Kidney Problems and Diving

Diving and the physical changes that take place with the underwater environment have little to relate to the urological system. There is very little in the way of articles and reports concerning the urological system and sport diving. However, there are some factors that must be taken into consideration by the diver and his doctor when deciding if a person with conditions of the urinary tract should dive. The entire urologic complex of the kidneys, ureters, bladder, prostate and urethra have to be considered — not just the kidneys alone.

The examination of prospective divers, sports scuba divers, underwater photographers and diving instructors with kidney disease should include the pertinent aspects of present and past history, review of systems and physical examination directed and designed to specifically detect those conditions that place a person in jeopardy for the following:

1). decompression illness
2). pulmonary over pressure accidents
3). loss of consciousness
4). inability to mentally or physically handle the in-water environment.

  • Post-surgical or post-debilitating illness
  • Diabetes
  • Asthma
  • Age Related
  • Mental obtundation
  • Air containing reconstructions or prostheses

The obvious reasons why a person should not dive are as follows:

  • Disorders that lead to altered consciousness
  • Disorders that inhibit the “natural evolution of Boyle’s Law”
  • Disorders that may lead to erratic and irresponsible behavior.

Basic Urological Anatomy and Physiology

Disorders of the urinary outlet of the kidney, such as obstructions of the ureter or stones, but also benign or malignant tumors and inborn diseases.

The kidneys themselves, concerning their function as a ‘waste disposal unit’, and the adrenals ‘belong’ to internal medicine or nephrology. The general surgeon performs operations concerning the adrenals. Kidney transplants are often performed by specialized surgical teams.
Disorders of the urinary bladder, like stones, tumors and inborn disorders. Incontinence in women is also part of urology, although some gynecologists deal with this kind of problems too.
Disorders of the urethra and prostate, like tumors, obstructions and infections.
When the kidneys are damaged by some systemic disease process (such as diabetes, arteriosclerosis, heavy metal poisoning or drugs) it’s ability to function as a filter is diminished and products of metabolism such as urea nitrogen and creatinine are not removed from the blood. This leads to blunting of the sensorium, loss of cognition and decrease in underwater skills. The extent to which this occurs varies greatly with the individual and a critical level of ‘BUN’ and creatinine (azotemia) causing mental and cerebral changes dangerous to a diver cannot be stated with accuracy. Individuals can continue to function with remarkably high levels of creatinine, having some degree of accommodation. These people also have significant fluid and electrolyte shifts, blood pressure problems and renal insufficiency to the point of requiring dialysis (peritoneal or AV shunt). Significant anemia occurs for several reasons and the O2 carrying capacity of the anemic diver in renal failure would be dangerous.

AUTHOR

Ernest S. Campbell, M.D., FACS

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