Sonographic nomogram of paediatric renal size in Pusat Perubatan Universiti Kebangsaan Malaysia (PPUKM)

@#Introduction: A person’s childhood is an important period of growth, and also one’s most vulnerable, as one can be exposed to various pathologies, for example those that could affect the growth of one’s kidney. Asians are physiologically different from Caucasians, and the nomogram renal size obtained from a Western population (mostly of Caucasians) is not be suitable for representing Asian children. As such a nomogram on paediatric renal size derived from Malaysia is needed. Methods: A total of 109 (64 males and 45 females) aged 0-12 in Pusat Perubatan Universiti Kebangsaan Malaysia (PPUKM) took part in this study. They underwent ultrasonography of both kidneys, and their demographic and anthropometric data were collected. The mean and standard deviations of the renal length and renal volume according to their age groups was calculated, and the final data was compared to the ones reported by Rosenbaum et al. (1984). Result: Body weight and Body Surface Area (BSA) of the children reported the strongest correlation with renal size. Significant differences were found between local and the data from Rosenbaum et al (1984). A nomogram on paediatric renal size based on children in PPUKM was then created. Discussion: Ultrasonography is regarded as the standard method for determining renal size. Body weight and BSA were both strongly correlated with renal size. It was shown that the widely used nomograms derived from data obtained from Caucasian was not suitable to represent the population of Malaysian children.

Renal Dimensions Measurements: Accuracy And Repeatability Of Sonographic Compared With That Of 64-slice Multidetector Computed Tomography

Renal size like length measured by ultrasound and volume measured by CT could be used to monitor the progressof chronic kidney diseases. Multi-Slice Computed Tomography (MSCT) has a growing importance in the evaluationof Kidney morphology and its vessels. But there is a risk of contrast media-induced nephropathy and exposure toradiation. Volume measured by CT is better than the length measured by CT.

Sonographic biometry of normal kidney dimensions among school-age children in Nsukka, Southeast Nigeria / Biometría sonográfica de las dimensiones normales del riñón entre niños de edad escolar en Nsukka, Sureste de Nigéria

BACKGROUND: Some kidney diseases are usually associated with changes in kidney size. OBJECTIVE: To determine sonographically the normal limits and percentile curves of the kidney dimensions according to age, gender and somatometric parameters among school-age children. METHODS: A prospective cross-sectional research design and convenience sampling method were utilized. Participants included 947 normal subjects (496 boys and 451 girls) aged 6-17 years old. The sonographic examination was performed on a Shenzhen DP-1100 machine with 3.5 MHz convex transducer. Longitudinal and transverse dimensions of the kidneys were obtained in coronal plane with the subject in the supine or left lateral decubitus position. RESULTS: The means of right and left kidney lengths in mm were 79.6 ± 8.1 and 81.6 ± 8.3, respectively while those of the right and left kidney widths in mm were 35.03 ± 3.6 and 35.09 ± 3.6, respectively. Dimensions of the kidneys were not statistically different in boys and girls (p > 0.05). There was a statistically significant difference between right and left kidney length (p < 0.05). Height correlated best with both kidney lengths. Thus the normal limits, prediction models and percentile curves of kidney lengths were established with respect to height. CONCLUSION: Sonographic determination of pathologic changes in the size of the kidney necessitates knowing the normal ranges of its length especially with respect to height in school-age children.

