Skeletal flourosis and chronic renal failure.

Flourosis has a world wide occurence posing a serious health problems. Approximately 25 to 30 million people are exposed to water polluted with flouride. Half to one million people are suffering from severe forms of flouride intoxication in our country. In Telengana,Flourosis was detected as early as in 1937, the problem being acute in Nalgonda District. It is observed that hidden renal disease is one of the main factors for development of skeletal flourosis early. Individuals suffering from latent renal disease develop skeletal flourosis early,even while consuming low levels of flouride. In this study, 52 cases of skeletal flourosis with chronic renal failure were described between 1983 to 1998. A detailed clinical evaluation and skeletal survey were carried out for flourosis. Renal function tests were carried out to assess renal function. Ultra sound examination of abdomen was carried out to assess the size of the kidneys. The results and pathophysiology were also discussed.

Kidney measurements by sonography on normal Filipino adults influence of age, sex, and habitus

OBJECTIVE: Measurement of kidney size by ultrasonography is an important parameter in the renal evaluation of patients. This study aims to establish the average size of kidneys of healthy adult Filipinos and examine the factors that influence it.DESIGN: Cross-sectional, observational study SETTING: Section of Nephrology, Department of Medicine and Department of Radiology, UP-PGH Medical Center, a tertiary government hospital PARTICIPANTS: 264 healthy Filipino adults underwent kidney ultrasound after preliminary screening by history, physical examination, urinalysis, and serum creatinine RESULTS: Renal sizes and volume were measured by ultrasound in 105 males and 159 females, with ages ranging from 18 to 75 years old. The left kidney was significantly larger than the right for mean length but not for width or thickness. Except for cortical thickness, renal length (L=98 mm, R=96mm vs. L=95mm, R=93mm), width (L=48mm, R=49mmvs. L=46mm,R=46mm), and thickness (L=43mm, R=42 mm vs. L=39 mm, R=39 mm) were significantly larger in males compared to females. While the gender differences persisted when corrected for age and body mass index, this disappeared when corrected for total body area. With advancing age, there was minimal shortening but significant increases in width and thickness (renal shape index) CONCLUSION: Our study provides estimates of the average kidney size for normal adult Filipinos. The average kidney size of Filipinos is smaller than that of Caucasians for length (L=96mm vs. 112 mm, R=94mm vs. 109mm) and for width (L=47mm vs. 58mm, R=48mm vs. 57mm). Males have larger kidneys than females but the gender difference disappeared when corrected for total body area. Height but not weight has a significant influence on kidney size. With advancing age, kidneys tend to increase in width and thickness with no significant decrease in length or volume.

Ultrasound kidney dimension and the correlation of kidney length and age, weight and height of children aged from 6 to 8 years old

Background:The dimension and function of kidney have close relationship. In the developing countries, the index on kidney dimension of children has rather fully studied. In Viet Nam, most of studies only conducted on adults. Objectives:This study aims to determine the ultrasound kidney dimension and the correlation of kidney length and age, weight and height of children aged from 6 to 8 years old. Subjects and method: The data was obtained from a prospective study on 180 normal children at age from 6 to 8 years. Each kidney was measured length, width , thickness, and parenchymal thickness, and the mean values were recorded. The relationship of kidney length with age, body weight, body height were also taken. Results: Kidney dimension was increased by age. The average ultrasound kidney dimension:+ Right kidney: At 6 years old: Boy: length: 72.8\xb14; width: 31.2\xb13 ; thickness: 33.9\xb12 ; Girl: length: 69.8\xb15; width: 30.4\xb12 ; thickness: 32.7\xb12. At 7 years old: Boy: length: 75.2\xb14; width: 31.9\xb12; thickness: 33.8\xb13; Girl: length: 75.8\xb15; width: 32.0\xb12; thickness: 32.9\xb14; + Left kidney: At 6 years old: Boy: length: 73.9\xb15; width: 33.7\xb13 ; thickness: 34.9\xb12 ; Girl: length: 71.1\xb14; width: 32.4\xb13 ; thickness: 32.4\xb16. At 7 years old: Boy: length: 77.7\xb13; width: 33.8\xb13 ; thickness:34.7\xb12; Girl: length: 76.9\xb17; width: 32.0\xb12; thickness: 33,9\xb15; The kidney length, kidney weight, kidney volume of boys were bigger than girls, and the difference was significant (p<0.05). Conclusion: The kidney length correlated strongly and positively with body weight, body height and age.

