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Dabers T, Sass P, Fechner F, Weyer J, Völzke H, Mahnken AH, Lorbeer R, Mensel B, Stracke S. Age- and Sex-Specific Reference Values for Renal Volume and Association with Risk Factors for Chronic Kidney Disease in a General Population-An MRI-Based Study. J Clin Med 2024; 13:769. [PMID: 38337463 PMCID: PMC10856696 DOI: 10.3390/jcm13030769] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2023] [Revised: 01/14/2024] [Accepted: 01/15/2024] [Indexed: 02/12/2024] Open
Abstract
BACKGROUND Renal volume (RV) is associated with renal function and with a variety of cardiovascular risk factors (CVRFs). We analysed RV using magnetic resonance imaging (MRI) in a large population-based study (Study of Health in Pomerania; SHIP-TREND) to find sex- and age-specific reference values for RV and to test the influence of several markers on RV. The main objective is to describe reference values for RV in people from the general population without kidney disease. METHODS 1815 participants without kidney disease (930 women) aged 21-81 years were included in our study. Right and left RV with and without body surface area (BSA) indexation were compared among three age groups (22-39 years, 40-59 years, 60-81 years) by median and interquartile range and tested separately in women and men. RESULTS The estimated glomerular filtration rate (eGFR), serum uric acid, and right and left RV were higher in men compared to women (all p < 0.001). Left kidneys were larger than right kidneys (both sexes). With age, RV showed a continuously decreasing trend in women and an upside-down U-shaped relation in men. In multivariable linear regression models, current smoking (β = 14.96, 95% CI 12.12; 17.79), BSA (β = 97.66, 95% CI 90.4; 104.93), diastolic blood pressure (β = 0.17, 95% CI 0.01; 0.32), and eGFR (β = 0.57, 95% CI 0.50; 0.65) were positively associated with both left and right RV, whereas uric acid (β = -0.03, 95% CI -0.05; -0.01) showed an inverse association with RV. Interestingly, the same eGFR correlated with higher RV in men compared to women. CONCLUSION Reference values for RV are different for age groups and sex. For any given age, female kidneys are smaller than male kidneys. RV associates positively with eGFR, but for any chosen eGFR, renal volume in females is lower compared to males. RV decreases with age, but in men showed a U-shaped correlation. This may reflect hyperfiltration and glomerular hypertrophy associated with the presence of CVRF in middle-aged males.
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Affiliation(s)
- Thomas Dabers
- Nephrology, Internal Medicine A, University Medicine Greifswald, 17475 Greifswald, Germany; (T.D.)
- KfH Renal Center, 17475 Greifswald, Germany
| | - Peter Sass
- Nephrology, Internal Medicine A, University Medicine Greifswald, 17475 Greifswald, Germany; (T.D.)
| | - Fritz Fechner
- Nephrology, Internal Medicine A, University Medicine Greifswald, 17475 Greifswald, Germany; (T.D.)
| | - Julian Weyer
- Nephrology, Internal Medicine A, University Medicine Greifswald, 17475 Greifswald, Germany; (T.D.)
| | - Henry Völzke
- Institute for Community Medicine—SHIP Clinical-Epidemiological Research, University Medicine Greifswald, 17475 Greifswald, Germany;
| | - Andreas Horst Mahnken
- Department of Diagnostic & Interventional Radiology, Philipps-University Marburg, 35037 Marburg, Germany;
| | - Roberto Lorbeer
- Department of Radiology, University Hospital, LMU Munich, 80539 Munich, Germany;
| | - Birger Mensel
- Department of Diagnostic & Interventional Radiology, Philipps-University Marburg, 35037 Marburg, Germany;
- Department of Diagnostic and Interventional Radiology and Neuroradiology, Central Hospital Bad Berka, 99438 Bad Berka, Germany
| | - Sylvia Stracke
- Nephrology, Internal Medicine A, University Medicine Greifswald, 17475 Greifswald, Germany; (T.D.)
- KfH Renal Center, 17475 Greifswald, Germany
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2
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Thanaj M, Basty N, Cule M, Sorokin EP, Whitcher B, Srinivasan R, Lennon R, Bell JD, Thomas EL. Kidney shape statistical analysis: associations with disease and anthropometric factors. BMC Nephrol 2023; 24:362. [PMID: 38057740 PMCID: PMC10698953 DOI: 10.1186/s12882-023-03407-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2023] [Accepted: 11/22/2023] [Indexed: 12/08/2023] Open
Abstract
BACKGROUND Organ measurements derived from magnetic resonance imaging (MRI) have the potential to enhance our understanding of the precise phenotypic variations underlying many clinical conditions. METHODS We applied morphometric methods to study the kidneys by constructing surface meshes from kidney segmentations from abdominal MRI data in 38,868 participants in the UK Biobank. Using mesh-based analysis techniques based on statistical parametric maps (SPMs), we were able to detect variations in specific regions of the kidney and associate those with anthropometric traits as well as disease states including chronic kidney disease (CKD), type-2 diabetes (T2D), and hypertension. Statistical shape analysis (SSA) based on principal component analysis was also used within the disease population and the principal component scores were used to assess the risk of disease events. RESULTS We show that CKD, T2D and hypertension were associated with kidney shape. Age was associated with kidney shape consistently across disease groups. Body mass index (BMI) and waist-to-hip ratio (WHR) were also associated with kidney shape for the participants with T2D. Using SSA, we were able to capture kidney shape variations, relative to size, angle, straightness, width, length, and thickness of the kidneys, within disease populations. We identified significant associations between both left and right kidney length and width and incidence of CKD (hazard ratio (HR): 0.74, 95% CI: 0.61-0.90, p < 0.05, in the left kidney; HR: 0.76, 95% CI: 0.63-0.92, p < 0.05, in the right kidney) and hypertension (HR: 1.16, 95% CI: 1.03-1.29, p < 0.05, in the left kidney; HR: 0.87, 95% CI: 0.79-0.96, p < 0.05, in the right kidney). CONCLUSIONS The results suggest that shape-based analysis of the kidneys can augment studies aiming at the better categorisation of pathologies associated with chronic kidney conditions.
