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Kon M, Nakamura M, Moriya K, Nishimura Y, Hirata Y, Nishida M, Higuchi M, Kitta T, Shinohara N. What are the Optimal Renal Ultrasound Parameters for Detecting Small Kidney in Young Children? Res Rep Urol 2021; 13:767-772. [PMID: 34737981 PMCID: PMC8558043 DOI: 10.2147/rru.s318793] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2021] [Accepted: 09/08/2021] [Indexed: 11/23/2022] Open
Abstract
Introduction Recent guidelines do not recommend routine screening of vesicoureteral reflux after a first febrile urinary tract infection in children without abnormal findings on ultrasound or atypical/recurrent urinary tract infection. Currently, there are no clear ultrasonographic parameters for detecting abnormalities in renal size, especially in young children. The aim of the present study was to determine an optimal cutoff value for detecting small kidney in children without apparent congenital anomalies except vesicoureteral reflux by retrospective chart review. Patients and Methods Children aged ≤3 years who had undergone nuclear renal scans and ultrasound were enrolled. Small kidney was defined as split renal function of <40%. Optimal cutoff values of various ultrasonographic parameters for detecting small kidney were calculated. Results Of the 69 children included in the present study, small kidney was identified in 20. There was a significant difference in renal size between each kidney in patients with small kidney, whereas there was no significant difference in those without small kidney. With a ratio of estimated renal area of 74.26%, maximum area under the curve with the highest sensitivity, specificity, positive predictive value, negative predictive value, and accuracy rate were obtained. In addition, simple measurement of renal length with a cutoff of 4.97 cm showed high specificity comparable with estimated renal area. Conclusion Small kidney may be screened by two-dimensional measurement on ultrasonographic examination, even in young children. With the cutoff described, risk stratification or an individualized approach may be possible.
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Affiliation(s)
- Masafumi Kon
- Department of Renal and Genitourinary Surgery, Hokkaido University Graduate School of Medicine, Sapporo, Japan
| | - Michiko Nakamura
- Department of Renal and Genitourinary Surgery, Hokkaido University Graduate School of Medicine, Sapporo, Japan
| | - Kimihiko Moriya
- Department of Renal and Genitourinary Surgery, Hokkaido University Graduate School of Medicine, Sapporo, Japan.,Department of Urology, Sapporo City General Hospital, Sapporo, Japan
| | - Yoko Nishimura
- Department of Renal and Genitourinary Surgery, Hokkaido University Graduate School of Medicine, Sapporo, Japan
| | - Yurie Hirata
- Department of Renal and Genitourinary Surgery, Hokkaido University Graduate School of Medicine, Sapporo, Japan
| | - Mutsumi Nishida
- Diagnostic Center for Sonography and Division of Laboratory and Transfusion Medicine, Hokkaido University Hospital, Sapporo, Japan
| | - Madoka Higuchi
- Department of Renal and Genitourinary Surgery, Hokkaido University Graduate School of Medicine, Sapporo, Japan
| | - Takeya Kitta
- Department of Renal and Genitourinary Surgery, Hokkaido University Graduate School of Medicine, Sapporo, Japan
| | - Nobuo Shinohara
- Department of Renal and Genitourinary Surgery, Hokkaido University Graduate School of Medicine, Sapporo, Japan
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Senra JC, Yoshizaki CT, Doro GF, Ruano R, Gibelli MABC, Rodrigues AS, Koch VHK, Krebs VLJ, Zugaib M, Francisco RPV, Bernardes LS. Kidney impairment in fetal growth restriction: three-dimensional evaluation of volume and vascularization. Prenat Diagn 2020; 40:1408-1417. [PMID: 32583885 DOI: 10.1002/pd.5778] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2019] [Revised: 02/28/2020] [Accepted: 06/16/2020] [Indexed: 11/10/2022]
Abstract
OBJECTIVES Renal development is impaired in fetal growth restriction (FGR). Renal size can be considered a surrogate of renal function in childhood, and could be impaired in that condition. Our aim was to evaluate the ratio of total renal volume, measured by three-dimensional ultrasound, to estimated fetal weight (TRV/EFW) among fetuses with and without growth restriction. Furthermore, we correlated TRV/EFW with fetal Doppler velocimetry and renal vascularization indexes and evaluated the association of renal volume and vascular parameters with adverse neonatal events in growth-restricted fetuses. METHODS In a retrospective cohort, TRV and renal vascularization of growth-restricted and normal fetuses were evaluated by three-dimensional ultrasonography and VOCAL technique. Independent samples t-tests and Mann-Whitney test were used for comparisons between groups. Logistic regression model was applied to evaluate the association between renal characteristics and adverse neonatal events. RESULTS Seventy-one growth-restricted fetuses were compared to 194 controls. The TRV/EFW was lower in the growth-restricted group (P < .001). In our sample, this ratio did not correlate with Doppler velocimetry parameters, renal vascular indexes or any adverse neonatal events. CONCLUSION The TRV/EFW ratio is decreased in FGR. Further studies are needed to investigate the association of this ratio with long-term renal outcomes.
