Does an Enlarged Prostate Hurt Your Kidneys?

Benign Prostatic Hyperplasia (BPH) could be a risk factor for kidney disease

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The prostate gland is an integral part of the male reproductive system.  It sits below the urinary bladder and wraps around its neck. That is the site where the urinary bladder leads into the urethra (which, in turn is the channel for urine to pass out from the bladder to the outside of the body). The prostate functions to secrete a fluid that is one of the components of semen.  This fluid is an essential part of the semen and therefore for male fertility.

 

Enlargement of the prostate gland in non-cancerous states, or benign prostatic hyperplasia (BPH) is a common problem in men over the age of 50, and commonly causes symptoms that range from frequent night-time awakening to pee, to painful difficult urination. These details are covered here. While these symptoms are well known, what is relatively less well understood is the damage that an enlarged prostate can sometimes inflict on your kidneys. BPH with obstruction is therefore a risk factor for chronic kidney disease, or CKD

HOW DOES AN ENLARGED PROSTATE IMPACT YOUR KIDNEY FUNCTION

Beyond the physical manifestations of urinary retention or weak stream or hesitancy, an enlarged prostate can inflict chronic damage to the kidney. If the obstruction around the bladder neck is bad enough, it can cause elevated pressure inside the urinary system.  This pressure is transmitted back to the kidney and can cause direct damage.

 This could also interfere with the blood supply to the kidney and create a tendency for urinary tract infections to ascend and reach the kidney.

Another relatively easy to understand mechanism by which the prostatic enlargement could be associated with kidney disease is obstructive uropathy at the junction of urethra and the urinary bladder.

 This obstruction ultimately leads to thickening of the bladder wall.  This thickness can also lead to decreased compliance of the bladder and increased pressures in the bladder.  These factors are known risk factors for kidney disease. 

In extreme cases, acute urinary retention associated with acute kidney failure can occur.  This is especially common in men with undiagnosed benign prostatic hyperplasia who take any medication that can worsen urinary tract obstruction. A common example are widely available over-the-counter oral decongestants which can get worsen prostate symptoms and and cause complete obstruction of the urinary tract at the level of the bladder neck.  This will often manifest with pain and an inability to pass any urine. If blood tests are done to work this up, they  would be suggestive of kidney failure.

Short of causing sudden onset acute kidney failure, an enlarged prostate does increase the tendency to develop relatively asymptomatic slow-onset, smoldering chronic kidney disease.

 In 2004, a study from the Mayo Clinic College of Medicine at Rochester was published that highlighted this association  between benign prostatic hyperplasia and chronic kidney disease.  The study subjects included over 2000 men who received a thorough evaluation including a prostate volume assessment with ultrasound, and blood tests.  The researchers found that even accounting for the participants age, diabetes, and high blood pressure (the usual suspects that cause chronic kidney disease), men with diminished urinary flow rates and urinary retention because of enlarged prostate were more likely to have chronic kidney disease.  In other words signs and symptoms of urinary obstruction from bladder outlet obstruction was  associated with chronic kidney disease while there was no association between asymptomatic enlargement in the prostate volume or even PSA levels.

CONCLUSION

An enlarged prostate, especially one which causes symptoms suggestive of obstruction, is an independent risk factor for chronic kidney disease. If you think you are at risk, it might be worthwhile getting a kidney function assessment. Talk to your doctor about it! 

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