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Affiliation(s)
- Marjola Thanaj
- Research Centre for Optimal Health, School of Life Sciences, University of Westminster, London, UK.
| | - Nicolas Basty
- Research Centre for Optimal Health, School of Life Sciences, University of Westminster, London, UK
| | | | | | - Brandon Whitcher
- Research Centre for Optimal Health, School of Life Sciences, University of Westminster, London, UK
| | | | - Rachel Lennon
- Wellcome Centre for Cell-Matrix Research, Division of Cell-Matrix Biology and Regenerative Medicine, School of Biological Sciences, Faculty of Biology Medicine and Health, Manchester Academic Health Science Centre, The University of Manchester, Manchester, UK
- Department of Paediatric Nephrology, Royal Manchester Children's Hospital, Manchester University Hospitals NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, UK
| | - Jimmy D Bell
- Research Centre for Optimal Health, School of Life Sciences, University of Westminster, London, UK
| | - E Louise Thomas
- Research Centre for Optimal Health, School of Life Sciences, University of Westminster, London, UK
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Kidney Perfusion in Contrast-Enhanced Ultrasound (CEUS) Correlates with Renal Function in Living Kidney Donors. J Clin Med 2022; 11:jcm11030791. [PMID: 35160243 PMCID: PMC8836871 DOI: 10.3390/jcm11030791] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2021] [Revised: 01/28/2022] [Accepted: 01/30/2022] [Indexed: 01/22/2023] Open
Abstract
Contrast-enhanced ultrasound (CEUS) is a widely used diagnostic tool for analyzing perfusion and characterizing lesions in several organs. However, to date, it has not been sufficiently investigated whether there is an association between CEUS findings and kidney function. This study aimed at identifying the potential relationship between kidney function and the renal perfusion status determined by CEUS in living kidney donors. A total of 30 living kidney donors examined between April 2018 and March 2020 were included in the study. All patients underwent various diagnostic procedures for evaluation of renal function. CEUS was performed in all 30 donors one day before nephrectomy. Kidney perfusion was quantified using a postprocessing tool (VueBox, Bracco Imaging). Various perfusion parameters were subsequently analyzed and compared with the results of the other methods used to evaluate kidney function. Of all parameters, mean signal intensity (MeanLin) had the strongest correlation, showing significant correlations with eGFR (CG) (r = −0.345; p = 0.007) and total kidney volume (r = −0.409; p = 0.001). While there was no significant correlation between any perfusion parameter and diethylenetriaminepentaacetic acid (DTPA), we detected a significant correlation between MeanLin and DTPA (r = −0.502; p = 0.005) in the subgroup of normal-weight donors. The results indicate that signal intensity in CEUS is associated with kidney function in normal-weight individuals. Body mass index (BMI) may be a potential confounder of signal intensity in CEUS. Thus, more research is needed to confirm these results in larger study populations.
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Torreggiani M, Esposito C, Martinelli E, Jouve T, Chatrenet A, Rostaing L, Colucci M, Pasquinucci E, Sileno G, Esposito V, Piccoli GB, Malvezzi P. Outcomes in Living Donor Kidney Transplantation: The Role of Donor's Kidney Function. Kidney Blood Press Res 2021; 46:84-94. [PMID: 33592619 DOI: 10.1159/000512177] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2020] [Accepted: 10/08/2020] [Indexed: 11/19/2022] Open
Abstract
INTRODUCTION Living donor kidney transplant (LDKT) is one of the best therapeutic options for end-stage kidney disease (ESKD). Guidelines identify different estimated glomerular filtration rate (eGFR) thresholds to determine the eligibility of donors. The aim of our study was to evaluate whether pretransplant donor eGFR was associated with kidney function in the recipient. METHODS We retrospectively studied LDKT recipients who received a kidney graft between September 1, 2005, and June 30, 2016 in the same transplant center in France and that had eGFR data available at 3, 12, 24, and 36 months posttransplant. RESULTS We studied 90 donor-recipient pairs. The average age at time of transplant was 51.47 ± 10.95 for donors and 43.04 ± 13.52 years for recipients. Donors' average eGFR was 91.99 ± 15.37 mL/min/1.73 m2. Donor's age and eGFR were significantly correlated (p < 0.0001, r2 0.023). Donor's age and eGFR significantly correlated with recipient's eGFR at 3, 12, and 24 months posttransplant (age: p < 0.001 at all intervals; eGFR p = 0.001, 0.003, and 0.016, respectively); at 36 months, only donor's age significantly correlated with recipient's eGFR. BMI, gender match, and year of kidney transplant did not correlate with graft function. In the multivariable analyses, donor's eGFR and donor's age were found to be associated with graft function; correlation with eGFR was lost at 36 months; and donor's age retained a strong correlation with graft function at all intervals (p < 0.001). CONCLUSIONS Donor's eGFR and age are strong predictors of recipient's kidney function at 3 years. We suggest that donor's eGFR should be clinically balanced with other determinants of kidney function and in particular with age.
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Affiliation(s)
| | - Ciro Esposito
- Unit of Nephrology and Dialysis, ICS Maugeri S.p.A., Pavia, Italy.,Dipartimento di Medicina Interna e Terapia Medica, Università di Pavia, Pavia, Italy
| | - Elena Martinelli
- Dipartimento di Medicina Interna e Terapia Medica, Università di Pavia, Pavia, Italy
| | - Thomas Jouve
- Service de Néphrologie, Hémodialyse, Aphérèses et Transplantation, Centre Hospitalier Universitaire Grenoble Alpes, Grenoble, France.,Université Grenoble Alpes, Grenoble, France
| | - Antoine Chatrenet
- Nephrology and Dialysis, Centre Hospitalier Le Mans, Le Mans, France
| | - Lionel Rostaing
- Service de Néphrologie, Hémodialyse, Aphérèses et Transplantation, Centre Hospitalier Universitaire Grenoble Alpes, Grenoble, France.,Université Grenoble Alpes, Grenoble, France
| | - Marco Colucci
- Unit of Nephrology and Dialysis, ICS Maugeri S.p.A., Pavia, Italy
| | - Ettore Pasquinucci
- Unit of Nephrology and Dialysis, ICS Maugeri S.p.A., Pavia, Italy.,Dipartimento di Medicina Interna e Terapia Medica, Università di Pavia, Pavia, Italy
| | - Giuseppe Sileno
- Unit of Nephrology and Dialysis, ICS Maugeri S.p.A., Pavia, Italy
| | | | - Giorgina B Piccoli
- Nephrology and Dialysis, Centre Hospitalier Le Mans, Le Mans, France.,Dipartimento di Scienze Cliniche e Biologiche, Università di Torino, Torino, Italy
| | - Paolo Malvezzi
- Service de Néphrologie, Hémodialyse, Aphérèses et Transplantation, Centre Hospitalier Universitaire Grenoble Alpes, Grenoble, France
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5
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Akoh JA, Schumacher KJ. Living kidney donor assessment: Kidney length vs differential function. World J Transplant 2020; 10:173-182. [PMID: 32742950 PMCID: PMC7360526 DOI: 10.5500/wjt.v10.i6.173] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/24/2020] [Revised: 05/19/2020] [Accepted: 05/21/2020] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND The key question in living kidney donor assessment is how best to determine the contribution of each kidney to overall renal function and guide selection of which kidney to donate, ensuring safety of procedure and good outcome for both recipient and donor. It is thought that a length difference > 2 cm may indicate significant difference in function and therefore need for measurement of differential function. AIM To determine the effect of using kidney length to decide which kidney to donate in a retrospective cohort of potential donors. METHODS All 333 potential living kidney donors between January 2009 and August 2018 who completed assessment were retrospectively evaluated. Donor assessment was performed as per United Kingdom guidelines. Data included age, sex, kidney length (cranio-caudal) obtained by computed tomography/ultrasono-graphy,51-chromium ethylenediamine tetraacetatic acid measured glomerular filtration rate, mercapto acetyl tri glycine split function and vascular anatomy. There were 48 exclusions due to inadequate data or incomplete investigations. Statistical analysis was performed using Excel pivot tables and GraphPad Prism. Correlation between kidney length and differential function was determined with Pearson's correlation coefficient. RESULTS Of 285 potential donors included in the study, there were 144 males (mean age 49.9 ± 14.75) and 141 females (mean age 51.2 ± 11.23). Overall, the Pearson's correlation between differences in length and divided function of kidney pairs was 0.1630, P = 0.0058. Of 73 with significant difference (> 10%) in divided function, 18 (24.7%) had no difference in kidney length; 54 (74%) had a difference of < 2 cm and only one of > 2 cm. Using a length difference of > 1 cm would only predict significant difference in divided function in 8/34 (23.5%) of cases. Using a difference of > 2 cm as cut off for performing split function would lead to false reassurance in 72 patients (6 had > 20% difference in divided function whereas 66 had 10%-20% difference). CONCLUSION Length difference between kidney pairs alone is not sufficient to replace measurement of divided function. This issue requires a randomised controlled trial to resolve it.
