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Saudi Journal of Kidney Diseases and Transplantation
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ORIGINAL ARTICLE  
Year : 2016  |  Volume : 27  |  Issue : 4  |  Page : 671-676
Relationship between renal volume calculated by using multislice computed tomography and glomerular filtration rate calculated by using the Cockcroft-Gault and modification of diet in renal disease equations in living kidney donors


1 Department of Radiology, Isfahan University of Medical Sciences, Isfahan, Iran
2 Department of Nephrology, Isfahan University of Medical Sciences, Isfahan, Iran

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Date of Web Publication5-Jul-2016
 

   Abstract 

It is essential to ascertain the state of health and renal function of potential kidney donors before organ removal. In this regard, one of the primary steps is to estimate the donor's glomerular filtration rate (GFR). For this purpose, the modification of diet in renal disease (MDRD) and the Cockcroft-Gault (CG) formulas has been used. However, these two formulas produce different results and finding new techniques with greater accuracy is required. Measuring the renal volume from computed tomography (CT) scan may be a valuable index to assess the renal function. This study was conducted to investigate the correlation between renal volume and the GFR values in potential living kidney donors referred to the multislice imaging center at Alzahra Hospital during 2014. The study comprised 66 subjects whose GFR was calculated using the two aforementioned formulas. Their kidney volumes were measured by using 64-slice CT angiography and the correlation between renal volume and GFR values were analyzed using the Statistical Package for the Social Science software. There was no correlation between the volume of the left and right kidneys and the MDRD-based estimates of GFR (P = 0.772, r = 0.036, P = 0.251, r = 0.143, respectively). A direct linear correlation was found between the volume of the left and right kidneys and the CG-based GFR values (P = 0.001, r = 0.397, P <0.001, r = 0.465, respectively). The kidney volume derived from multislice CT scan can help predict the GFR value in kidney donors with normal renal function. The limitations of our study include the small sample size and the medium resolution of 64-slice multislice scanners. Further studies with larger sample size and using higher resolution scanners are warranted to determine the accuracy of this method in potential kidney donors.

How to cite this article:
Adibi A, Mortazavi M, Shayganfar A, Kamal S, Azad R, Aalinezhad M. Relationship between renal volume calculated by using multislice computed tomography and glomerular filtration rate calculated by using the Cockcroft-Gault and modification of diet in renal disease equations in living kidney donors. Saudi J Kidney Dis Transpl 2016;27:671-6

How to cite this URL:
Adibi A, Mortazavi M, Shayganfar A, Kamal S, Azad R, Aalinezhad M. Relationship between renal volume calculated by using multislice computed tomography and glomerular filtration rate calculated by using the Cockcroft-Gault and modification of diet in renal disease equations in living kidney donors. Saudi J Kidney Dis Transpl [serial online] 2016 [cited 2021 Oct 19];27:671-6. Available from: https://www.sjkdt.org/text.asp?2016/27/4/671/185222

   Introduction Top


Various indicators are used to assess the degree of chronic kidney disease (CKD), among which glomerular filtration rate (GFR) is the best marker for renal function and has been proposed by the National Kidney Foundation for staging and classification of kidney injury. [1]

Inulin clearance is the gold standard for measuring GFR but is not routinely possible to perform. [2] An alternative test is the determination of creatinine clearance in a 24-h urine specimen but this method also has considerable difficulty to be used as a screening test at the community level.

More recently, most studies use the Cockcroft-Gault (CG) and modification of diet in renal disease (MDRD) formulas to estimate the GFR. [3],[4] Both these methods have limitations; for example, the MDRD equation is less accurate in individuals without kidney disease such as living kidney donors; [5],[6],[7],[8] however, most epidemiological studies use these two formulas for calculating GFR as a screening tool at the community level.

Living-donor kidney transplant alongside deceased donation has received plenty of attention. [9],[10],[11] It is essential that the donors' state of health is carefully ascertained to avoid any harm or damage to the donor; therefore, different methods of estimating renal function are performed. One of these methods is the use of computed tomography (CT) angiography for the evaluation of kidney and its vasculature.

