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Saudi Journal of Kidney Diseases and Transplantation
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RENAL DATA FROM ASIA - AFRICA  
Year : 2014  |  Volume : 25  |  Issue : 5  |  Page : 1117-1121
Usefulness of renal length and volume by ultrasound in determining severity of chronic kidney disease


1 Department of Medicine, Usmanu Danfodiyo University Teaching Hospital, Sokoto, Nigeria
2 Department of Medicine, University Teaching Hospital, Ilorin, Nigeria
3 Department of Radiology, University Teaching Hospital, Ilorin, Nigeria

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Date of Web Publication2-Sep-2014
 

   Abstract 

To determine the correlation of renal ultrasonic parameters and degree of kidney function among chronic kidney disease patients seen at the Nephrology unit of the University of Ilorin Teaching Hospital (UITH) Ilorin, we studied 322 patients. The results were analyzed with specific reference to socio-demography and correlating renal length and volume with estimated glomerular filtration rate. The male to female ratio was 2:1, with an age range from 20 to 80 years and mean age of 45.06 (±13.0) years. The serum creatinine levels ranged from 201 to 1205 μmol/L, with a mean of 388 ± 168 μmol/L, while the estimated glomerular filtration rate (eGFR) ranged from 3.77 to 44.32 mL/min, with a mean of 18.2 ± 7.19 mL/min. The right and left renal lengths ranged from 6.9 to 13.0 cm, with a mean of 9.11 ± 1.06, and 6.5-13.4 cm, with a mean of 9.23 ± 1.07 cm, respectively. The mean volumes of the right and left kidneys were 98.6 ± 41.9 cm 3 and 105 ± 46.2 cm 3 , respectively. The Pearson correlation of the right and left kidneys length to eGFR were -0.197 and -0.137 respectively, while that of the right and left kidney volume to eGFR were -0.122 and -0.043, respectively. Our study showed that there is a positive correlation between ultrasonic renal measurements and degree of kidney function.

How to cite this article:
Makusidi MA, Chijioke A, Braimoh KT, Aderibigbe A, Olanrewaju TO, Liman HM. Usefulness of renal length and volume by ultrasound in determining severity of chronic kidney disease. Saudi J Kidney Dis Transpl 2014;25:1117-21

How to cite this URL:
Makusidi MA, Chijioke A, Braimoh KT, Aderibigbe A, Olanrewaju TO, Liman HM. Usefulness of renal length and volume by ultrasound in determining severity of chronic kidney disease. Saudi J Kidney Dis Transpl [serial online] 2014 [cited 2019 Nov 15];25:1117-21. Available from: http://www.sjkdt.org/text.asp?2014/25/5/1117/139981

   Introduction Top


Chronic kidney disease (CKD) is one of the world's major public health problems, and its prevalence is on the increase. [1] CKD is usually a silent disease in the early stages with a long latent period, and may be masked by other conditions. [2] Failure to recognize CKD early is a missed opportunity to prevent or delay the development of ESRD or other cardiovascular events complicating CKD. [3],[4],[5]

Knowledge of renal size is important in the diagnosis, treatment and determination of prognosis in renal disease. [6],[7],[8],[9],[10] The prognostic importance of kidney size can be further ex­plored by evaluating the cross-sectional and longitudinal relationship of kidney size with nephron mass in health and in disease. [11]

There has been a documented significant correlation between renal length and volume with glomerular filtration rate (GFR). [10]

The aim of this study was to assess the cor­relation between renal ultrasonic parameters and degree of kidney function among CKD patients seen at our center.


   Materials and Methods Top


We studied 322 patients (215 male and 107 female) with male:female ratio of 2:1. Their ages ranged from 20 to 80 years, with a mean (±SD) of 45.1 ± 13.0 years. Informed consents were obtained from the patient and control groups. Ethical approval was also obtained from the Ethical and Research Committee of the hospital (UITH).

The study patients presented for the first time with CKD and did not previously have any form of renal replacement therapy. The exclusion criteria included those patients who required urgent dialysis and those who pre­sented with concomitant co-morbidity. The patients who were on drugs such as cime-tidine, co-trimoxazole, salicylates, probenecid and trimethoprim were asked to stop the drugs at least three days before the study. Patients with sickle cell nephropathy, diabetic nephro-pathy, polycystic kidney disease, myeloma kidneys and renal amyloidosis were also excluded from the study.