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Affiliation(s)
- Janaína Campos Senra
- Department of Obstetrics and Gynecology, Clinics Hospital, University of São Paulo, São Paulo, Brazil
| | - Carlos Tadashi Yoshizaki
- Department of Obstetrics and Gynecology, Clinics Hospital, University of São Paulo, São Paulo, Brazil
| | - Giovana Farina Doro
- Department of Obstetrics and Gynecology, Clinics Hospital, University of São Paulo, São Paulo, Brazil
| | - Rodrigo Ruano
- Maternal-Fetal Medicine Division, Department of Obstetrics and Gynecology, Mayo Clinic College of Medicine, Rochester, Minnesota, USA
| | | | - Agatha Sacramento Rodrigues
- Statistician, Department of Obstetrics and Gynecology, Clinics Hospital, University of São Paulo, São Paulo, Brazil
| | - Vera Hermina Kalika Koch
- Pediatric Nephrology Unit, Department of Pediatrics, Clinics Hospital, University of São Paulo, São Paulo, Brazil
| | - Vera Lúcia Jornada Krebs
- Neonatal Unit, Department of Pediatrics, Clinics Hospital, University of São Paulo, São Paulo, Brazil
| | - Marcelo Zugaib
- Department of Obstetrics and Gynecology, Clinics Hospital, University of São Paulo, São Paulo, Brazil
| | | | - Lisandra Stein Bernardes
- Department of Obstetrics and Gynecology, Clinics Hospital, University of São Paulo, São Paulo, Brazil
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Miliku K, Voortman T, Bakker H, Hofman A, Franco OH, Jaddoe VWV. Infant Breastfeeding and Kidney Function in School-Aged Children. Am J Kidney Dis 2015; 66:421-8. [PMID: 25747235 DOI: 10.1053/j.ajkd.2014.12.018] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2014] [Accepted: 12/30/2014] [Indexed: 11/11/2022]
Abstract
BACKGROUND Early life factors may influence kidney growth and function throughout the life course. We examined the associations of breastfeeding duration and exclusivity and age at introduction of solid foods with kidney outcomes at school age. STUDY DESIGN Prospective cohort study from fetal life onward. SETTING & PARTICIPANTS 5,043 children in the Netherlands. PREDICTORS Infant feeding was assessed prospectively using questionnaires. OUTCOMES & MEASUREMENTS In children at a median age of 6.0 years, we measured kidney volume with ultrasound, estimated glomerular filtration rate (eGFR) from serum creatinine level, and microalbuminuria from urinary albumin and creatinine levels. RESULTS 92% of all children were ever breastfed, of whom 27% were breastfed for more than 6 months and 21% were breastfed exclusively for at least 4 months. Compared with ever-breastfed children, never-breastfed children had smaller combined kidney volumes (-2.69 [95% CI, -4.83 to -0.56] cm(3)) and lower eGFRs (-2.42 [95% CI, -4.56 to -0.28] mL/min/1.73 m(2)) at school age. Among breastfed children, shorter duration of breastfeeding was associated with smaller combined kidney volume and lower microalbuminuria risk (P<0.05). Compared to exclusive breastfeeding for 4 months, nonexclusive breastfeeding in the first 4 months was associated with smaller combined kidney volume and lower eGFR (both P<0.05). Associations with eGFR were explained largely by kidney volume. Age at introduction of solid foods was not associated with any kidney outcome. LIMITATIONS Observational study, so causality cannot be established. Follow-up measurements were available for 76% of children. CONCLUSIONS These results suggest that breastfeeding is associated with subclinical changes in kidney outcomes in childhood. Further studies are needed to explore whether early life nutrition also affects the risk of kidney disease in adulthood.