ANTECEDENTES: Algunas enfermedades renales se asocian generalmente a cambios en el tamaño del riñón. OBJETIVO: Determinar sonográficamente los límites normales y las curvas percentiles de las dimensiones del riñón según edad, género y parámetros somatométricos entre niños en edad escolar. MÉTODOS: Se utilizó un diseño de investigación transversal prospectivo y un método de muestreo de conveniencia. Los participantes incluyeron 947 sujetos normales (496 niños y 451 niñas) de 6-17 años de edad. El examen sonográfico fue realizado con un equipo Shenzhen DP-1100 con transductor convexo de 3.5 MHz. Las dimensiones longitudinales y transversales de los riñones fueron obtenidas en el plano coronal con el sujeto en posición supina o decúbito lateral izquierdo. RESULTADOS: Los promedios de las longitudes de los riñones derechos e izquierdos en mm fueron 79.6 ± 8.1 and 81.6 ± 8.3, respectivamente, mientras que los de las anchuras de los riñones derechos e izquierdos en mm fueron 35.03 ± 3.6 and 35.09 ± 3.6, respectivamente. Las dimensiones de los riñones no fueron estadísticamente diferentes en los niños y las niñas (p > 0.05). Hubo una diferencia estadísticamente significativa entre la longitud del riñón derecho y el izquierdo (p < 0.05). La altura guardó una mejor correlación con ambas longitudes del riñón. Así los límites normales, los modelos de predicción y las curvas percentiles de las longitudes del riñón, fueron establecidas con respecto a la altura. CONCLUSIÓN: La determinación sonográfica de los cambios patológicos en el tamaño del riñón requiere que se conozcan los rangos normales de su longitud, especialmente con respecto a la altura, en los niños en edad escolar.

Individual influencing factors of the normal adult kidney size / 中华健康管理学杂志

Objective To explore the relationship between the size of the kidney and gender,age,height,weight,waist circumference then derive an estimation formula of a normal kidney size for different people.Methods We investigated 1 000 normal cases who accepted the examination in Tianjin Medical University General Hospital from December 2011 to April 2012,including 462 males,538 females,aged 21-78 years.All the investigated subjects were healthy except for hypertension,diabetes,coronary heart disease.Blood urea nitrogen (BUN) and creatinine (Cr),fasting glucose,uric acid,routine urine test were all in the normal range.Height,weight,and waist circumference were measured for all the subjects.The renal length and transverse diameter in supine coronal sections,anteroposterior diameter in vertical cross-section of the renal hilum were measured by the same technical experts with Philip iU22 C5-1,3.5 MHz convex array probe.Results The right and left kidney size both are significantly related to height (right r=0.845,left r=0.876,P＜0.01).By multiple regression analysis,there was a significant association between height,weight,body surface area and kidney size (R2＞0.5).Linear regression formula for the kidney length and the height(H,cm):Kidney length of men:right 0.059×H+0.144; left:0.061 ×H+0.287.Kidney length of women:right 0.039×H+3.679; left:0.035×H+4.454.Regardless of gender,the formula of left kidney length:0.052× H+0.721.Linear regression formula about the left kidney length and the height,body weight and body surface area (unit:H cm,W kg,BSA m2):0.114×H+0.139×W-10.287×BSA+2.112.Conclusion There is the best correlation between kidney length and height.Height,weight,body surface area have great influence on kidney size.

Sexual hormones modulate compensatory renal growth and function / Las hormonas sexuales modulan el crecimiento renal compensador (CRC) y la función renal en la uninefrectomía (uNx)

The role played by sexual hormones and vasoactive substances in the compensatory renal growth (CRG) that follows uninephrectomy (uNx) is still controversial. Intact and gonadectomized adult Wistar rats of both sexes, with and without uNx, performed at 90 days age, were studied at age 150 days. Daily urine volume, electrolyte excretion and kallikrein activity (UKa) were determined. Afterwards, glomerular filtration rate and blood pressure were measured, the kidneys weighed and DNA, protein and RNA studied to determine nuclei content and cell size. When the remnant kidney weight at age 150 days was compared with the weight of the kidney removed at the time of uNx, male uNx rats showed the greatest CRG (50%) while growth in the other uNx groups was 25%, 15% and 19% in orchidectomized, female and ovariectomized rats, respectively. The small CRG observed in the uNx female rats was accompanied by the lowest glomerular filtration value, 0.56 ± 0.02 ml/min/g kwt compared, with the other uNx groups, p < 0.05. Cell size (protein or RNA/DNA) was similar for all the groups except for uNx orchidectomized rats. In this group the cytoplasmatic protein or RNA content was lower than in the other groups while DNA (nuclei content) was similar. Some degree of hyperplasia was determined by DNA content in the uNx groups. Male sexual hormones positively influenced CRG and its absence modulated cell size. Female sexual hormones, instead, did not appear to stimulate CRG. The kallikrein kinin system may not be involved in CRG.

