 3pm and from the age of 5 to 12 years because he does not want to use the school toilets could this cause chronic renal insufficiency? The child always had to urinate but not because he was embarrassed to use public toilets. This is a case of paruresis. What effects could this have on the child including the growth of his bones? Would there be other symptoms? Could this alter the blood calcitriol and PHT levels and reduce childhood bone growth and height. Would not urinating and holding the urine in bladder (tighten spinster and penis muscles) reduce blood flow and growth to his penis and testicles?
doctor
Answered by Dr. Sree Bhushan Raju (3 days later)
Brief Answer:
hi

Detailed Answer:
hi,
Holding the urination when bladder is not good in the long run. It can lead to obstruction symptoms due to dilatation of ureters and consequent pressure effect on the kidneys. It might turn out be detrimental to kidney function though it is not scientifically proven. However many nehrologists advice the people not to hold the urination when in full bladder.
As far as the children are concerned, its not a good habit as they have small bladders and become a bad habit. Urinary bladder thickening usually can not be contributed by this. Bladder thickness is invariably due to recurrent urine infection whcih can roughen the mucosa inside the bladder.
Chidren with recurrent UTIs are invariably due to abnormal urinary tract which can gradually damage the kidneys.Children can develop stunted growth and abnormal calcitirol and PTH values when the kidney dysfunction is mild.
Holding the urine will not have any effect on the blood flow and would not develop any impairement in the growth of either the penis or the testes
Above answer was peer-reviewed by : Dr. Vinay Bhardwaj
doctor
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Follow up: Dr. Sree Bhushan Raju (53 minutes later)
I had no UTI's; so as I read holding my bladder full for 8 hours per day during the ages of 5 to 12 could cause mild kidney disfunction? This could cause the calcitriol and PTH values to be abnormal resulting in reduced growth; with no other symptoms?
Would there be other symptoms?

If I had relax or uropathy would I know? For example I remember times when i needed to urinate and I did not ; i mean for some time. After I while I would not need to urinate. Then when I needed to urinate I would have to wait a while for bladder muscle to relax. It is like the spinster muscle was so strong that it held in the urine and then it went out the urethers back to the kidney. I would think this would have killed the GFR.


Now ; would there be a way to tell if this had occurred when I was younger? For example by an ultrasound and what to look for?

Might my calcitriol and pth values be abnormal now; due to damage to kidney calctitriol cells? So you know when i sit in the sun I feel better. I feel that my body only makes calcitriol if the vitamin D levels are very high. Is this possible?

Would the stunted growth effect my hands and feet more than my arms; especially if I started urinating more frequently around 13. Remember hand and foot bone growth plates close much earlier than femur growth plates.
My hands are at least 5% smaller than my fathers; smaller than my brothers. Is hand bone growth an indication of calcium health status as a child? I am a couple inches taller than my father but still only 171cm. My brother is 175. His feet are size 10; my fathers are 9.5; mine are 9. In metric this is a difference of 4% for compared to my brother and 3% compared to my dad.

I also read that altered PTH values effect Gonadtrophin Releasing Hormone. Is this true? Remember I probably damaged my kidneys a bit and would have a lower GFR. This would continue even through puberty due to damage. The PTH value could be off and GNRH would be effected which would effect the growth of testicles with all consequences. This would explain why I have small testicles (10 to 12 ML); reduced testosterone and a below average sperm count? Also a voice that is not as deep as my dad or many men?

Also what is the expected GFR in a healthy 38 year old with no other symptoms?



Also it is proven that hypertrophy of the bladder reduces GFR.
And they have also proven that even with a bladder only 60% full the GFR is SIGNIFICANTLY reduced.

Dear Doctor:
First if you go to google and enter 'bladder hypertrophy effect on globular filtration rate' you will soon find a study which shows that it is reduce significantly even when bladder 60% full. You also told me that infrequent urination would have no effect on testicle or penis growth. Please tell me ; if you reduce the GFR what happens to calcitriol levels going into the blood? And PHT? And what happens to GNRH? And if urine actually goes back into the kidneys ; would this call uraemia?