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Affiliation(s)
- Kozeta Miliku
- The Generation R Study Group, Erasmus MC, University Medical Center, Rotterdam, the Netherlands; Department of Epidemiology, Erasmus MC, University Medical Center, Rotterdam, the Netherlands; Department of Pediatrics, Erasmus MC, University Medical Center, Rotterdam, the Netherlands
| | - Trudy Voortman
- The Generation R Study Group, Erasmus MC, University Medical Center, Rotterdam, the Netherlands; Department of Epidemiology, Erasmus MC, University Medical Center, Rotterdam, the Netherlands
| | - Hanneke Bakker
- The Generation R Study Group, Erasmus MC, University Medical Center, Rotterdam, the Netherlands; Department of Epidemiology, Erasmus MC, University Medical Center, Rotterdam, the Netherlands; Department of Pediatrics, Erasmus MC, University Medical Center, Rotterdam, the Netherlands
| | - Albert Hofman
- Department of Epidemiology, Erasmus MC, University Medical Center, Rotterdam, the Netherlands
| | - Oscar H Franco
- Department of Epidemiology, Erasmus MC, University Medical Center, Rotterdam, the Netherlands
| | - Vincent W V Jaddoe
- The Generation R Study Group, Erasmus MC, University Medical Center, Rotterdam, the Netherlands; Department of Epidemiology, Erasmus MC, University Medical Center, Rotterdam, the Netherlands; Department of Pediatrics, Erasmus MC, University Medical Center, Rotterdam, the Netherlands.
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Weitz M, Licht C, Müller M, Haber P. Renal ultrasound volume in children with primary vesicoureteral reflux allows functional assessment. J Pediatr Urol 2013; 9:1077-83. [PMID: 23639632 DOI: 10.1016/j.jpurol.2013.03.007] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/24/2012] [Accepted: 03/14/2013] [Indexed: 10/26/2022]
Abstract
OBJECTIVE Renal scintigraphy represents the current diagnostic standard to assess split kidney function. We tested the hypothesis that the relative renal volume assessed by ultrasound provides an equally reliable but less invasive tool for assessment of kidney function as compared to renal scintigraphy in patients with primary vesicoureteral reflux. METHODS Renal ultrasound and renal scintigraphy were performed in 85 patients (median age 4.5 years, range 0.25-7.7) and repeated in 74 patients after 2-13 months (mean 7) of the primary investigation. Renal size was measured by ultrasound, and relative renal volume was calculated for each kidney by using the formula of a prolate ellipsoid. Renal function was estimated for each side (split renal function) by scintigraphy with (99m)Tc MAG3. RESULTS The mean difference between relative renal volume measured by ultrasound and split renal function determined by renal scintigraphy was 2.8% (standard deviation ± 4.1%; 95% confidence interval 10.8/-5.2%). There was a statistically significant correlation between relative renal volume estimated by ultrasound and split renal function estimated by renal scintigraphy at first examination (r = 0.98; p < 0.001) and at follow-up (r = 0.91; p < 0.001). CONCLUSION We conclude that ultrasound measurement of relative renal volume is capable of assessing split renal function in children with primary vesicoureteral reflux and, thus, should be considered instead of the more invasive MAG3 scintigraphy.