Variable Factors affecting the Neonatal Kidney Size / 대한주산의학회잡지

OBJECTIVE: There are reports that a history of low birth weight, and accordingly, a small kidney could be a risk factor for hypertension and end-stage renal disease in older age. We looked for factors that have an influence on the kidney size to make guidelines for follow up and early detection of renal diseases. METHODS: From April 2003 to October 2004, we studied the kidney size of neonates, who had an abdominal ultrasound done within two weeks of life. We measured the kidney length and anterior-posterior (AP) diameter and compared the values with each patient's gestational age, birth weight, height, body surface area (BSA), percentile, blood pressure, laboratory findings and various neonatal diseases. RESULTS: The kidney length and AP diameter had a good correlation with the patient's gestational age, birth weight, height and BSA. The kidney size was larger in the appropriate for gestational age (AGA) than in the small for gestational age (SGA) group in full term neonates. The kidney size did not have a correlation with systolic and diastolic blood pressure, laboratory findings, such as hemoglobin or hematocrit, and various diseases, except congenital heart disease, which had a weak correlation with kidney size. CONCLUSION: Neonates with early gestational period, low birth weight, small height and BSA tend to have a small kidney. Also SGA patients, especially symmetrical type, tend to have a small kidney. So we recommend high risk neonates to be followed up for early detection of hypertension and renal diseases.

Analysis of the Impacts of the Ratio of Kidney Weight to the Recipient's Body Weight and of the Kidney Volume to Body Surface Area on the Renal Function after Renal Transplantation

PURPOSE: It is known that in animal experiments, a very small transplanted kidney relative to the recipient's size caused renal failure by a hyperfiltration injury on the nephron. Currently, studies of post-transplant renal function related to the allograft size are in process at many centers, checking the weight and the volume of the transplanted kidney. The results, however, need to be analyzed because of the diverse outcomes from different analytic points. The proper discriminating point should provide sound predictable factors for obtaining better recipient and graft survival. METHODS: We analyzed the results of renal function according to the different comparative points of the ratios of the kidney weight to the recipient's body weight (KW/BW) and of the kidney volume to the recipient's body surface area (KV/BSA). Among 243 patients who underwent a renal transplant between December 1995 and July 1997, 71 cases were excluded because of early graft loss, acute rejection and incomplete data. The remaining 172 patients were grouped into two groups above and below the various comparative points of the KW/BW and KV/BSA. Thereafter, serum Cr and 24-hr urine protein at 1-yr and 2-yr post- transplantation were compared between the groups. Also we analyzed the correlation between the renal size index (KW/BW, KV/BSA) and the serum Cr, the 24-hr urine protein, and the creatinine clearance at one and two years. RESULTS: From 2.5 to 2.9 of KW/BW, there were relatively consistent results; the transplanted kidneys which had more larger sizes excreted less protein in the 24-hr urine at one year (p<0.05). However, there was no difference in serum Cr level at 1- and 2-yr post-transplantation or in the 24-hr urine protein at 2 yr. Also there were correlations between the KW/BW and the 24-hrurine protein at 1 yr and between the KV/BSA and serum Cr at 1 yr (p<0.05). CONCLUSION: We conclude that the KW/BW, rather than the KV/BSA, was more predictable for post-transplant renal function such as urinary protein excretion, especially at 1 yr. The comparative point, however, should be deliberately adopted by using different multiple point. Also a method of measuring the functional size of the kidney, other than the simple geometric size, needs to be found.