Please see this study http://ndt.oxfordjournals.org/content/17/3/368.full
If the testosterone level is lowered during puberty; the penis will grow less than it would have.
Please comment on above questions.

Thank you.

doctor
Answered by Dr. Sree Bhushan Raju (44 hours later)
Brief Answer:
hi

Detailed Answer:
hi
can you please send me your renal function tests along with PTH, Vitamin D and calcitriol levels so that i can answer you better along with explanations
Otherwise,
1. holding the urine for such along time usually would noit affetct PTH and clacitriol levels
2. no study ahowed convincingly that hol;ding urine alone can damage the kidney unless there is a reflux nephropthaty
3. Reflux will manifest as double voiding means you feel like passing urine immediately afetr or few minutes afetr apssing urine and you also pass adeqiuate qunatuty
4. Ultra sound can suggest you by dilatation of pelvi calyceal sysytem
5. PTH can get elevated if your kidney function is abnormal called secondary hyper parathyroidism
6. bladder hypertrophy indicated recurrent UTI and there can be a consequent fall in GFR
7. GRH can be reduced if the renal functions are decreased. So.please check your creatinine. If the kidney function is less ( called CKD) can cause small testes and penis.
can you please send me those reports along with ultrasound abdomen report




Above answer was peer-reviewed by : Dr. Vinay Bhardwaj
doctor
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Follow up: Dr. Sree Bhushan Raju (16 hours later)
Okay; I will get the tests you ask for. So you know i have many times gone to void; and then had to void again 5 to 20 minutes later.
I think it was when i had to go to bathroom really badly.

What can you to do to help testicles and penis grow to normal size; I am 38. What hormones would you prescribe?

My GFR clearance rate was 95/ML/minute normal scale; adjusted for weight and age. I am 38 and in good health. This was based on creatine of 90.

The urinemea test was negative.

Which Vitamin D test do I do (other than calcitriol one).

What do I ask the ultrasound doctor to look for when he does the x ray?
I need to tell them what to look for; to test for signs of previous reflux neuropathy or urpopathy.
Please confirm Penis and testicles would have grown less during childhood? Or during puberty.

That is when I grew more and the doctor did not think I needed growth hormone.


Is there use of taking testorone and hog or FSH now? Please confirm. How would you treat a hypogondic kidney patient who did not
doctor
Answered by Dr. Sree Bhushan Raju (5 days later)
Brief Answer:
Kidney function normal.

Detailed Answer:
The kidney function is normal.the testes and penis size will be determined at the time of puberty and invariably that will sustain throughout the life
GH or GnRH at this age might not help you. Vitamin D deficiency is a common phenomenon now a days, Testosterone will be harmful in the long run and better to avoid. You require an endocrinologist opinion in this regard. As you have normal kidney function as per the report, so you will be considered as any other normal person of your age group.
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
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Follow up: Dr. Sree Bhushan Raju (3 hours later)
Dear Doctor:

I think you mis understood. I am now 38. All my questions are referring to the past. The GFR as of today is 95. I had the ultrasound of kidneys done and the nephrologist told me the kidneys look very healthy. There is no proteinuria.

If there there was reflux nephropathy when I was a child (around age 8 to 11) would you see the scars on the ultrasound? I mean if the kidneys were damaged?When I was a child I did not urinate at the school ; almost every day from age 5 to 10. The school day was from 7am to 3pm.

Can the calcitrol and PTH levels be altered if the bladder if full several hours per day? Could this cause a reduction in the Glomular Filtration Rate; AND CALCITRIOL production even if there is no permanent kidney damage? Can calcitriol and PTH levels be lowered due to daily reduced GFR due to full bladder?
Could this result in reduced growth? I suspect this and am asking you what you think on my theory? Is there anyway to find out? Is it possible that the rate of calcitriol and PTH would still be lowered today due to prior childhood kidney insufficiency? Yes, no, maybe; or in which context?