CT angiography is one of the most important new techniques for studying the renal arteries and veins of living-donors that has a high level of accuracy and specificity according to various previous studies. [1],[12] CT angiography is a fast, noninvasive method of evaluating the abdominal aorta and its branches including renal arteries and renal veins. [13],[14]

Another parameter that can be estimated from renal CT angiograms is the renal volume which can be calculated using the length, width, and thickness of the kidneys. Since renal volume of a kidney is related to renal allograft function, [1],[15],[16] measuring this parameter can be an indicator of the donors' kidneys health while reporting CT scans. [2] Therefore, measuring renal volume and GFR and their relationship may help to understand better the health status of the donor kidney.

The purpose of our study was to investigate the correlation between GFR and renal volume, so that the donor kidney volume can be used as an evaluating criterion in imaging.


   Subjects and Methods Top


This analytical study was performed in 2014 at the multislice imaging center at Alzahra Hospital, Isfahan, Iran. The study was approved by the Vice Chancellor of Research in Isfahan University of Medical Sciences under the research project number 393451, on May 28, 2014. The study population consisted of potential living kidney donors referred to our center during 2014.

The inclusion criteria for this study were as follows: Potential living kidney donors who gave consent for the participation in the study and to undergo multislice CT scanning.

Patients were excluded from the study in the event of the non-availability of serum blood urea and creatinine (SCr) measurements to calculate GFR, the presence of abdominal deformity leading to difficulty in measuring kidney dimensions, and the presence of any growth/pathology in the kidney on CT, including any space occupying lesion such as solid tumor, simple or complex cyst, hydronephrosis, pelvi-ureteric junction obstruction, and duplex pelvic system.

Convenient sampling was used and finally a total of 66 individuals entered the study. The study patients were first examined by a nephrologist and in case no abnormalities were found, they were then referred for multislice scanning. Age, sex, race, weight, and SCr level were recorded for all study subjects. Based on the images obtained from 64-slice multislice CT scanning, the largest dimensions of length, width, and the thickness of kidneys were measured by multiple measurements in several slices and the mean of these values was used for calculating the kidney volume.

The GFR values were calculated by MDRD [GFR (mL/min/1.73 m 2 ) = 175 × (SCr) − 1.154 × (Age) − 0.203 × (0.742 if female) × (1.212 if African American)] and CG [(140−Age) × W/P Cr × 72 (0.85 if female)] equations. The values were recorded and their correlation with the kidney volume was investigated.

All data were entered into International Business Machines (IBM) SPSS Statistics for Windows, Version 22.0 (IBM Corp., Armonk, NY, USA) and were analyzed using Pearson correlations, paired t-tests and regression analysis.


   Results Top


This study comprised 66 potential kidney donors. The mean age of the studied individuals was 41.05 ± 16.3 years. There were 55 males (83.3%) and 11 females (16.7%). [Table 1] shows the mean and standard deviation of SCr levels, weight, estimates of GFR based on the MDRD and the CG equations and the volumes of right and left kidneys. The mean SCr level was 1.12 ± 0.37 mg/dL and the mean weight of the participants was 76 ± 14.27 kg.
Table 1: Distribution of the general and demographic features of the studied subjects.

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The mean MDRD-based estimate of GFR was 83.11 ± 21.07 and the mean CG-based GFR was 100.05 ± 27.61. The Pearson correlation coefficient showed that there was a direct correlation of 70% between these two indices, which was statistically significant (P <0.001). The mean volumes of the right and left kidneys were 264.3 ± 65.78 and 261 ± 59.35 cm 3 , respectively.

According to our statistical analysis, there was no correlation between the left and right kidney volumes and the MDRD-based estimates of GFR according to the Pearson correlation coefficient (r = 0.036, P = 0.772, P = 0.251, r = 0.143, respectively).

A direct linear correlation was found between the left kidney volume and the CG-based GFR values (P = 0.001, r = 0.397). There was also a significant direct linear correlation between the right kidney volume and the GFR values derived from the CG equation (P <0.001, r = 0.465).

