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A Homage to Good Ol’ Rene E Della Vescica

"All about the Aging Kidney and Bladder"
By: Marc Evans Abat, MD, FPCP, FPCGMA Homage to Good Ol’ Rene E Della Vescica

Let’s talk about the kidneys or “rene” first.  It is basically a multifunctional organ that is involved in the cleaning of the blood of waste products and hormonal control of many bodily processes (like stimulation of blood production, absorption of calcium and blood pressure control).   It is mainly composed of highly organized units of blood vessels, tubules and other cells that carry out the aforementioned processes.  As the body ages, certain changes are also noted in the kidneys.

·         Blood flow into the kidneys decreases by about 10% for every decade of life such that blood flow is only half of its original value by the 9th decade.  With this drop in blood flow, efficiency in filtration and handling of the salts in the blood can be a sensitive balance.  The filtration rate of the kidney in a bulk of the population, also decreases by 10% for every decade after 40 years. 

·         If one looks at the kidneys under a microscope, aging leads to gradual loss of the nephrons (the functional filtration units of the kidney), with consequent replacement of these units by connective tissue.

What are the implications?  The older kidneys become very sensitive to substances or conditions that can injure it. 

·         Anything that may abnormally lower the blood pressure of an older patient or suddenly reduces blood flow into the kidneys (e.g. dehydration from diarrhea or a sudden BP drop due to high doses of antihypertensive medications), may impair kidney function and cause injury. 

·         On the other hand, an older patient may also not be able to handle excessive amounts of ingested or infused water (like putting water inside a bottle with only a small hole).  An older patient may become bloated, edematous or congested. 

·         In both situations, there will be difficulty to balance the amount of salts and acids in our blood (our bodies are like batteries after all), especially in disease states.  Dehydration may lead to excessively high amounts of sodium in the body.  Uncontrolled diabetes may lead to increased acid in the blood.  Excessive water intake may dilute all the salts in the blood.  Older persons may suddenly develop a difficulty to conserve salts in the blood through the tubules of the kidney.

·         The kidneys become exquisitely sensitive to injury from many substances. Older persons tend develop many diseases as time passes.  Arthritis is one very common condition to occur, and as a result, intake of pain relievers, particularly non-steroidal anti-inflammatory drugs or NSAIDs, become very common.  However, these substances can cause a broad spectrum of severity of kidney injury. 

·         The other hormonal functions of the kidney may also become inadequate or easily impaired.  Some patients with chronic diseases or inflammation (e.g. those with rheumatic diseases, or chronic obstructive pulmonary disease), may become anemic (have a low level of blood hemoglobin) due to suppression of the kidneys’ production of erythropoietin (a hormone produced in the kidney that stimulates blood production).

The urinary bladder is basically that bag where we store urine produced from the kidneys for latter disposal at a convenient time (this later ability to wait for the right time is what we call continence).  The control over the urinary bladder is complex and the process of urination is controlled on several levels.  Aging brings about several changes in the urinary bladder.

·         The capacity of the bladder to hold urine decreases.  This is mainly due to the development of fibrous tissue in the bladder wall, making it less stretchy.  Hence, as one gets older, the bladder gets filled up easily and urination is more frequent.

·         The ability to delay urination on initially sensing the amount of urine in the bladder is also diminished.  This is particularly true for people who do not drink enough water (hence they have a concentrated urine that is particularly irritating to the bladder) or those who habitually urinate even if their bladder is not full yet that full.

·         Bladder contraction speed decreases leading to a slower rate of urine flow.  Hence urination time may become more prolonged.  In older males with normal- sized prostate glands, this may be one mechanism causing prolonged urination and the need to strain.

·         Sensitivity of the bladder to neurotransmitters increases.  Older people have a stronger need to urinate when they are anxious, nervous or scared.  Some may even suffer from intermittent incontinence or leakage of urine, whenever the get excited.  Also, spontaneous stimulation of bladder contractions become more frequent and difficult to suppress as one gets older (e.g. you feel the need to urinate when you hear dripping water from the faucet).

·         In females, the urinary bladder sphincter becomes less competent, partly as a result of menopause.  The loss of estrogen leads to thinning of the urinary sphincter, leading in part to a risk for incontinence and risk for urinary tract infections.

So how do we take care of our kidneys and bladder?

  1. Take enough water for your needs.  You can consult your doctor for this and work out with him the proper amount of water your body needs (it is not as easy as “8 glasses of water”).
  2. Avoid medications that may injure the kidney as much as possible, especially if your kidneys are already at risk.
  3. Proper treatment and control of your other illnesses to prevent complications on the kidneys.
  4. Maintain proper perineal hygiene, to prevent infection coming from the external urinary orifice.
  5. Especially for those experiencing leakage of urine, you can do Kegel exercises to strengthen the pelvic floor and urinary sphincter.  Try contracting the appropriate muscles for 10 seconds, resting for 10 seconds then repeating to complete 10 repetitions, 3x a day.
  6. Be careful of supplements.  Some may actually be harmful for the kidney or have side effects that is not worth the supposed benefits.

There you have it!  I hope you have a better idea of the kidneys and bladder as one ages.  Arrividerci!

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