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Affiliation(s)
- Jacob A Akoh
- Department of Surgery, Derriford Hospital, University Hospitals Plymouth NHS Trust, Plymouth PL6 8DH, Devon, United Kingdom
- South West Transplant Centre, Derriford Hospital, University Hospitals Plymouth NHS Trust, Plymouth PL6 8DH, Devon, United Kingdom
| | - Katharina J Schumacher
- Department of Surgery, Derriford Hospital, University Hospitals Plymouth NHS Trust, Plymouth PL6 8DH, Devon, United Kingdom
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6
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Kim JK, Lorenzo AJ, Farhat WA, Chua ME, Ming JM, Dos Santos J, Koyle MA. A comparison of post-transplant renal function in pre-emptive and post-dialysis pediatric kidney transplant recipients. Pediatr Transplant 2019; 23:e13377. [PMID: 30735602 DOI: 10.1111/petr.13377] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/03/2018] [Revised: 01/14/2019] [Accepted: 01/18/2019] [Indexed: 11/30/2022]
Abstract
PURPOSE Little is known regarding post-transplant renal function following pediatric pre-emptive KT. Therefore, this study aims to determine whether there is a difference in 1 year post-transplant renal function outcomes between pre-emptive and post-dialysis KT in pediatric transplant recipients. METHODS A retrospective review of patients who underwent kidney transplant at our institution between 2000 and 2015 was performed. Kidney transplant recipients were divided into four groups: pre-DD, post-DD, pre-LD, and post-LD. The clinical outcomes, measured in eGFR (mL/min/1.73 m2 ), acute rejection episodes within 1 year, and hospitalization within 1 year were compared to between groups in their respective donor types (pre-DD vs post-DD; pre-LD vs post-LD). RESULTS The 324 patients were identified (21 pre-DD, 151 post-DD, 54 pre-LD, and 98 post-LD). Post-DD group had more females (P = 0.018) and post-operative complications (P = 0.023), although there was no difference in complications requiring intervention (P = 0.129). Post-LD patients were more likely to be females (P = 0.017) and those with intrinsic renal (non-urological/structural) ESRD etiology (P = 0.003). The 1-year eGFR was similar between pre-DD and post-DD groups (70.3 [IQR 53.5-88.5] vs 74.3 [IQR 62.3-90.5], P = 0.613), as well as pre-LD and post-LD groups (66.6 [IQR 47.8-73.7] vs 63.9 [IQR 55.0-77.1], P = 0.600). There were no significant differences in rates of acute rejection episodes or hospitalization within 1 year of transplantation for in LD/DD groups. CONCLUSION There is no significant difference in renal function at 1 year post-transplant in pediatric patients receiving pre-emptive or post-dialysis kidney transplants.
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Affiliation(s)
- Jin K Kim
- Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada.,Division of Urology, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Armando J Lorenzo
- Division of Urology, The Hospital for Sick Children, Toronto, Ontario, Canada.,Department of Surgery, University of Toronto, Toronto, Ontario, Canada
| | - Walid A Farhat
- Division of Urology, The Hospital for Sick Children, Toronto, Ontario, Canada.,Department of Surgery, University of Toronto, Toronto, Ontario, Canada
| | - Michael E Chua
- Department of Surgery, University of Toronto, Toronto, Ontario, Canada.,nstitute of Urology, St. Luke's Medical Center, Quezon City, Philippines
| | - Jessica M Ming
- Department of Surgery, University of Toronto, Toronto, Ontario, Canada.,Department of Surgery, University of New Mexico, Albuquerque, NM, USA
| | - Joana Dos Santos
- Division of Urology, The Hospital for Sick Children, Toronto, Ontario, Canada.,Department of Pediatrics, University of Toronto, Toronto, Ontario, Canada
| | - Martin A Koyle
- Division of Urology, The Hospital for Sick Children, Toronto, Ontario, Canada.,Department of Surgery, University of Toronto, Toronto, Ontario, Canada
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Lizarraga-Mollinedo E, Martínez-Calcerrada JM, Padrós-Fornieles C, Mas-Pares B, Xargay-Torrent S, Riera-Pérez E, Prats-Puig A, Carreras-Badosa G, de Zegher F, Ibáñez L, Bassols J, López-Bermejo A. Renal size and cardiovascular risk in prepubertal children. Sci Rep 2019; 9:5265. [PMID: 30918295 PMCID: PMC6437212 DOI: 10.1038/s41598-019-41757-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2018] [Accepted: 03/14/2019] [Indexed: 11/21/2022] Open
Abstract
Renal size is an important parameter for the evaluation and diagnosis of kidney disease and has been associated with several cardiovascular risk factors in patients with kidney failure. These results are however discordant and studies in healthy children are lacking. We aimed to study the association between renal size (length and volume) and cardiovascular risk parameters in healthy children. Clinical, analytical and ultrasound parameters [renal length, renal volume, perirenal fat and carotid intima-media thickness (cIMT)] were determined in 515 healthy prepubertal children (176 lean, 208 overweight and 131 obese). Renal length and volume associated significantly and positively with several anthropometric and cardiovascular risk parameters including cIMT and systolic blood pressure (SBP) (all p < 0.001). Renal length and volume associated with cIMT and SBP in all study subgroups, but these associations were predominant in obese children, in whom these associations were independent after adjusting for age, gender and BSA (all p < 0.05). In multivariate analyses in the study subjects as a whole, renal length was an independent predictor of cIMT (β = 0.310, p < 0.0001) and SBP (β = 0.116, p = 0.03). Renal size associates with cIMT and SBP, independent of other well-established cardiovascular risk factors, and may represent helpful parameters for the early assessment of cardiovascular risk in children.