Estimation of Kidney Size by Ultrasonography in Normal Korean Adults / 대한신장학회잡지

BACKGROUND: The kidney size is important in differentiating many renal diseases. Some studies have been reported about the normal kidney size in the foreign countries. However, no studies were performed by using ultrasonography in Korea. Therefore, we investigated the normal kidney length, the factors affecting the kidney length and the relationship of each other. METHODS: One thousand three hundred eighty eight healthy Koreans were scanned for the kidney length by ultrasonography and were measured for their body index(height, weight, body surface area, total body water, and fat free mass). We analyzed the association between kidney length and body index. RESULTS: Eight hundred four male and five hundred eighty four female were involved in this study and their mean age was 47.8+/-10.3 in male, 48.1+/-9.5 in female. 1) The average value of left and right kidney was 10.65+/-0.80cm, 10.50+/-0.78cm respectively, and the left kidney was greater than right one(P<0.01). 2) The difference between male and female was 10.77+/-0.79cm, 10.49+/-0.78cm respectively in the left kidney and 10.66+/-0.76cm, 10.27+/-0.75cm in the right kidney(P<0.01). 3) The aging process nearly does not affects the kidney size from 4th decade to 7th decade. However, the kidney size is getting smaller after 8th decade. 4) The correlation coefficient between the kidney size and height, weight, body surface area, total body water, fat free mass was 0.37, 0.41, 0.43, 0.37, 0.38(P<0.01) respectively. CONCLUSION: The kidney length showed normal distribution in normal Korean adult and the length greater than 12.36cm, smaller than 8.76cm means out of its range of normal(+/-2SD) irrespective of sex and position. The body surface area has the largest correlation with kidney size in both sex(r=0.38/0.44; left/right, P<0.01).

The Effect of Ratio of Kidney Weight to Recipient Weight and Body Surface Area on the Renal Allograft Outcome / 대한이식학회지

The hyperfiltration hypothesis postulates that kidney with reduced renal mass will progress toward failure due to hypertrophy of the remaining nephron to meet the excess load, eventually leading to nephron exhaustion. We assessed the influence of renal size on graft function in all allogrft except loss of graft within 6 month between September 1995 and February 1997(n=58). Patients were divided into two groups based on the ratio of kidney weight to recipient body surface area(KW/BSA>or=0.11, KW/BSAor=0.3, KW/BW<0.3) respectively and outcomes were compared by methods including student t-test and Chi-square test. Three conditions, in which hyperfiltration might be suspected, proposed by Teraski, were studied also: grafts from females to males compared with males to females, kidneys that experience rejection episodes and cadaveric grafts compared with living donor grafts. There was no correlation between KW/BSA, KW/BW and serum creatinine and degree of proteinuria at 1, 3, 6, 12 months posttransplant. Three conditions under which hyperfiltration damage might be suspected had no differences in study groups. Although more cases should be studied with long term follow-up, we conclude that donor kidney size has no apparent effect on renal allograft outcome in short term follow-up.

Measurement of Kidney Size in Korean Newborn Infants by Ultrasonography / 대한비뇨기과학회지

The kidney size of newborn infant provides an important value in the diagnosis and treatment of the congenital renal diseases. Renal measurements were made by ultrasonography in 500 healthy newborn infants. Two dependent variables( kidney length and depth ) were measured, together with three independent variables( birth weight, height, head circumference, chest circumference and gestational age). The right kidney size was 3.98+/-0.482cm x 1.98+/-0.288cm(mean+/-standard deviation, length x depth), and the left kidney size was 4.02+/-0.504cm x 1.89+/-0.299cm. The left kidney had long length and short depth compared with right kidney. The mean difference of both kidneys was 0.39+/-0.323cm in length and 0.25+/-0.207cm in depth. The kidney size of male infants was larger than that of female infants in length and depth of both kidneys. There was significant difference in kidney length and depth for birth weight and height(P < 0.01 ). The regression equation was: length(cm) = 0.266 x birth weight (kg) + 3.12, depth(cm) =0.144 x birth weight(kg) + 1.46.

The Normal Renal Size of Korean Children: Radiologic Estimation / 대한비뇨기과학회지

A nephropathy following urinary tract infection is usually referred to as renal scarring. The main radiologic features are an overall reduction in the size of the kidney, with coarse scar, deformity of calyces and indentation of the surface. If adequately treated, the progressive renal scarring by urinary tract infection could be prevented. Therefore, the early radiologic detection of renal damage following urinary tact infection or vesicoureteral reflux is great importance for the evaluation of the pathogenesis of renal scarring and for the planning of the therapy. To evaluate the renal damage, we must have the normal data of the kidneys. Many reports discussed the renal size in normal children, but there are no reports in the Korean children. We estimate the renal length, width, several focal parenchymal thicknesses for renal size evaluation and segmental lumbar vertebral length at the intravenous pyelography in the normal Korean children. And the linear equations are obtained by the regression analysis between the various renal parameters and segmental vertebral length. Thereafter we make out the nomogram by the obtained equations. The renal length and width are highly correlated to the segmental lumbar vertebral length than various renal parenchymal thicknesses. These result suggest that the renal length and width are reliable parameters for normal renal size evaluation in growing kidney. And then the obtained equations and normograms might be useful in the diagnosis of parenchymal loss in early scarring and follow-up.

