Renal Susceptibility to Barotrauma

We also understand that um the kidneys are very, very susceptible to pressures in the bladder and um in about the in the 1960s, a urologist studied this very um extensively and came up with a safe pressure in the bladder at which adult kidneys can survive, and that is 40 centimeters of water. We don't know what the safe pressures are for children because children go through different stages of growth and development, so we don't have an exact cutoff for children. And we know that a transplanted kidney is even more susceptible than even a child's kidney. So when we have a transplant kidney, we're very, very careful making sure that that bladder is not seeing high pressures. So this is why the understanding the pressures that the uh urine is stored in the bladder at is important because when you have high pressures in the bladder, it damages the kidneys. And this is showing that, so when you have a very, very high pressure in the bladder, your bladder becomes very thick, becomes inelastic, very stiff, doesn't store a lot of urine, and transmit that pressure directly up into the kidneys and destroys kidneys. Uh, when we have that scenario, we will start off with medications like Ditropan. Sometimes we'll use Botox injections into the bladder to try and stretch out that bladder. Uh, when that none of that works, then we have to do a surgery called augmentation where we will, uh, add intestinal tissue to the bladder to make the bladder bigger and more elastic. On the other end of the spectrum we have a big floppy bladder in that blue curve, and there the bladder is not a high pressure bladder early on, but as it overfills it becomes a high pressure and it's not able to empty well and in those instances we'll have to teach the family and the child how to empty their bladder using a catheter so they can empty the bladder to completion, get all the pressure out of the system and protect the kidneys, and also by emptying the bladder better, they're reducing the risk of infections. So really by understanding what is going on with the child's bladder, we can institute the appropriate and very individualized care plan for the child.