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Affiliation(s)
| | | | | | - Berta Mas-Pares
- Maternal-Fetal Metabolic Group, [Girona Biomedical Research Institute] IDIBGI, Salt, 17190, Spain
| | - Silvia Xargay-Torrent
- Pediatric Endocrinology Group, [Girona Biomedical Research Institute] IDIBGI, Salt, 17190, Spain
| | | | - Anna Prats-Puig
- Department of Physical Therapy, EUSES University School, Salt, 17190, Spain
| | - Gemma Carreras-Badosa
- Pediatric Endocrinology Group, [Girona Biomedical Research Institute] IDIBGI, Salt, 17190, Spain
| | - Francis de Zegher
- Department of Development & Regeneration, University of Leuven, Leuven, 3000, Belgium
| | - Lourdes Ibáñez
- Endocrinology, Pediatric Research Institute Sant Joan de Déu, 08950, Esplugues, Spain.,[Spanish Biomedical Research Centre in Diabetes and Associated Metabolic Disorders] CIBERDEM, ISCIII, Madrid, 28029, Spain
| | - Judit Bassols
- Maternal-Fetal Metabolic Group, [Girona Biomedical Research Institute] IDIBGI, Salt, 17190, Spain.
| | - Abel López-Bermejo
- Pediatric Endocrinology Group, [Girona Biomedical Research Institute] IDIBGI, Salt, 17190, Spain. .,Pediatrics, Dr. Trueta University Hospital, Girona, 17007, Spain.
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8
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Chua ME, Kim JK, Gnech M, Ming JM, Amir B, Fernandez N, Lorenzo AJ, Farhat WA, Hebert D, Dos Santos J, Koyle MA. Clinical implication of renal allograft volume to recipient body surface area ratio in pediatric renal transplant. Pediatr Transplant 2018; 22:e13295. [PMID: 30315631 DOI: 10.1111/petr.13295] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/28/2018] [Revised: 08/04/2018] [Accepted: 08/27/2018] [Indexed: 12/18/2022]
Abstract
Our study aims to assess the clinical implication of RAV/rBSA ratio in PRT as a predictor for attained renal function at 1 year post-transplantation and its association with surgical complications. A retrospective cohort was performed for PRT cases from January 2000 to December 2015 in our institution. Extracted clinical information includes the recipient's demographics, donor type, renal allograft characteristics, arterial, venous and ureteral anastomoses, vascular anastomosis time while kidney off ice, overall operative time, and estimated blood loss. The RAV/rBSA was extrapolated and assessed for its association with renal graft function attained in 1 year post-transplantation and surgical complications within 30-day post-transplantation. A total of 324 PRTs cases were analyzed. The cohort consisted of 187 (52.4%) male and 137 (42.3%) female recipients, with 152 (46.9%) living donor and 172 (53.1%) deceased donor renal transplants, and an overall median age of 155.26 months (IQR 76.70-186.98) at time of renal transplantation. The receiver operating characteristic identified that a RAV/rBSA ratio of 135 was the optimal cutoff in determining the renal graft function outcome. Univariate and multivariate analyses revealed the relative OR for RAV/rBSA ≥ 135 ratio in predicting an eGFR ≥ 90 attained within 1 year post-transplant was highest among younger pediatric recipients (<142.5 months) of deceased kidney donors (OR = 11.143, 95% CI = 3.156-39.34). Conversely, Kaplan-Meier analysis revealed that RAV/rBSA ratio ≥ 135 is associated with lower odds of having eGFR <60 (OR = 0.417, 95% CI = 0.203-0.856). The RAV/rBSA ratio was not associated nor predictive of transplant-related surgical complications. Our study determined that the RAV/rBSA ratio is predictive of renal graft function at 1-year PRT, but not associated with any increased surgical complications.
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Affiliation(s)
- Michael E Chua
- Division of Urology, The Hospital for Sick Children, Toronto, Ontario, Canada.,Institute of Urology, St. Luke's Medical Center, Quezon City, Philippines
| | - Jin Kyu Kim
- Division of Urology, The Hospital for Sick Children, Toronto, Ontario, Canada.,Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Michele Gnech
- Division of Urology, The Hospital for Sick Children, Toronto, Ontario, Canada.,Department of Surgery, University of Padova, Padua, Veneto, Italy
| | - Jessica M Ming
- Division of Urology, The Hospital for Sick Children, Toronto, Ontario, Canada.,Department of Surgery, University of New Mexico, Albuquerque, New Mexico
| | - Bisma Amir
- Division of Urology, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Nicolas Fernandez
- Division of Urology, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Armando J Lorenzo
- Division of Urology, The Hospital for Sick Children, Toronto, Ontario, Canada.,Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Walid A Farhat
- Division of Urology, The Hospital for Sick Children, Toronto, Ontario, Canada.,Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Diane Hebert
- Department of Nephrology, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Joana Dos Santos
- Division of Urology, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Martin A Koyle
- Division of Urology, The Hospital for Sick Children, Toronto, Ontario, Canada.,Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
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9
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Garcia-Covarrubias L, Valdéz DR, Bermudez LA, Córdoba R, Avelar FJ, Villanueva RM, Ortuño D, Hernández JC, García A, Castro I. Correlation of the Renal Cortex Volume With the Glomerular Filtration Rate in Live Donors for Renal Transplantation. Transplant Proc 2018; 50:428-432. [PMID: 29579820 DOI: 10.1016/j.transproceed.2017.12.045] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2017] [Accepted: 12/05/2017] [Indexed: 11/26/2022]
Abstract
INTRODUCTION As a pretransplantation evaluation, renal function is determined by the glomerular filtration rate (GFR) with the use of renal scintigraphy (RS) and the estimated glomerular filtration rate (eGFR). To date, there are few studies that correlate renal cortex volume with eGFR determined with renal gammagram (GR) and eGFR by equations (Cockroft-Gault, Modification of Diet in Renal Disease, and Chronic Kidney Disease Epidemiology Collaboration equation) in Latin American living donors. AIM This study sought to determine whether there is correlation of the volume of the renal cortex by Herts equation with the GFR determined with renal gammagram (GFR-GR). PATIENTS AND METHODS This was an analytical, observational, and cross-sectional study. A review of the donor charts from January 1, 2014, to December 1, 2014, with a complete clinical file, kidney measurements, predonation tomography volume, and eGFR by different formulas and by renal scintigraphy. RESULTS Thirty-three donors were included, 51.5% male and 48.5% female. The mean age was 38.58 ± 10 years, with an average volume of 127.83 ± 28.30 mL, with diethylenetriamine-pentaacetate (DTPA) of 54.80 ± 7.13 mL/min/1.73 m2 in the donated kidney. Spearman correlation showed the best association with the Herts equation (r = 0.346) reaching significance (P = .049) when comparing the different equations against the GFR with DTPA. Using the Bland-Altman method, the lowest variability and best significance was verified with the same equation compared to the other formulas (P = .0002). CONCLUSIONS There is no consensus regarding which is the best formula for calculating the GFR of both kidneys. Of the different formulas, the one that best correlated with the GFR was the Herts method, which uses the volume of the kidney.