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Affiliation(s)
- Marcus Weitz
- University of Tuebingen, Department of Pediatrics, Hoppe-Seyler-Strasse 1, 72076 Tübingen, Germany.
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Jovanović D, Gasic B, Pavlovic S, Naumovic R. Correlation of kidney size with kidney function and anthropometric parameters in healthy subjects and patients with chronic kidney diseases. Ren Fail 2013; 35:896-900. [DOI: 10.3109/0886022x.2013.794683] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Abstract
PURPOSE The purposes of this study were to establish reference values for renal size determined from 99mTc-MAG3 renal scintigraphy and to derive regression equations to predict normal limits. METHODS The study population consisted of 106 subjects evaluated for kidney donation who underwent 99mTc-MAG3 renal scintigraphy. Renal length, width, and area were determined from the pixel length and area of whole-kidney regions of interest and correlated with patient sex, height, weight, body mass index, and body surface area (BSA). Reference values were obtained based on estimation of the lower and upper percentiles via quantile regression. RESULTS The mean (SD) left and right kidney lengths was 12.2 (1.0) and 12.1 (1.0) in male and 11.9 (0.9) and 11.8 (0.9) in female patients, respectively. Sex was not a significant factor in the quantile regression models. Regression equations defining the lower and upper limits of renal length (cm) and area (cm) are as follows: left kidney length (5th percentile), 8.2+1.3×BSA; left kidney length (95th percentile), 9.1+2.3×BSA; right kidney length (5th percentile), 8.8+1.0×BSA; right kidney length (95th percentile), 11.1+1.4×BSA; left kidney area (5th percentile), 32.5+9.6×BSA; left kidney area (95th percentile), 12.6+31.7×BSA; right kidney area (5th percentile), 16.1+18.5×BSA; right kidney area (95th percentile), 32.6+22.2×BSA. CONCLUSIONS Regression equations have been developed, which define the upper and lower limits of renal size from 99mTc-MAG3 images and may assist in the detection of unsuspected bilateral increases or decreases in renal size.
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Scholbach T, Weitzel D. Body-surface-area related renal volume: a common normal range from birth to adulthood. SCIENTIFICA 2012; 2012:949164. [PMID: 24278761 PMCID: PMC3820439 DOI: 10.6064/2012/949164] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/18/2012] [Accepted: 05/03/2012] [Indexed: 06/01/2023]
Abstract
Renal volume is an important parameter of renal development. Deviations from normal volume may indicate pathologic conditions. Thus, during childhood, the ever changing renal volumes require the continuous referral to normal volume charts in order to classify actual volumes, which is rather inconvenient. In daily practice this is frequently disregarded and kidneys are evaluated by their appearance only. Therefore, we tested the hypothesis that body surface area (BSA) and renal volume grow proportionally from birth to adulthood. We divided the renal volume of a child by its BSA to get the BSA-related renal volume (BSARV) and found no differences between left and right kidneys and a normal distribution for all kidneys regardless of the patient's age. BSARV has a common normal range for all age groups with the 10th percentile of 45 and the 90th percentile of 85 mL/m(2). 80% of all kidneys do not exceed the volume of their counterparts by more than 20%. BSARV alleviates the correct evaluation of a child's renal volume regardless of age and reveals pathological influences by the simple observation that a kidney deviates from a former percentile or z-value. This is especially valuable in the followup of kidneys with chronic diseases.