La importancia que pueden tener las hormonas sexuales y sustancias vasoactivas sobre el crecimiento renal compensador (CRC) que sigue a la uninefrectomía es aún materia de debate. Se estudiaron ratas Wistar de ambos sexos, a los 150 días de vida, intactas y gonadectomizadas con y sin uNx, realizada a los 90 días de vida. Se midió volumen urinario diario y excreción de electrolitos y actividad de kalikreína urinaria. Se midió filtrado glomerular y presión arterial media extrayéndose luego los riñones que fueron pesados y preparados para estudios histológicos y determinación de ADN, ARN y proteínas para estimar contenido nuclear y tamaño celular. El CRC fue calculado comparando el peso del riñón al momento de las uNx (90 dias de vida) con aquel obtenido a los 150 días de vida. En las ratas macho uNx se observó el mayor CRC (50%) mientras que, en los otros grupos uNx solo alcanzó un 25%, 15% y 19%. El filtrado glomerular acompañó los cambios morfológicos observándose el menor filtrado en las ratas hembras uNx respecto al resto de los grupos 0.56 ± 0.02, p < 0.05. El tamaño celular (proteína o ARN/ ADN) fue similar para todos los grupos excepto para los orquidectomizados uNx, cuyo contenido citoplasmático fue menor. El contenido nuclear (ADN) fue semejante en todos los grupos. Se observó que el CRC está influenciado positivamente por las hormonas sexuales masculinas y su ausencia modula el tamaño celular. La falta de hormonas sexuales femeninas, en cambio, afecta negativamente el CRC. El sistema kalikreína kinina no parecería estar involucrado en el CRC.

Doença parenquimatosa renal: correlação histológico-sonográfica / Renal parenchymal disease: histopathologic-sonographic correlation

OBJETIVO: Este estudo foi planejado para avaliar a correlação da ecografia do rim com as lesões histológicas e com os achados clínico-laboratoriais na doença parenquimatosa renal, por análise de regressão logística multivariada. MÉTODOS: Os dados clínicos, laboratoriais, ecográficos e as biópsias foram avaliados em 154 pacientes. A ecogenicidade cortical foi graduada como menor que grau zero, igual a grau um ou maior que grau dois a do parênquima hepático ou esplênico. As lesões histológicas - proliferação mesangial (PM), permeação leucocitária (PL), crescente e necrose fibrinóide (CNF), infiltrado inflamatório intersticial (II), esclerose glomerular segmentar (ES), obsolescência glomerular (OG), atrofia tubular (AT), fibrose intersticial (FI) e edema intersticial (EI) - foram graduadas de acordo com a extensão, em normal (0 por cento), leve (<25 por cento), moderada (>25 por cento <50 por cento), e grave (>50 por cento). RESULTADOS: a) II, FI, ES, EI e creatinina elevada ocorreram menos no grau 0 de ecogenicidade cortical; b) PM, hipertensão arterial e espessura normal do parênquima foram preditores do grau 1 de ecogenicidade cortical; c) FI, EI, creatinina elevada e parênquima fino foram preditores do grau 2 de ecogenicidade cortical; d) Excluindos os obesos, em jovens com hematócrito baixo, a pirâmide proeminente foi mais comum; e) Creatinina elevada e OG foram preditores de rins pequenos. CONCLUSÃO: A ecogenicidade cortical foi um sensível marcador de doença parenquimatosa renal. Lesões distintas mais do que o grau de severidade da lesão contribuiram para o aumento da ecogenicidade cortical. O EI aumenta exponencialmente o efeito da FI na ecogenicidade cortical.