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Affiliation(s)
- L Garcia-Covarrubias
- Surgery Division, Hospital de Especialidades, Centro Médico Nacional Siglo XXI, Instituto Mexicano del Seguro Social, Mexico City, Mexico; Transplantation Department, Hospital General de México, Mexico City, Mexico.
| | - D R Valdéz
- Surgery Division, Hospital de Especialidades, Centro Médico Nacional Siglo XXI, Instituto Mexicano del Seguro Social, Mexico City, Mexico
| | - L A Bermudez
- Transplantation Department, Hospital de Especialidades, Centro Médico Nacional Siglo XXI, Instituto Mexicano del Seguro Social, Mexico City, Mexico
| | - R Córdoba
- X Ray and Image Department, Hospital de Especialidades Centro Médico Nacional Siglo XXI, Instituto Mexicano del Seguro Social, Mexico City, Mexico
| | - F J Avelar
- X Ray and Image Department, Hospital de Especialidades Centro Médico Nacional Siglo XXI, Instituto Mexicano del Seguro Social, Mexico City, Mexico
| | - R M Villanueva
- Nuclear Medicine Department, Hospital de Especialidades, Centro Médico Nacional Siglo XXI, Instituto Mexicano del Seguro Social, Mexico City, Mexico
| | - D Ortuño
- Familiar Medicine Unit No. 20, Instituto Mexicano del Seguro Social, Mexico City, Mexico
| | - J C Hernández
- Transplantation Department, Hospital de Especialidades, Centro Médico Nacional Siglo XXI, Instituto Mexicano del Seguro Social, Mexico City, Mexico
| | - A García
- Transplantation Department, Hospital General de México, Mexico City, Mexico
| | - I Castro
- Transplantation Department, Hospital General de México, Mexico City, Mexico
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Eze CU, Eze CU, Adeyomoye A. Sonographic evaluation of kidney echogenicity and morphology among HIV sero-positive adults at Lagos University Teaching Hospital. J Ultrasound 2018; 21:25-34. [PMID: 29374399 PMCID: PMC5845938 DOI: 10.1007/s40477-017-0279-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2017] [Accepted: 12/13/2017] [Indexed: 11/28/2022] Open
Abstract
AIM To evaluate the role of kidney echogenicity and morphology in the diagnosis of human immunodeficiency virus-associated nephropathy (HIVAN). SUBJECTS AND METHODS In the cross-sectional study, a sample of 340 anti-retroviral therapy (ART)-naïve AIDS patients underwent laboratory CD4+ count, serum creatinine determination and sonographic renal echogenicity grading and size measurement. Rounded kidneys were described as bulbous while bean-shaped kidneys were described as reniform; echogenicity was categorized into grades 0, 1, 2 and 3. Kidney length, width, thickness and volume were measured in HIVAN and control groups. RESULTS Mean age of the population was 42.7 ± 9.4 years; 87.4% had HIVAN. Mean CD4+ count, serum creatinine and GFR for HIVAN patients were 153.1 ± 103.2 cells/mm3, 218.4 ± 147.4 mmol/L and 50.1 ± 23.6 mL/min/1.73 m2 for males and 121.9 ± 91.0 cells/mm3, and 222.0 ± 150.4 mmol/L and 39.3 ± 20.6 mL/min/1.73 m2 for females, respectively; control subjects and non-HIVAN patients had grade 0 renal echogenicity; 56.9% of HIVAN patients had echogenicity grade 3; 5.3% had kidney length < 10 cm; 73.9% had bulbous kidneys; the kidney was significantly wider and thicker in HIVAN (p < 0.05). CONCLUSION Sonographic evaluation of renal echogenicity and morphology can reliably predict HIVAN diagnosis. Apathy to screening and late presentation were high while HIV/AIDS remains an important public health problem in the city of Lagos. Unilateral reduction in kidney size could be a major sequela of AIDS while sonographic measurement of absolute kidney length appears inadequate in the evaluation of AIDS patients with nephropathy.
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Affiliation(s)
- Cletus Uche Eze
- Department of Radiation Biology, Radiotherapy, Radiodiagnosis and Radiography, Faculty of Clinical Sciences, College of Medicine, University of Lagos, Ishaga Road, Idi-araba, Lagos, Nigeria.
| | - Charles Ugwoke Eze
- Department of Medical Radiography and Radiological Sciences, Faculty of Health Sciences and Technology, College of Medicine, University of Nigeria, Enugu Campus, Enugu, Nigeria
| | - Adekunle Adeyomoye
- Department of Radiation Biology, Radiotherapy, Radiodiagnosis and Radiography, Faculty of Clinical Sciences, College of Medicine, University of Lagos, Ishaga Road, Idi-araba, Lagos, Nigeria
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Narasimhamurthy M, Smith LM, Machan JT, Reinert SE, Gohh RY, Dworkin LD, Merhi B, Patel N, Beland MD, Hu SL. Does size matter? Kidney transplant donor size determines kidney function among living donors. Clin Kidney J 2017; 10:116-123. [PMID: 28638611 PMCID: PMC5469570 DOI: 10.1093/ckj/sfw097] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2016] [Accepted: 08/16/2016] [Indexed: 01/05/2023] Open
Abstract
BACKGROUND Kidney donor outcomes are gaining attention, particularly as donor eligibility criteria continue to expand. Kidney size, a useful predictor of recipient kidney function, also likely correlates with donor outcomes. Although donor evaluation includes donor kidney size measurements, the association between kidney size and outcomes are poorly defined. METHODS We examined the relationship between kidney size (body surface area-adjusted total volume, cortical volume and length) and renal outcomes (post-operative recovery and longer-term kidney function) among 85 kidney donors using general linear models and time-to-chronic kidney disease data. RESULTS Donors with the largest adjusted cortical volume were more likely to achieve an estimated glomerular filtration rate (eGFR) ≥60 mL/min/1.73 m2 over a median 24-month follow-up than those with smaller cortical volumes (P <0.001), had a shorter duration of renal recovery (1.3-2.2 versus 32.5 days) and started with a higher eGFR at pre-donation (107-110 versus 91 mL/min/1.73 m2) and immediately post-nephrectomy (∼63 versus 50-51 mL/min/1.73 m2). Similar findings were seen with adjusted total volume and length. CONCLUSIONS Larger kidney donors were more likely to achieve an eGFR ≥60 mL/min/1.73 m2 with renal recovery over a shorter duration due to higher pre-donation and initial post-nephrectomy eGFRs.