Socio-demographic and anthropometric para­meters were recorded, and 5 mL of venous blood was collected under aseptic conditions into lithium-heparin bottles. A flame photo­meter was used for electrolytes and spectro-photometer was used for urea and creatinine. The diacetyl-monoamine method was used for urea and Jaffe's (picric) method was used for creatinine. [12] The analysis was performed in the hospital laboratory by one of the authors. The estimated GFR (eGFR) was calculated using Cocroft-Gault equation. [13]

Ultrasound examinations were performed with Apogee 800 plus manufactured in Japan (2005), with a 3.5 MHz curvilinear trans­ducer. All the ultrasound examinations were carried out by one of the authors. Renal measurements were obtained with the subject in a prone position. Sonographic measurements were taken in the maximum longitudinal and transverse kidney sections. An average of two measurements was taken for the purpose of this study. The renal length (L) was defined as the bipolar diameter (BPD), while the kidney volume was determined using the formula by Dinkel et al, [14] 0.523 × L × W × (D1 + D2/2), where L is the maximum BPD, W is the maximum width in the hilar region and D is the maximum depth in the longitudinal (D1) and transverse sections (D2).


   Data Analysis Top


Data obtained were analyzed using EPI info version 5 computer statistical software package. The categorical parameters were summarized as frequencies and percentages, while conti­nuous parameters were summarized as means ± standard deviation. Discrete variables were analyzed using the Chi square function, while the Student t-test was used for continuous variables. The correlation between renal ultra­sonic parameters (length, volume and echo-genicity) and stages of CKD was determined using the Pearson (parametric data) and Spear­man (non-parametric data) correlation coeffi­cients. Probability values of less than 0.05 were accepted as statistically significant.


   Results Top


[Figure 1] shows the age distribution of the pa­tients. [Table 1] and [Table 2] demonstrate the patient demographic characteristics and laboratory findings in the study group. The leading cause of CKD was chronic glomerulonephritis (55.6%), followed by hypertensive nephro­sclerosis (43.2%), while others are as shown in [Table 3]. The serum creatinine levels ranged from 201 to 1205 μmol/L, with a mean of 389 ± 168 μmol/ L, the estimated GFR (eGFR) ranged from 3.77 to 44.32 mL/min GFR, with a mean of 18.2 ± 7.19 mL/min, while the serum urea levels ranged from 5.1 to 37.0 mmol/L, with a mean of 11.2 ± 5.4 mmol/L.
Figure 1: Age distribution of the study patients.

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Table 1: Demographic characteristics of the study subjects.

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Table 2: Laboratory parameters of the study subjects.

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Table 3: Prevalence of chronic kidney disease in the study subjects.

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The right kidney length ranged from 6.9 to 13 cm, with a mean of 9.11 ± 1.06 cm, while the left kidney length ranged from 6.5 to 13.4 cm, with a mean of 9.23 ± 1.07 cm. The means of the volumes of the right and left kidneys were 98.5 ± 41.9 cm 3 and 106 ± 46.2 cm 3 , respectively.

[Table 4] shows the correlation between the kidney parameters and serum creatinine, eGFR and urea. The Pearson correlation of the right and left kidney length to eGFR was -0.197 and -0.137, respectively, while that of the right and left kidney volume to eGFR was -0.122 and -0.043, respectively.
Table 4: Correlation of eGFR with renal parameters.

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   Discussion Top


Patients with end-stage kidney disease may have bilateral shrunken kidneys, but at early stages of CKD the kidney length may be with­in the normal range. The majority of our cases presented in the advanced stages of CKD that required dialysis in less than three months, similar to previous reports from other parts of the country. [10],[15] The most likely explanation could be attributed to low socio-economic status and ignorance. [16]

Our study demonstrated a strong correlation between renal length and advancing CKD, but to a lesser degree between renal volume and advancing CKD, comparable to the findings by Emamian et al [17] who reported a positive correlation between renal length and creatinine clearance, but in contrast to the report by Sanusi et al [18] who found a strong correlation between renal volume and GFR deter­mined by predictive formulas of Cockcroft- Gault and MDRD. The correlation was main­tained even when the kidney volume was corrected for body surface area. The diffe­rences in our findings with that reported by Sanusi et al [13] could probably be explained by the sample size, as 312 cases were recruited in our study against 37 in theirs. In a similar study by Shathabish et al, [11] it was reported that the kidney size in patients with CKD changes over time, with atrophy related directly to the decline in renal function and kidney. Bakker et al [19] argued that ultrasound determination of kidney volume has its de­merits, as an ellipsoid formula is being applied to the kidney; thus, he suggested the use of magnetic resonance imaging (MRI) as a better technique. But, considering the high cost, availability and time involved in getting an MRI, ultrasound may probably remain the modality of choice for measuring the dimen­sions of the kidneys.

We conclude that our study demonstrates that sonographically measured kidney length is more sensitive than kidney volume in pre­dicting renal function in established CKD. Renal ultrasound appears to be the investi­gation of choice in our environment for mea­suring the renal length and volume on a rou­tine basis, while MRI is reserved for specific difficult cases and research purposes.