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Affiliation(s)
- Th. Scholbach
- Klinik für Kinder- und Jugendmedizin, Städtischen Klinikum, Chemnitz gGmbH, Flemmingstraße 4, 09116 Chemnitz, Germany
| | - D. Weitzel
- Fachbereich Kinderheilkunde und Jugendmedizin, Deutsche Klinik für Diagnostik, Aukamm Allee 33, 65191 Wiesbaden, Germany
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Johnson S, Rishi R, Andone A, Khawandi W, Al-Said J, Gletsu-Miller N, Lin E, Baumgarten DA, O'Neill WC. Determinants and functional significance of renal parenchymal volume in adults. Clin J Am Soc Nephrol 2011; 6:70-6. [PMID: 20847095 PMCID: PMC3022251 DOI: 10.2215/cjn.00030110] [Citation(s) in RCA: 61] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2010] [Accepted: 07/22/2010] [Indexed: 11/23/2022]
Abstract
BACKGROUND AND OBJECTIVES The significance of renal parenchymal volume and the factors that influence it are poorly understood. DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS Renal parenchymal volume (RPV) was measured on contrast-enhanced CT scans after exclusion of sinus fat and vessels in 224 healthy subjects evaluated as kidney donors and in a separate cohort of 22 severely obese individuals before and after 6 months of weight loss. GFR was measured by iohexol clearance in 76 of the transplant donors. RPV was correlated with age, GFR, and various anthropometric parameters. RESULTS In potential transplant donors, RPV correlated with body surface area (BSA; r = 0.68) and was 7% larger in men but did not vary with age or race. Gender and body size were independent determinants of RPV. RPV correlated well with GFR (r = 0.62) and accounted for almost all of the variability in a model of GFR that included age, race, gender, and body surface area. GFR correlated more strongly with RPV than with creatinine-based equations. The same relationship between RPV and BSA was observed in obesity, and RPV decreased with weight loss. CONCLUSIONS In healthy adults younger than 65 years, renal parenchymal volume is governed by body size and gender but not age or race and is strongly correlated with GFR. This indicates that renal parenchymal volume varies to meet metabolic demand and is closely linked to renal function.
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The impact of sodium chloride and volume depletion in the chronic kidney disease of congenital chloride diarrhea. Kidney Int 2008; 74:1085-93. [DOI: 10.1038/ki.2008.401] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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Adibi A, Adibi I, Khosravi P. Do kidney sizes in ultrasonography correlate to glomerular filtration rate in healthy children? ACTA ACUST UNITED AC 2007; 51:555-9. [DOI: 10.1111/j.1440-1673.2007.01864.x] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Cheung CM, Shurrab AE, Buckley DL, Hegarty J, Middleton RJ, Mamtora H, Kalra PA. MR-derived renal morphology and renal function in patients with atherosclerotic renovascular disease. Kidney Int 2006; 69:715-22. [PMID: 16395249 DOI: 10.1038/sj.ki.5000118] [Citation(s) in RCA: 42] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Appropriate selection of patients with atherosclerotic renovascular disease (ARVD) for revascularization might be improved if accurate non-invasive investigations were used to assess severity of pre-existing parenchymal damage. The purpose of this study was to evaluate the associations between magnetic resonance imaging (MRI)-measured renal morphological parameters and single-kidney glomerular filtration rate (GFR) in ARVD. Three-dimensional (3D)-MRI was performed on 35 ARVD patients. Renal bipolar length (BL), parenchymal volume, parenchymal (PT), and cortical thicknesses (CT) were measured in 65 kidneys. Thirteen kidneys were supplied by normal vessels, 13 had insignificant (<50%) renal artery stenosis (RAS), 33 significant (>or=50%) RAS, and six complete vessel occlusion. All patients underwent radioisotopic measurement of single-kidney GFR (isoSK-GFR). Overall, 3D parameters such as parenchymal volume were better correlates of isoSK-GFR (r=0.86, P<0.001) than BL (r=0.78, P<0.001), PT (r=0.63, P<0.001) or CT (r=0.60, P<0.001). Kidneys with >or=50% RAS did show significant reduction in mean CT compared to those supplied by normal vessel (5.67+/-1.63 vs 7.28+/-1.80 mm, P=0.002; 22.1% reduction) and an even greater loss of parenchymal volume (120.65+/-47.15 vs 179.24+/-86.90 ml, P<0.001; 32.7% reduction) with no significant reduction in BL. In a proportion of >or=50% RAS kidneys, a disproportionately high parenchymal volume to isoSK-GFR was observed supporting a concept of 'hibernating parenchyma'. 3D parameters of parenchymal volume are stronger correlates of isoSK-GFR than two-dimensional measures of BL, PT or CT. 3D morphological evaluation together with isoSK-GFR might be useful in aiding patient selection for renal revascularization. Kidneys with increased parenchymal volume to SK-GFR might represent a subgroup with the potential to respond beneficially to angioplasty.