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Affiliation(s)
- Meenakshi Narasimhamurthy
- Division of Kidney Disease and Hypertension, Department of Medicine, Warren Alpert Medical School of Brown University, Rhode Island Hospital, Providence, RI, USA
| | - Lachlan M. Smith
- Department of Diagnostic Imaging, Warren Alpert Medical School of Brown University, Rhode Island Hospital, Providence, RI, USA
| | - Jason T. Machan
- Biostatistics Core, Lifespan Hospital System, Departments of Orthopedic and Surgery, Warren Alpert Medical School of Brown University, Providence, RI, USA
| | - Steven E. Reinert
- Lifespan Information Services, Lifespan Hospital System, Providence, RI, USA
| | - Reginald Y. Gohh
- Division of Renal Transplantation, Department of Medicine, Warren Alpert Medical School of Brown University, Rhode Island Hospital, Providence, RI, USA
| | - Lance D. Dworkin
- Division of Kidney Disease and Hypertension, Department of Medicine, Warren Alpert Medical School of Brown University, Rhode Island Hospital, Providence, RI, USA
| | - Basma Merhi
- Division of Kidney Disease and Hypertension, Department of Medicine, Warren Alpert Medical School of Brown University, Rhode Island Hospital, Providence, RI, USA
| | - Nikunjkumar Patel
- Division of Kidney Disease and Hypertension, Department of Medicine, Warren Alpert Medical School of Brown University, Rhode Island Hospital, Providence, RI, USA
| | - Michael D. Beland
- Department of Diagnostic Imaging, Warren Alpert Medical School of Brown University, Rhode Island Hospital, Providence, RI, USA
| | - Susie L. Hu
- Division of Kidney Disease and Hypertension, Department of Medicine, Warren Alpert Medical School of Brown University, Rhode Island Hospital, Providence, RI, USA
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Lucisano G, Comi N, Pelagi E, Cianfrone P, Fuiano L, Fuiano G. Can renal sonography be a reliable diagnostic tool in the assessment of chronic kidney disease? JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2015; 34:299-306. [PMID: 25614403 DOI: 10.7863/ultra.34.2.299] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
OBJECTIVES Kidney size has been found to be correlated with anthropometric features and kidney function. Therefore, we postulate that if the conventionally measured renal sonographic parameters (pole-to-pole length, width, and parenchymal thickness) are taken according to standardized rules and corrected for body height, their association with kidney function could be strengthened, thus helping validate renal sonographic information for a better assessment of chronic kidney disease (CKD) status. METHODS This cross-sectional study included 72 stable adult patients with stage 1 to 4 CKD. Sonographic parameters were obtained from both kidneys and averaged, and the measurements obtained were further corrected for patients' body height. The glomerular filtration rate (GFR) was estimated by the Chronic Kidney Disease Epidemiology Collaboration equation. RESULTS Parenchymal thickness and renal length showed the highest correlation level with the GFR. This significant correlation, however, was greatly ameliorated by the correction for patients' body height (r = 0.537; P < .001; r = 0.510; P < .001, respectively). Of note, the product of these two parameters corrected for body height showed the best degree of correlation with the GFR (r = 0.560; P < .001), as confirmed by analysis of variance after subdivision of the population into CKD stage groups according to the GFR. Receiver operating characteristic curve analysis for discrimination of a GFR of less than 60 mL/min indentified the combined parameter as the one with the highest area under the curve (0.78; 95% confidence interval, 0.66-0.89), followed renal length corrected for height (area under the curve, 0.77; 95% confidence interval, 0.66-0.88). CONCLUSIONS Correction of renal sonographic parameters for body height strengthens the degree of the correlation of renal sonography with the GFR. The improved correlation with the GFR makes renal sonography a reliable tool for a more complete assessment of patients with CKD.
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Affiliation(s)
- Gaetano Lucisano
- Nephrology and Dialysis Unit, Magna Graecia University of Catanzaro, Catanzaro, Italy.
| | - Nicolino Comi
- Nephrology and Dialysis Unit, Magna Graecia University of Catanzaro, Catanzaro, Italy
| | - Elena Pelagi
- Nephrology and Dialysis Unit, Magna Graecia University of Catanzaro, Catanzaro, Italy
| | - Paola Cianfrone
- Nephrology and Dialysis Unit, Magna Graecia University of Catanzaro, Catanzaro, Italy
| | - Laura Fuiano
- Nephrology and Dialysis Unit, Magna Graecia University of Catanzaro, Catanzaro, Italy
| | - Giorgio Fuiano
- Nephrology and Dialysis Unit, Magna Graecia University of Catanzaro, Catanzaro, Italy
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13
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Braley-Berthoumieux E, Gamé X, Marque P, de Boissezon X, Rischmann P, Castel-Lacanal E. [Study of the sensitivity of renal ultrasonography as an indirect means of assessing renal function in patients with neurogenic bladder, from a cohort of 103 patients]. Prog Urol 2014; 24:1114-9. [PMID: 25450757 DOI: 10.1016/j.purol.2014.09.044] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2014] [Revised: 09/19/2014] [Accepted: 09/22/2014] [Indexed: 11/16/2022]
Abstract
OBJECTIVES The assessment of renal function is essential to follow up the patients with neurogenic bladder. The objective of this study was to determine if renal ultrasonography would both evaluate the morphology of the urinary tract and renal function. METHOD In a retrospective study, all patients followed for neurogenic bladder were included, regardless of their neurological disease. Renal function was estimated by creatinine clearance (Cl24 h), the reference test in neurological patients, the glomerular filtration rate by the MDRD simplified (MDRDs) and CKD-EPI creatinine formula, and we identified renal abnormalities detected on ultrasonography. RESULTS One hundred and three patients were included (57 men-36 women), mean age 51±13 years. Fifty-nine patients had multiple sclerosis, 23 spinal cord injury. Depending on the method used (Cl24h, MDRDs, CKD-EPI creatinine) respectively 54, 49 and 39 patients had abnormal renal function; eleven patients had abnormal findings on renal ultrasonography. The sensitivity of ultrasonography as an indirect indicator of renal function depending on the method used (Cl24h, MDRDs, CKD-EPI creatinine) was equal respectively to 14%, 8% and 10%. CONCLUSION Renal ultrasonography, which is essential to follow up the neurogenic bladder, is not enough sensitive to detect abnormal renal function and should continue to be associated with an evaluation of renal function, which is suitable for neurological patients. LEVEL OF EVIDENCE 4.