Roentgenographic Measurement of Normal Kidney Size in Korean Children / 대한비뇨기과학회지

The kidney sizes including length, with and cortical thickness were measured on IVP of normal kidney in 366 Korean children according to age Height of L2 vertebra and distance between top of L1 vertebra to bottom of L4 vertebra ware also measured simultaneously and then correlated with kidney sizes. At first this report was aimed to provide the normal value of kidney size in Korean children which is often decisive to evaluate the renal status, but in addition game interesting dates were obtained through this study. 1. The kidney size which was 6.5-6.6cm. in length and 3.3-3.5cm in width at age 1 had rapid growth in age 1 and 2 and then relatively constant growing rate, so that at age 15 11.7-12.1cm. and 6.3-6.5cm. in size were gained. This was under 1cm. smaller size than that of Korean adults. At each age group the normal variation was 1 -3cm. deviation from the mean. 2. Comparing with the western authors the kidney size of Korean children was very similar to that of western children 3. The kidney index, width venous length, was constant at any age with the ratio 0.49-0.52 on Rt. side 2nd 0.5-0.55 on Lt side. 4. Kidney cortical thickness which was 1.7cm at upper pole and 1.4cm. at mid portion at age 1, increased constantly upto 2.9cm. and 2.2cm. at upper 15. In each age group the index, cortical thickness versus width, was 0.3-0.4 invariably. In consideration of this result with the length-width index the calyopelvic system growth might be more greater than that of kidney cortex. 5. Kidney mean length was a little more longer than the distance between L1 and L4 under age 2, but tended to be shorter than L1-L4 distance except the age 3-5 in which both were very similar, so that kidney length became 2.1-2.5cm shorter at age 15. 6. Mid cortical thickness was very similar to the height of L2 vertebral body under the age 10, while in age above 10 the height of the vertebra L2 was more greater so that became similar to the upper cortical thickness.

A Study on Measurement of Kidney Size by Ultrasonogram and Computerized Tomography / 대한비뇨기과학회지

Though ultrasonogram has many advantages, including no ionizing radiation, the non-invasive character of procedure, the rapidity of study and economy, it is used for complementing modality yet due to the in accuracy of image. Previously in our department of Urology, the report on "A Study on Measurement of Kidney Size by Ultrasonography in Normal Kidney and Hydronephrosis of Korean Adults" had been published. It is an important indicator to measure the renal size and parenchymal depth accurately for indicator of nephrectomy. The author measured the size of the kidney longitudinally, transversely and parenchymal depth by ultrasonogram and computerized tomography (CT) compared with that of excretory urogram in 22 kidneys without hydronephrosis and 15 kidneys with hydronephrosis. In the same method, the kidney was measured by ultrasonogram and CT compared with postoperative specimen in 5 nonvisualized kidneys. The results were obtained as follows 1. Among the 22 kidneys without hydronephrosis, the length and width of the kidney on ultrasonogram (11.2 ( 0.67cm, 5.7( 0,58cm) were very similar to CT (11. 1 ( 0.53cm, 5.5( 0.54 cm) . Among the 9 kidneys with hydronephrosis, the size of the kidney on ultrasonogram were similar to CT 2. Among the 22 kidneys without hydronephrosis, the parenchymal depth of the kidney on ultrasonogram (2.0 ( 0.66cm) was smaller than on CT (2.4 (0.47cm) and the difference was 0.4cm. Among the 9 kidneys with hydronephrosis, the difference was 0.3cm. 3. In comparison with 5 kidneys of the specimen, the length and width of the kidney on ultrasonogram and CT were similar to the specimen. The parenchymal depth of the kidney on CT was similar to the specimen( mean error rate 7 29 (0.18% , correlation coefficient 0.97, P <0.005) but ultrasonogram was much different from the specimen (mean error rate 19.99 ( 6.45% , correlation coefficient 0.94, P <0.005) . By reviewing the above results, CT is more informative and accurate in evaluation of the renal size and parenchymal depth than other modalities, such as excretory urogram or ultrasonogram.