I am 171cm; my father is 166 but he grew up eating no meat or eggs. My mom is 160cm and ate meat. My maternal grandfather was 178cm. My brother is 175cm. Both my father and brother have larger hands and feet than me. I have hands that are only 18.5cm from middle finger to first wrist crease. My feet are only 26.5cm. My hand palms are wide; my feet (central part) are wide. My thumb and little finger are of very normal size; but my middle finger and index fingers are relatively short; and get narrow as you get closer to the tip starting with the 2nd joint from the tip. Would a calcitriol kidney growth problem effect my hands and feet more than my longer bones? Would my hand structure be consistent with a calcitriol (kidney problem)?

I do not understand why my hands are relatively even shorter than my height compared to general population; and specifically my brother and dad who both have feet and hands larger than population compared to their height. For example; my hands are smaller than 85% percent of men; (especially the height); the width is smaller than perhaps half of men; feet smaller than 85% of men; but my height is smaller than 76% of men. To me this finding is consistent with kidney problem.

I have relatively small testicles (4cm tall or so); 15ml or so.

I feel that a kidney problem may have stunted my growth which is why I would appreciate if you answer the above questions.

At this point it may at least help me treat my small testicles which HCG and FSH so they grow larger; I fear a lack of GnRH during puberty due to kidney deficit could be to blame.

I have a prolactin level of 20 u/ML and oestrogen level at the top of the range for a man (40).
doctor
Answered by Dr. Sree Bhushan Raju (13 hours later)
Brief Answer:
hi

Detailed Answer:
I think you mis understood. I am now 38. All my questions are referring to the past. The GFR as of today is 95. I had the ultrasound of kidneys done and the nephrologist told me the kidneys look very healthy. There is no proteinuria.
THIS RELATIVELY RULES OUT THE PRESENCE OF RENAL DYSFUCNTION. FOR YOUR AGE, GFR OF 95 IS ABSOUTLEY NORMAL

If there there was reflux nephropathy when I was a child (around age 8 to 11) would you see the scars on the ultrasound? I mean if the kidneys were damaged?When I was a child I did not urinate at the school ; almost every day from age 5 to 10. The school day was from 7am to 3pm.
MOST OF THE CHILDREN AND WOMEN DO NOT FEEL LIKE PASSING URINE IN THE PUBLIC TOILETS AND AT THE WORKING PLACES DUE TO POOR FACILITIES OR SOCIAL EMBARRASSMENT. THEY HOLD URINE FOR SEVERAL HOURS WITH GOOD CONTINENCE AND YOUR CASE IS NOT AN UNUSUAL ONE. SCAR IN THE KIDNEY, IF AT ALL FORMED DUE TO REFLUX CAN BE MADE OUT BY DMSA SCAN WHICH CAN SHOW THE SCAR IN THE KIDNEY. MCUG WHICH IS DONE TO DIAGNOSE FRFLUX MAY NOT ABLE TO DETECT AS WITH GROWTH OF BODY, THE REFLUX MIGHT DISAPPEAR

Can the calcitrol and PTH levels be altered if the bladder if full several hours per day? Could this cause a reduction in the Glomular Filtration Rate; AND CALCITRIOL production even if there is no permanent kidney damage? Can calcitriol and PTH levels be lowered due to daily reduced GFR due to full bladder?
Could this result in reduced growth? I suspect this and am asking you what you think on my theory? Is there anyway to find out? Is it possible that the rate of calcitriol and PTH would still be lowered today due to prior childhood kidney insufficiency? Yes, no, maybe; or in which context?
HORMONES CHANGE EVEN WITH SLIGHTEST CHANGES THAT AFFECT THEIR PRODUCTION. IT CHANGES EVERY MINUTE AND HAS GOT DIURNAL VARIATION. PTH AND CALCOTRIOL ARE THE HORMONES WHICH ARE NO EXCEPTION. SEVERAL FACTORS AFFECT THE CONCENTRATION OF THESE TWO HORMONES AND YOU NEED TO UNDERSTAND THOSE FACTORS BEFORE CALLING THEM AS NORMAL OR ABNORMAL. VITAMIN D DEFICIENCY CAN AFFECT THESE TWO AND THIS IS THE MOST COMMON CAUSE IN THOSE WITH NORMAL KIDNEY FUNCTION.