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Affiliation(s)
- E Braley-Berthoumieux
- Service de médecine physique et de réadaptation, centre hospitalier universitaire Rangueil, 1, avenue Jean-Poulhès, 31059 Toulouse 1, France
| | - X Gamé
- Département d'urologie et de transplantation rénale et d'andrologie, centre hospitalier universitaire Rangueil, 1, avenue Jean-Poulhès, 31059 Toulouse 2, France
| | - P Marque
- Service de médecine physique et de réadaptation, centre hospitalier universitaire Rangueil, 1, avenue Jean-Poulhès, 31059 Toulouse 1, France
| | - X de Boissezon
- Service de médecine physique et de réadaptation, centre hospitalier universitaire Rangueil, 1, avenue Jean-Poulhès, 31059 Toulouse 1, France
| | - P Rischmann
- Département d'urologie et de transplantation rénale et d'andrologie, centre hospitalier universitaire Rangueil, 1, avenue Jean-Poulhès, 31059 Toulouse 2, France
| | - E Castel-Lacanal
- Service de médecine physique et de réadaptation, centre hospitalier universitaire Rangueil, 1, avenue Jean-Poulhès, 31059 Toulouse 1, France.
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Zhang WX, Zhang ZM, Cao BS, Zhou W. Sonographic measurement of renal size in patients undergoing chronic hemodialysis: Correlation with residual renal function. Exp Ther Med 2014; 7:1259-1264. [PMID: 24940422 PMCID: PMC3991538 DOI: 10.3892/etm.2014.1560] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2013] [Accepted: 02/10/2014] [Indexed: 11/09/2022] Open
Abstract
Previous studies have reported that renal size may change when the function is compromised. However, it is not known whether sonographically measured renal size reflects the residual renal function (RRF) in patients undergoing chronic hemodialysis. A total of 140 patients undergoing chronic hemodialysis (≥3 months) were investigated in the present study. The patients were divided into two groups according to the daily urine volume: Individuals with RRF (RRF+ group; ≥200 ml; n=65) and without RRF (RRF− group; <200 ml; n=75). Renal sizes were measured using sonography and renal volumes were calculated with the ellipsoid formula. Univariable and multivariable stepwise forward logistic regression analyses were performed to examine the correlation between the presence of RRF and various variables. The results indicated that there were statistically significant differences (P<0.001) between the RRF+ and RRF− groups with regard to renal length, width, thickness and volume of the left (length, 7.9±1.2 vs. 6.8±1.2 cm; volume, 60.0±26.7 vs. 40.2±18.1 ml, respectively) and right (length, 7.6±1.2 vs. 6.7±1.2 cm; volume, 50.2±26.5 vs. 33.9±15.3 ml, respectively) sides of the kidney. Multivariable stepwise forward logistic regression analyses showed that the mean renal length or volume and hemodialysis duration were independent predictors of the presence of RRF. Therefore, renal size assessment by ultrasonography may be useful for RRF evaluation in patients undergoing chronic hemodialysis.
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Affiliation(s)
- Wu-Xing Zhang
- Department of Nephrology, PLA Center of Transplantation, PLA 309th Hospital, Beijing 100091, P.R. China
| | - Zhi-Min Zhang
- Department of Nephrology, PLA Center of Transplantation, PLA 309th Hospital, Beijing 100091, P.R. China
| | - Bing-Sheng Cao
- Department of Ultrasound, PLA 309th Hospital, Beijing 100091, P.R. China
| | - Wei Zhou
- Department of Nephrology, PLA Center of Transplantation, PLA 309th Hospital, Beijing 100091, P.R. China
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Hu S, Igari M, Walle N, Steffes M, Beland M, Collins S, Gohh R. Kidney Transplant Donor Glomerular Filtration Rate by Iohexol Clearance During Computerized Tomographic Angiography of the Kidneys. Transplant Proc 2013; 45:3229-33. [DOI: 10.1016/j.transproceed.2013.05.010] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2013] [Accepted: 05/09/2013] [Indexed: 10/26/2022]
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16
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Halleck F, Diederichs G, Koehlitz T, Slowinski T, Engelken F, Liefeldt L, Friedersdorff F, Fuller TF, Magheli A, Neumayer HH, Budde K, Waiser J. Volume matters: CT-based renal cortex volume measurement in the evaluation of living kidney donors. Transpl Int 2013; 26:1208-16. [PMID: 24118327 DOI: 10.1111/tri.12195] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2013] [Revised: 07/21/2013] [Accepted: 09/15/2013] [Indexed: 01/12/2023]
Abstract
Currently, no international standard for the pre-transplant evaluation of living donor renal function exists. Following a standardized questionnaire on current practice in all Eurotransplant (ET) centers, we compared a new CT-based technique to measure renal cortex volume with our standard of DTPA-clearance combined with MAG3-scintigraphy (DTPA × MAG3) and with creatinine-based methods in 167 consecutive living kidney donors. Most ET centers use creatinine-clearance (64%) to measure total renal function and radioistopic methods (82%) to assess split renal function. Before transplantation, CT-measured total cortex volume (r = 0.67; P < 0.001) and estimated GFR using the Cockcroft-Gault formula [eGFR(CG)] (r = 0.55; P < 0.001) showed the strongest correlation with DTPA-clearance. In contrast, the correlation between DTPA-clearance and creatinine clearance was weak (r = 0.21; P = 0.02). A strong correlation was observed between CT-measured split cortex volume and MAG3-measured split renal function (r = 0.93; P < 0.001). A strong correlation was also found between pre-transplant split renal function assessed by eGFR(CG) together with cortex volume measurement and post-transplant eGFR(CG) of both, the donor (r = 0.83; P < 0.001) and the recipient (r = 0.75; P < 0.001). In conclusion CT-based assessment of renal cortex volume bears the potential to substitute existing methods to assess pre-transplant living donor split renal function.