A Study on Measurement of Kidney Size by Ultrasonography in Normal Kidney and Hydronephrosis of Korean Adults / 대한비뇨기과학회지

Advances in gray scale ultrasonography have increased the usefulness of their modality in the clinical diagnostic method. Major improvements in the image resolution have greatly increased the diagnostic value of renal ultrasonography. The non-invasive and safe nature of ultrasound makes this technique ideal for accurate and quick evaluation. It has been well known facts that it is very difficult to obtain precise size, shape parenchymal thickness of the kidneys by conventional radiological techniques such as retrograde pyelography, antegrade percutaneous pyelography or arteriography and also the techniques are invasive to patients comparatively. Because of its simplicity, innocuousness and accurateness, diagnostic ultrasound is quite useful in the evaluation of functionally inactive kidney and should precede or be substitute for other aggressive technique. In those kidneys which remain unseen even after massive dose of dye, the ultrasound scan should be used before retrograde ureteral catheterization is undertaken. The author measured the size of kidney longitudinally, transversely and in thickness by ultrasonogram and compared with that of excretory urogram in 60 normal healthy persons and 32 cases of hydronephrosis. The results were obtained as follows: 1. The length of right kidney on ultrasonogram (11.4+/-0.55 cm) was smaller than on excretory urogram (12.2+/-0.45 cm) and the difference was 0.8 cm (t value: 2.21, p<0.02), and the length of left kidney on ultrasonogram (11.9+/-0.42 cm) was smaller than on excretory urogram (12.6+/-0.78 cm) and the difference was 0.7 cm (t value: 2.43. p<0.02). The width of right kidney on ultrasonogram (5.4+/-0.57 cm) was smaller than on excretory urogram (6.3+/-0.61 cm) and the difference was 0.9 cm (t value: 1.75, p<0.1) and the width of left kidney on ultrasonogram (5.6+/-0.58 cm) was smaller than on excretory urogram (6.3+/-0.49 cm) and the difference was 0.7 cm (t value: 1.82, p<0.1). The parenchymal depth of right kidney on ultrasonogram (2.2+/-0.48 cm) was larger than on excretory urogram (2.1+/-0.56 cm) and the difference was 0.1 cm (t value: 2.89, p<0.001), and the parenchymal depth of left kidney on ultrasonogram (2.1+/-0.54 cm) was alike on excretory urogram (2.1+/-0.57 cm) and there was no difference (t value: 2.31, p<0.05). 2. Among the 32 cases of hydronephrosis. 17 cases of hydronephrosis could be diagnosed by excretory urogram. In mild hydronephrosis, the length of kidney on ultrasonogram (12.2+/-0.56 cm) was smaller than on excretory urogram (12.8+/-0.46 cm) and the difference was 0.6 cm, the width of kidney on ultrasonogram (6.1+/-0.27 cm) was smaller than on excretory urogram (6.4+/-0.38 cm) and the difference was 0.3 cm, and the parenchymal depth of kidney on ultrasonogram (2.1+/-0.34 cm) was alike on excretory urogram (2.1+/-0.49 cm) and there no difference. In moderate hydronephrosis, the length of kidney on ultrasonogram(13.5+/-0.47 cm) was smaller than on excretory urogram(14.2+/-0.67 cm)and the difference was 0.7cm, the width of kidneys no ultrasonogram(7.2+/-0.58 cm) was smaller than on excretory urogram(7.8+/-0.73 cm) and the difference was 0.6cm, and the parenchymal depth of kidney on ultrasonogram(1.2+/-0.57 cm) was smaller than on excretory urogram(1.47+/-0.27 cm)and the difference was 0.2 cm. In severe hydronephrosis, the length of kidney on ultrasonogram(15.7+/-0.39 cm)was smaller than on excretory urogram(16.6+/-0.53 cm) and the difference was 0.9cm, the width of kidney on ultrasonogram(8.8+/-0.46 cm) was smaller than on excretory urogram(9.5+/-0.48 cm)and the difference was 0.7 cm, and the parenchymal depth of kidney on ultrasonogram was 0.7+/-0.27 cm but could not be measured on excretory urogram. 3. Among 32 cases of hydronephrosis,15 cases of hydronephrosis were non-visualized kidney on excretory urogram. On them, the renal sized and parenchymal depth were measured accurately by ultrasonography. By reviewing the above results, the ultrasonography of kidney is useful in measurement of kidney size and can be substitute for invasive uroradiological methods in evaluation of patients with hydronephrosis.