I am 171cm; my father is 166 but he grew up eating no meat or eggs. My mom is 160cm and ate meat. My maternal grandfather was 178cm. My brother is 175cm. Both my father and brother have larger hands and feet than me. I have hands that are only 18.5cm from middle finger to first wrist crease. My feet are only 26.5cm. My hand palms are wide; my feet (central part) are wide. My thumb and little finger are of very normal size; but my middle finger and index fingers are relatively short; and get narrow as you get closer to the tip starting with the 2nd joint from the tip. Would a calcitriol kidney growth problem effect my hands and feet more than my longer bones? Would my hand structure be consistent with a calcitriol (kidney problem)?
THE BODY MORPHOLOGY THOUGH DEPENDS ON GENETIC FACTORS, EVERYBODY NEED NOT BE THE REPLICA OF THEIR PARENTS AND THERE WILL BE WIDE VARIATIONS WITH THE GENETICALLY SIMILAR PEOPLE IN THE FAMILY. YOU NEED NOT WORRY ABOUT THOSE FACTORS WHICH YOU CAN NOT EITHER DETERMINE OR ALTER



I do not understand why my hands are relatively even shorter than my height compared to general population; and specifically my brother and dad who both have feet and hands larger than population compared to their height. For example; my hands are smaller than 85% percent of men; (especially the height); the width is smaller than perhaps half of men; feet smaller than 85% of men; but my height is smaller than 76% of men. To me this finding is consistent with kidney problem.
PSEUDO HYPOPARATHYROIDISNM IS ONE CONDITION WHERE FINGERS CAN BE SMALL DUE TO SMALL METATARSAL BONES. WHICH CAN THINK OF THEM BASED ON GENETIC STUDIES. THOSE FINDINGS ARE NORMAL AND THOSE VARIATIONS ARE EXPECTED IN GENERAL POPULATION

I have relatively small testicles (4cm tall or so); 15ml or so.
FUNCTIONING OF THE TESTES DIESNT DEPEND ON THE SIZE ALONE AND ARTHER IT DEPENDS ON THE SEVERAL HOMEOES ETC
YOUR SIZE APPEARS TO NOT ABNORMAL

I feel that a kidney problem may have stunted my growth which is why I would appreciate if you answer the above questions.
NO. IT IS NOT TRUE
At this point it may at least help me treat my small testicles which HCG and FSH so they grow larger; I fear a lack of GnRH during puberty due to kidney deficit could be to blame.
NO. IT WILL CHANGE AS YOU CROSSED THE AGE LIMIT AND IT MAY BE HARMFUL ASLO
I have a prolactin level of 20 u/ML and oestrogen level at the top of the range for a man (40).
THESE TWO HORMONE LEVELS ARE ACCEPTABLE AT THIS AGE
CAN YOU TELL ME ABOUT YOUR MARITAL, ASEXUAL ND SOCIAL LIFE SO THAT WE CAN DISCUSS MORE IN DETAIL WHETHER THE HORMONE THERAPY IS APPROPRIATE FOR YOU OR NOT
Note: For further queries related to kidney problems and comprehensive renal care, talk to a Nephrologist. Click here to Book a Consultation.

Above answer was peer-reviewed by : Dr. Prasad
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Answered by
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Dr. Sree Bhushan Raju

Nephrologist

Practicing since :1994

Answered : 92 Questions

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What Is The Effect Of Chronic Bladder Hypertrophy On Kidney Function?

Brief Answer: hi Detailed Answer: hi, Holding the urination when bladder is not good in the long run. It can lead to obstruction symptoms due to dilatation of ureters and consequent pressure effect on the kidneys. It might turn out be detrimental to kidney function though it is not scientifically proven. However many nehrologists advice the people not to hold the urination when in full bladder. As far as the children are concerned, its not a good habit as they have small bladders and become a bad habit. Urinary bladder thickening usually can not be contributed by this. Bladder thickness is invariably due to recurrent urine infection whcih can roughen the mucosa inside the bladder. Chidren with recurrent UTIs are invariably due to abnormal urinary tract which can gradually damage the kidneys.Children can develop stunted growth and abnormal calcitirol and PTH values when the kidney dysfunction is mild. Holding the urine will not have any effect on the blood flow and would not develop any impairement in the growth of either the penis or the testes