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Affiliation(s)
- C M Cheung
- Department of Renal Medicine, Hope Hospital, Salford, and Imaging Science and Biomedical Engineering, University of Manchester, UK.
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Mancini M, Mainenti PP, Speranza A, Liuzzi R, Soscia E, Sabbatini M, Ferrara LA, Federico S, Salvatore M. Accuracy of sonographic volume measurements of kidney transplant. JOURNAL OF CLINICAL ULTRASOUND : JCU 2006; 34:184-9. [PMID: 16615053 DOI: 10.1002/jcu.20212] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/08/2023]
Abstract
PURPOSE Sonographic measurement of renal volume is one of the parameters used in the diagnosis of renal transplant dysfunction and in follow-up of patients with renal transplant. The aim of this study was to compare the prolate ellipsoid formula with a new formula in calculating the volume of a transplanted kidney. METHODS The renal volumes in 24 patients with a stable renal transplant were determined sonographically with the ellipsoid formula and via helical CT with the voxel-count method, which is the gold standard. A new formula that uses renal length and the cross-sectional area at the maximum transverse section has been evaluated in a small series of transplanted kidneys. RESULTS Renal volume was underestimated with the sonographic ellipsoid formula and the new formula. The new formula yielded the lowest underestimation of the mean renal volume, and the measurements obtained with it were not significantly different from those obtained with CT. CONCLUSIONS The use of sonography is appropriate for accurate calculation of renal volume, and the new formula that uses only 2 ultrasound parameters best represents the volume of a renal transplant.
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Affiliation(s)
- Marcello Mancini
- Biostructure and Bioimaging Institute, National Research Council, Istituto di Biostrutture e Bioimmagini-CNR, Via S. Pansini, 5 Ed. 10, 80131 Naples, Italy
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Riccabona M, Fritz GA, Schöllnast H, Schwarz T, Deutschmann MJ, Mache CJ. Hydronephrotic kidney: pediatric three-dimensional US for relative renal size assessment--initial experience. Radiology 2005; 236:276-83. [PMID: 15955855 DOI: 10.1148/radiol.2361040158] [Citation(s) in RCA: 44] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
PURPOSE To prospectively evaluate accuracy of three-dimensional (3D) ultrasonography (US) for assessment of relative renal size in infants and children with hydronephrosis. MATERIALS AND METHODS Informed consent was obtained from parents and also from children who were older than 8 years. Study was approved by ethics committee. Two-dimensional (2D) US, 3D US, and scintigraphy were performed in 40 patients with hydronephrosis (age range, neonate to 16 years; seven girls, 33 boys) without acute renal disease. Twenty patients also underwent magnetic resonance (MR) urography. US and MR urography were performed by one experienced pediatric radiologist; 3D US and MR urographic volume calculations were performed by specifically trained radiologists. Three-dimensional US was performed with integrated 3D volume probes or external system based on electromagnetic positioning devices. At 2D US, kidney volume was calculated with application of ellipsoid equation. At MR urography and 3D US, real renal parenchymal volume was calculated with subtraction of dilated collecting system. Split renal function was assessed with static renal scintigraphy. Three-dimensional US results were graded with respect to image quality and compared with results of 2D US, scintigraphy, and MR urography by using mean difference percentage and standard deviation of the difference. All investigations were performed with blinding. Inter- and intraobserver variability were calculated with coefficient of variation. RESULTS In 76 of 80 kidneys, 3D US image of diagnostic quality was obtained. Three-dimensional US volume measurements compared well with MR urographic measurements (mean difference, -2.5% +/- 7.8 [standard deviation] vs 25.8% +/- 32.2 for 2D US) and with scintigraphically assessed split renal function (mean difference, 1.2% +/- 9.2 vs 15.9% +/- 43.8 for 2D US). Intra- and interobserver variability were +/-6.4% and +/-9.9%, respectively. CONCLUSION Initial experience with renal 3D US indicates that it is an accurate method for assessment of renal parenchymal volume and relative renal size, provided there is no acute renal disease.