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Affiliation(s)
- Fabian Halleck
- Department of Nephrology, Charité Universitätsmedizin Berlin, Campus Mitte, Berlin, Germany
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Kruszka PS, Manoli I, Sloan JL, Kopp JB, Venditti CP. Renal growth in isolated methylmalonic acidemia. Genet Med 2013; 15:990-6. [PMID: 23639900 PMCID: PMC4149057 DOI: 10.1038/gim.2013.42] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2012] [Accepted: 02/28/2013] [Indexed: 01/05/2023] Open
Abstract
PURPOSE We sought to predict renal growth based on clinical and metabolic parameters in patients with isolated methylmalonic acidemia, a group of disorders associated with chronic kidney disease. METHODS Fifty patients with methylmalonic acidemia, followed from 2004 to 2011, were classified by molecular genetics and studied using a combined cross-sectional and longitudinal design that included renal ultrasound examinations, anthropometric measurements, and metabolic phenotyping. Renal length was compared with that of healthy controls and modeled to other clinical parameters using multiple-regression analyses. RESULTS Comparisons with age-matched controls showed that renal length in subjects with methylmalonic acidemia was significantly decreased (P < 0.05). Stepwise regression modeling found that combinations of height, serum cystatin C, and serum methymalonic acid concentrations best predicted kidney size. The regression equations used to generate methylmalonic acidemia kidney nomograms were renal length (cm) = 6.79 + 0.22 × age for the controls and 6.80 + 0.09 × age for the methylmalonic acidemia cohort (P < 0.001; constant and slope). CONCLUSION Renal length, reflective of kidney growth, significantly decreased in patients with methylmalonic acidemia over time as compared with controls and was predictable with select clinical parameters. Cystatin C and serum methylmalonic acid concentrations were highly correlated with smaller kidneys and decreased renal function in this patient population.
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Affiliation(s)
- Paul S Kruszka
- Genetics and Molecular Biology Branch, National Human Genome Research Institute, National Institutes of Health, Bethesda, Maryland, USA
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18
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Gupta S, Singh AH, Shabbir A, Hahn PF, Harris G, Sahani D. Assessing renal parenchymal volume on unenhanced CT as a marker for predicting renal function in patients with chronic kidney disease. Acad Radiol 2012; 19:654-60. [PMID: 22578224 DOI: 10.1016/j.acra.2012.02.006] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2011] [Revised: 02/10/2012] [Accepted: 02/13/2012] [Indexed: 11/18/2022]
Abstract
OBJECTIVES To estimate renal volume in chronic kidney disease (CKD) patients using a semiautomated software and compare them with split renal function estimates from radionuclide renogram (RR). We proposed that renal volume from unenhanced computed tomography (CT) scans may serve as surrogate marker for assessing renal function in CKD patients. MATERIALS AND METHODS Unenhanced multidetector CT scans of 26 patients with CKD (estimated glomerular filtration rate [eGFR] <60 mL/kg/body surface area [BSA]) and 10 controls (eGFR >60 mL/kg/BSA) were analyzed to calculate renal volumes using a semiautomated software (AMIRAV5.2.0). Volumes obtained were then correlated with corresponding eGFR and split renal function estimates from RR. Volumes were also compared with those obtained on enhanced scans in 10 cases (five disease group, five controls). Bland-Altman analysis was used to assess agreement between methods. RESULTS A moderately positive correlation was found between renal volume obtained on unenhanced CT and eGFR (r = 0.65, P < .0001), whereas a significantly high correlation with split function estimates from RR (r = 0.95, P < .001) was found. Bland-Altman analysis revealed a good agreement between renal volume from CT and renal function from RR (34/36 observations were within 95% CI and there were two outliers). Correlation between volumes obtained from unenhanced and enhanced CT scans was also significant (r = 0.96). CONCLUSION In patients with CKD, renal volume derived from unenhanced CT can possibly serve as a surrogate marker for assessing and monitoring renal function reserves to plan further management.
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Affiliation(s)
- Supriya Gupta
- Department of Abdominal and Interventional Radiology, Massachusetts General Hospital, 55 Fruit Street, White 270, Boston, MA 02114, USA.
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Di Leo G, Di Terlizzi F, Flor N, Morganti A, Sardanelli F. Measurement of renal volume using respiratory-gated MRI in subjects without known kidney disease: Intraobserver, interobserver, and interstudy reproducibility. Eur J Radiol 2011; 80:e212-6. [DOI: 10.1016/j.ejrad.2010.09.005] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2010] [Revised: 08/31/2010] [Accepted: 09/03/2010] [Indexed: 10/18/2022]
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Donadio C, Abdelkawy H, Grassi G. Echographic Renal Dimensions Can Predict Glomerular Filtration Rate of Potential Living Kidney Donors. Transplant Proc 2010; 42:1035-9. [DOI: 10.1016/j.transproceed.2010.03.039] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Akoh JA, Rana TA, Stacey SL. Isotope Differential Renal Function Versus Ultrasound Measured Kidney Size in Assessing Potential Living Donors. ACTA ACUST UNITED AC 2010. [DOI: 10.1002/dat.20398] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
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Kariyanna SS, Light RP, Agarwal R. A longitudinal study of kidney structure and function in adults. Nephrol Dial Transplant 2009; 25:1120-6. [PMID: 19948878 DOI: 10.1093/ndt/gfp654] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Although kidney size is commonly measured in patients with chronic kidney disease (CKD), its relationship with kidney function is poorly understood. We conducted this longitudinal study to better understand the relationship between kidney size and function. METHODS We retrospectively studied 178 kidneys measured by ultrasound in 93 patients with CKD who did not have autosomal polycystic kidney disease. Renal function was measured using estimated glomerular filtration rate (GFR). A mixed model that accounted for repeated measurements or nested observations was used for statistical analysis. RESULTS In cross-sectional analyses, the following independent variables emerged as predictors of kidney size: estimated GFR along with its squared term, height, age and interactions of each of these two independent variables with aetiology of CKD. In longitudinal analyses over a median follow-up of 3.7 years, after accounting for predictors of baseline kidney size such as aetiology, height and estimated GFR, we found that kidney atrophy occurred at a rate of 0.072 cm/year (SD 0.016, P = 0.007). This atrophy was 'blunted' with declining GFR. Each 1 mL/min/1.73 m(2)/year greater decline in eGFR abrogated kidney atrophy by 0.015 cm/year (P = 0.024). CONCLUSION Although in cross-sectional surveys kidney size is directly related to function, the longitudinal relationship between form and function is inverted. Since the rate of change in GFR determines kidney atrophy, we conclude that kidney size is a determinant of renal prognosis.
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Grassi G, Abdelkawy H, Barsotti M, Paleologo G, Tregnaghi C, Rizzo G, Donadio C. Living Kidney Transplantation: Evaluation of Renal Function and Morphology of Potential Donors. Transplant Proc 2009; 41:1121-4. [DOI: 10.1016/j.transproceed.2009.02.057] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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