 
   References Top

1.Basile J. Chronic kidney disease: It's time to recognise it in our patients with hypertension. J Clin Hypertens 2004;6:548-51.  Back to cited text no. 1
    
2.McClellan WM, Ramirrez SP, Jurkovitz C. Screening for chronic kidney disease: Unre­solved issues. J Am Soc Nephrol 2003;14(7 Suppl 2):81-7.  Back to cited text no. 2
    
3.Hood SA, Sondheimer JH. Impact of pre end staged renal disease management on dialysis outcomes: A review. Semin Dial 1998;11: 175-80.  Back to cited text no. 3
    
4.Valderrabano F, Horl WH, Macdougall IC, Rossert J, Rutkwski B, Wauters JP. Survey on anaemia management. Nephrol Dial Transplant 2003;18:89-100.  Back to cited text no. 4
    
5.Obrador GT, Ruthazer R, Arora P, Kansz AT, Pereurs BJ. Prevalence of and factors asso­ciated with suboptimal care before initiation of dialysis in the United States. J Am Soc Nephrol 1999;10:1793-800.  Back to cited text no. 5
    
6.Oviasu E, Benka - Coker LB. Renal size in healthy adults Nigerians: An ultrasonographic assessment. Niger Med J 1998;1:20-2.  Back to cited text no. 6
    
7.Oviasu E, Benka - Coker LB. Renal size in sickle cell haemoglobinopathy using ultra-sonography. J Nephrol 1999;3:175-7.  Back to cited text no. 7
    
8.Ozoh JO. Onuigbo MA, Okoye IJ, et al. Age and sex distribution of normal renal sizes in South Eastern Nigeria. Orient J Med 1991;3: 146-9.  Back to cited text no. 8
    
9.Emamian SA, Nielsen MB, Pedersen JF, Ytte L. Kidney dimensions at sonography: Corre­lation with age, sex and habits in 665 adult volunteers. AJR Am J Roentgenol 1993; 160:83-6.  Back to cited text no. 9
[PUBMED]    
10.Salako BL, Atalab OM, Amusat AM, Adeniji S. Renal length, packed cell volume and biochemical parameters in subjects with chronic renal failure: A preliminary report. Trop J Nephrol 2006;2:99-102.  Back to cited text no. 10
    
11.Kariyanna SS, Light RP, Agarwal R. A longitudinal study of kidney structure and function in adults. Nephrol Dial Transplant 2010;25:1120-6.  Back to cited text no. 11
    
12.Satirapoj B, Supasyndh O, Patumanond J, Choovichian P. Estimation of GFR in Asian patients with CKD from bioelectrical impe­dance analysis. J Med Assoc Thai 2006;89: 1584-91.  Back to cited text no. 12
    
13.Sanusi AA, Akinsola A, Ajayi AA. Creatinine clearance estimation from serum creatinine values: An evaluation of five established for­mulae in Nigerian patients. Afr J Med Sci 2000;29:7-11.  Back to cited text no. 13
    
14.Dinkel E, Ertel M, Dittrich M, Peters H, Berres M, Schulte-Wissermann H. Kidney size in childhood. Sonographical growth charts for kidney length and volume. Pediatr Radiol 1985;15:38-43.  Back to cited text no. 14
[PUBMED]    
15.Alebiosu CO, Ayodele OO, Abbas A, Olutoyin AI. Chronic renal failure at the Olabisi Onabanjo University Teaching Hospital, Sagamu, Nigeria. Afr Health Sci 2006;6:132-3.  Back to cited text no. 15
    
16.Afshar R, Sanavi S, Salimi J. Epidemiology of chronic renal failure in Iran, a 4 year single centre experience. Saudi J Kidney Dis Transpl 2007;18:191-5.  Back to cited text no. 16
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17.Emamian SA, Nielson MB, Pedersen JF, Ytte L. Kidney dimensions at sonography: corre­lation with age, sex, and habitus in 665 adult volunteers. AJR Am J Roentgenol 1993;160: 83-6.  Back to cited text no. 17
    
18.Sanusi AA, Arogundade FA, Famurewa OC, et al. Relationship of ultrasonographically determined kidney volume with measured GFR, calculated creatinine clearance and other parameters in chronic kidney disease. Nephrol Dial Transplant 2009;24:1690-4.  Back to cited text no. 18
    
19.Bakker J, Olree M, Kaatee R, et al. Renal volume measurements: Accuracy and repeata­bility of US compared with that of MRI. Radiology 1999;211:623-8.  Back to cited text no. 19
    

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Correspondence Address:
Dr. Muhammad Aliyu Makusidi
Department of Medicine, Usmanu Danfodiyo University Teaching Hospital, P. M.B 2370, Sokoto
Nigeria
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DOI: 10.4103/1319-2442.139981

PMID: 25193925

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    Materials and Me...
   Data Analysis
   Results
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