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Affiliation(s)
- Michael Riccabona
- Department of Radiology, Division of Pediatric Radiology, University Hospital Graz, Auenbruggerplatz 9, A-8036 Graz, Austria.
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Schmidt IM, Damgaard IN, Boisen KA, Mau C, Chellakooty M, Olgaard K, Main KM. Increased kidney growth in formula-fed versus breast-fed healthy infants. Pediatr Nephrol 2004; 19:1137-44. [PMID: 15309602 DOI: 10.1007/s00467-004-1567-0] [Citation(s) in RCA: 34] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/18/2003] [Revised: 05/25/2004] [Accepted: 05/25/2004] [Indexed: 11/30/2022]
Abstract
A high protein intake results in increased kidney growth and glomerular filtration rate in human adults and young rats. It is unknown whether kidney size in young infants is influenced by increased protein intake in formula-fed compared with breast-fed infants. We investigated the effect of formula versus breast feeding on kidney growth in a cohort of 631 healthy children examined at birth, and at 3 and 18 months of age. Kidney size was determined by ultrasonography and related to gender, age, body size, and feeding category (fully breast fed, partially breast fed, or fully formula fed at 3 months). Serum urea nitrogen, serum creatinine, and estimated creatinine clearance were measured at 3 months of age. Kidney growth and serum urea nitrogen were significantly increased in partially or fully formula-fed 3-month-old infants. This effect was more pronounced in boys than in girls. The changes in relative kidney size were temporary, as they did not persist at 18 months of age, when all children received a normal mixed diet. The immediate renal effects of formula feeding should be taken into consideration for recommendations concerning infant feeding. Whether there are any long-term effects of early increased protein intake on later kidney function remains to be seen.
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Affiliation(s)
- Ida M Schmidt
- University Department of Growth and Reproduction, Rigshospitalet, Blegdamsvej 9, 2100 Copenhagen, Denmark.
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Schmidt IM, Main KM, Damgaard IN, Mau C, Haavisto AM, Chellakooty M, Boisen KA, Petersen JH, Scheike T, Olgaard K. Kidney growth in 717 healthy children aged 0-18 months: a longitudinal cohort study. Pediatr Nephrol 2004; 19:992-1003. [PMID: 15206038 DOI: 10.1007/s00467-004-1479-z] [Citation(s) in RCA: 36] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/27/2003] [Revised: 03/09/2004] [Accepted: 03/09/2004] [Indexed: 12/23/2022]
Abstract
Kidney size is an important parameter in the evaluation of children with renal disease. However, reference materials for kidney size in healthy children have been limited beyond the neonatal period. We performed a longitudinal cohort study of 717 healthy children born at term with normal birth weight. Kidney size and shape were determined by ultrasonography and related to gender, age, and body size (weight, length, body surface area, skinfold thickness) at 0, 3, and 18 months of age. Gender-differentiated reference charts were established. Boys had significantly larger kidney volumes than girls ( P<0.001) and larger relative volumes (kidney volume/weight) at 0 and 3 months ( P<0.001), but not at 18 months of age. The best single predictor of gender-differentiated kidney volume was weight. Relative kidney volume changed with increasing age and height in a two-phase pattern: an initial decrease until a height of 65-70 cm was reached followed by a stable level. In conclusion, kidney size was significantly influenced by gender, age, and body composition. Relative kidney volume decreased with increasing age and height in a two-phase pattern. These characteristic changes in kidney volume indicated that infant kidney growth might be influenced by sex steroids and growth hormone in addition to body composition.
