From the Guidelines
Yes, chronic urinary retention requiring daily catheterizations can lead to the development of Chronic Kidney Disease (CKD). According to the most recent guideline evidence from the American Urological Association (AUA) and the Society of Urodynamics, Female Pelvic Medicine & Urogenital Reconstruction (SUFU) 1, patients with neurogenic lower urinary tract dysfunction (NLUTD) are at risk of developing urological complications, including chronic kidney disease. The guideline recommends annual renal function assessment for patients with moderate-risk NLUTD and stable urinary signs and symptoms, as well as upper tract imaging every 1-2 years. For high-risk NLUTD patients, the guideline recommends annual renal function assessment, annual upper tract imaging, and multichannel urodynamic studies.
The development of CKD in patients with chronic urinary retention is thought to be due to the increased pressure in the bladder that can back up into the kidneys, causing hydronephrosis (swelling of the kidneys) and damaging kidney tissue over time. Additionally, urinary retention increases the risk of recurrent urinary tract infections, which can ascend to the kidneys and cause pyelonephritis, leading to scarring and progressive kidney damage.
Key measures to minimize the risk of CKD in patients with chronic urinary retention requiring intermittent catheterization include:
- Maintaining strict catheterization schedules
- Proper hygiene techniques
- Adequate fluid intake
- Regular monitoring of kidney function through blood tests (creatinine, BUN) and imaging studies
- Prompt treatment of urinary tract infections
- Addressing the underlying cause of retention when possible
It is essential to note that the risk of CKD can be mitigated with proper management and monitoring, as highlighted in the AUA/SUFU guideline 1. While other studies, such as the systematic review and cost-effectiveness analysis of intermittent self-catheterization 1, provide valuable information on the complications and management of urinary retention, the most recent and highest-quality evidence from the AUA/SUFU guideline 1 should be prioritized in clinical decision-making.
From the Research
Chronic Urinary Retention and CKD
- Chronic urinary retention can lead to kidney damage or urosepsis if left unidentified and untreated 2
- The condition can be acute or chronic, with chronic urinary retention often being more difficult to identify due to its asymptomatic nature 2, 3
- Chronic urinary retention is associated with increased post-void residual urine, which can lead to complications such as urinary tract infections and post-renal problems 4, 3
Management of Chronic Urinary Retention
- Management of chronic urinary retention involves assessment of urethral patency and prompt bladder decompression by catheterization 3
- Clean intermittent catheterization is often preferred due to its lower complication risk compared to other forms of catheterization 4
- De-obstructive prostate surgery may be considered in suitable cases to increase the chance of stopping catheterization 4
Relationship between Chronic Urinary Retention and CKD
- There is no direct evidence in the provided studies to suggest that chronic urinary retention requiring daily catheterizations leads to the development of CKD
- However, studies suggest that urinary retention can lead to kidney damage if left untreated 2, and that patients with CKD are at risk of progression to kidney failure 5, 6
- Factors such as hyperuricemia and fluid intake may play a role in the progression of CKD, but the relationship between chronic urinary retention and CKD is not explicitly stated in the provided studies 5, 6