PURPOSE: This study was designed to address the correlation between sonography of a kidney with histological lesions and clinical findings in patients with renal parenchymal disease based on a multivariate logistic regression analysis. METHODS: Clinical and laboratory data, sonograms and renal biopsies were evaluated in 154 patients. Cortical echogenicity was graded as less than (0), equal to (1) or greater than (2) liver/spleen parenchyma. Histological lesions - mesangial proliferation (MP), leukocyte permeation (LP), fibrinoid necrosis and crescents (FNC), interstitial infiltrate (II), segmental glomerular sclerosis (SGS), glomerular obsolescence (GO), tubular atrophy (TA) interstitial fibrosis (IF) and interstitial edema (IE) - were graded according to extension and severity as normal (0 percent), mild (<25 percent), moderate (>25 percent <50 percent), and severe (>50 percent). RESULTS: a) II, IF, SGS, IE and increased creatinine occurred less in cortical echogenicity grade 0; b) MP, arterial hypertension and normal parenchymal thickness predict cortical echogenicity grade 1; c) IF, IE, increased creatinine and thin parenchyma predict occurrence of echogenicity grade 2; d) Excluding obese patients, both youth and hematocrit accounted for pyramid prominence; e) increased creatinine and GO was probable in patients with small kidneys. CONCLUSIONS: Increased cortical echogenicity was a very sensitive marker of renal parenchymal disease. Different lesions rather than degree of lesion severity accounted for progressive increase of cortical echogenicity. IE exponentially increased the effect of IF on cortical echogenicity.

Ultrasonographic evaluation of renal dimension and resistive index in clinically healthy Korean domestic short-hair cats

Renal length, height, width, resistive index (RI), size of cortex, and medulla were determined by renal ultrasonography in 50 healthy Korean domestic short-hair cats. In the sagittal plane, the renal length was 3.83 +/- 0.51 cm (mean +/- SD) in the left kidney and 3.96 +/- 0.48 cm in the right kidney, whereas the renal height was 2.42 +/- 0.27 cm in the left kidney and 2.36 +/- 0.28 cm in the right kidney. In the transverse plane, the renal height was 2.42 +/- 0.28 cm in the left kidney and 2.38 +/- 0.27 cm in the right kidney, whereas the renal width was: 2.65 +/- 0.35 cm in the left kidney and 2.63 +/- 0.31 cm in the right kidney. In the dorsal plane, the renal length was 3.84 +/- 0.53 cm in the left kidney and 3.97 +/- 0.54 cm in the right kidney, whereas the renal width was 2.65 +/- 0.34 cm in the left kidney and 2.66 +/- 0.33 cm in the right kidney. There were no significant differences (p > 0.05) among the same structure sizes measured in different planes. In the sagittal plane, the size of the renal cortex was 0.47 +/- 0.08 cm in the left kidney and 0.47 +/- 0.08 cm in the right kidney, whereas of the size of the renal medulla was 0.55 +/- 0.30 cm in the left kidney and 0.50 +/- 0.07 cm in the right kidney. RI evaluated by pulsed wave Doppler sonography was 0.52 +/- 0.05 in the left kidney and 0.55 +/- 0.05 in the right kidney. The actual renal dimensions determined by gross examination were not statistically different from those determined by ultrasonography. Furthermore the renal dimensions and RI were statistically correlated to the body weight of cats.

Changes in Renal Size by Infusion of Contrast Agent and Furosemide / 대한비뇨기과학회지

Changes in renal size by infusion of contrast agent and furosemide were studied in normal adult kidneys. Renal sizes were measured in simple, 5, 15, 25, and 45 minutes films, in Group I, which was performed IVP with Hypaque and Group II, which was performed IVP with Hypaque and furosemide infusion. 1. Kidney size Simple film : Group I : 12.22+/-0.61cm Group II : 12.19+/-0.75cm 15min. film : Group I : 12.67(0.89%) Group II : 13. 49+/-0.63cm Maximal increase in size : Group I: 0.41cm Group II : 1. 30cm 2. Possible application to unilateral renovascular disease: Enhancement of renal size difference in unilateral renovascular hypertension.