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Affiliation(s)
- Ida M Schmidt
- University Department of Growth and Reproduction, Rigshospitalet, Blegdamsvej 9, 2100, Copenhagen, Denmark,
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Abstract
Sonography has become integral to the evaluation and management of patients with renal disease. Although many of the procedures discussed in this issue are not feasible for all nephrologists, sonography clearly is. It is convenient and saves time, both for the physician and the patient, and the equipment is not expensive. It is not a difficult skill to learn, as evidenced by the growing number of nephrologists who have learned it, and it greatly enhances the practice of nephrology. Even nephrologists who do not plan to acquire this skill should be familiar with it to understand the indications and limitations, and to participate in its interpretation. Sonography, both the performance and interpretation, is an acquired skill that requires hands-on training, supervision, and practice, and thus cannot be learned solely by reading. Therefore, the goal here is not to teach sonography but rather to provide a basic overview of sonography, discuss its role in nephrology, and present information relevant to incorporating sonography into a nephrology practice.
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17
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Abstract
Sonography is a critical component of the evaluation of both acute and chronic renal failure; however, most nephrologists have a limited knowledge of this procedure. The acoustic properties, limited spectrum of pathological changes, and ease of visualization of the kidneys, coupled with the safety, simplicity, and low cost of sonography, make it the modality of choice for renal imaging. This review discusses the basics of sonography as they apply to the kidney and describes the findings encountered in the more common causes of renal failure. Although many sonographic findings are nonspecific, their diagnostic use is greatly enhanced by a familiarity with the clinical presentation and a thorough understanding of renal pathophysiological characteristics. Therefore, nephrologists should be knowledgeable about renal sonography and participate in its interpretation.
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Affiliation(s)
- W C O'Neill
- Renal Division, Emory University School of Medicine, Atlanta, GA, USA.
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18
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Abstract
Stereologic methods are used to obtain quantitative information about three-dimensional structures based on observations from section planes or--to a limited degree--projections. Stereologic methods, which are used in biologic research and especially in the research of normal and pathologic kidneys, will be discussed in this review. Special emphasis will be placed on modern stereologic methods, free of assumptions of the structure, size, and shape, etc., so-called UFAPP (unbiased for all practical purposes) stereologic methods. The basic foundation of all stereology, sampling, will be reviewed in relation to most of the methods discussed. Estimation of error variances and some of the basic problems in stereology will be reviewed briefly. Finally, a few comments will be made about the future directions for stereology in kidney research.
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Affiliation(s)
- J R Nyengaard
- Stereological Research Laboratory, University Institute of Pathology, University of Aarhus, Denmark.
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19
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Moukarzel AA, Ament ME, Buchman A, Dahlstrom KA, Vargas J. Renal function of children receiving long-term parenteral nutrition. J Pediatr 1991; 119:864-8. [PMID: 1960600 DOI: 10.1016/s0022-3476(05)83034-3] [Citation(s) in RCA: 27] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
Renal function was assessed in 13 children at a mean (+/- SD) age of 9 +/- 4.9 years who had been receiving total parenteral nutrition for 7.9 +/- 4.1 years. All children had normal blood pressure, urinary sediment, and serum creatinine concentrations (58.3 +/- 1.0 mumol/L). Glomerular filtration rate was measured by plasma clearance of diethylenetriaminepentaacetic acid labeled with indium 111. All 13 children had decreased glomerular filtration rate (65.5 +/- 11.9 ml/min per 1.73 m2; range 49.5 to 83.7). Creatinine clearance was 69.1 +/- 10.9 ml/min per 1.73 m2. No tubular damage, as assessed by beta 2-microglobulinuria, was detectable. Renal ultrasonography showed normal architecture with no evidence of nephrocalcinosis in all subjects. The kidney size was normal in seven children; six had reduced (less than -1 SD) size. No relationship was seen between the true glomerular filtration rate and diagnosis, number of episodes of infections, or antibiotics used. The duration of total parenteral nutrition was inversely correlated with the true glomerular filtration rate (r = -0.66, p less than 0.01). The decrease in glomerular filtration rate was not related to the underlying disease or to the nephrotoxic drugs used; the mechanism was not identified. We conclude that long-term total parenteral nutrition is associated with a decrease in glomerular filtration rate.
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Affiliation(s)
- A A Moukarzel
- Department of Pediatrics, University of California, Los Angeles
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