[Figure 1] shows the correlation between CG-based GFR and the left kidney volume that can be estimated by linear equation: y = 51.9 + 0.184x in which, y is CG-based GFR and x is left kidney volume. [Figure 2] shows the correlation between CG-based GFR and right kidney volume that can be estimated by the linear equation: y = 48.4 + 0.196x in which, y is the CG-based GFR and x is the right kidney volume. If the correlation between CG-based GFR and left and right kidney volume is considered together, it can be estimated by the equation: y = 43.9 + 0.05x 1 + 0.16x 2 in which, y is the CG-based GFR, x 1 is the left kidney volume and x 2 is the right kidney volume.
Figure 1: Correlation between the GFR and left kidney volume. y = 51.9 + 0.184x.

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Figure 2: Correlation between the GFR and right kidney volume. y = 48.4 + 0.196x.

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   Discussion Top


The main objective of this study was to determine the correlation between renal volume obtained on CT angiography and GFR values in living donor candidates. Based on our findings, kidney volume can help in the estimation of GFR. Since CKD occurs as a result of various pathophysiologic processes which are associated with abnormal renal function and progressive decline of GFR, [3] the first step in the assessment of candidates is to measure the GFR.

According to the National Kidney Foundation guidelines, the prevalence of early stages of CKD is 11% more than previously thought. [4] According to studies conducted in the United States of America, 26.3 million people, representing 13.1% of adult population, suffer from CKD and 8.04% have GFR values below 60. [17],[18],[19] The prevalence of CKD has been reported to be 6.4% in Italy, [20] 4.7% in Norway, [21] 8.1% in Switzerland, [22] 5.1% in Spain, [23] 4.2% in Netherlands, [24] and 7.2% to 24.7% in Iceland. [25]

Based on previous studies, the incidence of CKD in Iran has been 238 cases per 1 million population in 2000. [26] Fortunately, in parallel with this increase in the incidence of CKD and end-stage renal disease (ESRD), considerable progress has been made toward the treatment options that may improve duration of survival for these patients of which dialysis and kidney transplantation are most notable.

Kidney transplantation is considered the best and most effective treatment option for patients with ESRD. Kidneys for transplant come from a living donor or a deceased (cadaver) donor. The most important step prior to the surgical removal of the kidney for transplantation is to ascertain that the donor is in excellent health and to know the consequences of kidney donation on the living donor. In this regard, the first step is to estimate the donor's GFR along with other clinical tests.

Use of multidetector CT scans to determine the kidney volume is one of the measures, which can be used in living donors. In our study, no correlation was found between the GFR values derived from MDRD equation and the volumes of the left and right kidneys. However, GFR values derived from the CG formula had a direct linear correlation with the volume of both the left and right kidneys.

According to our results, MDRD-based GFR cannot be predicted by left and right kidney volumes, but the CG-based GFR can be predicted from left and right kidney volume.

It has been shown by Herts et al that their model for estimating GFR which incorporated renal volume derived indirectly from CT scan correlated well with measured GFR obtained from the MDRD equation. [27] In their study, unlike the present study, the right or left sidedness was not investigated. On the other hand, the different resolution of the multislice CT scanners, difference in accuracy and precision of measurements and errors in measuring and calculating the results can explain these apparently contradictory results. In a study done by Tsushima et al, there was a statistically significant association between GFR values calculated from CT and the values obtained from 24-h urine creatinine clearance. [28] Similar results have been shown by Hackstein et al as well. [29] Sanusi et al have shown that renal length and kidney volume correlate with GFR. [30] Since the CG equation has been found to be more accurate than the MDRD equation, the overall conclusion of our study is that multislice CT scan can be used to predict the GFR.

The limitations of our study include small sample size, wide age-range of the participants, and the medium resolution of the 64-slice multislice scanners. Further studies with larger sample size and using higher resolution scanners are warranted to determine the accuracy of this method in candidates for kidney donation.

Conflict of interest: None declared.

 
   References Top

1.
Dachman AH, Newmark GM, Mitchell MT, Woodle ES. Helical CT examination of potential kidney donors. AJR Am J Roentgenol 1998;171:193-200.  Back to cited text no. 1
[PUBMED]    
2.
Giral M, Nguyen JM, Karam G, et al. Impact of graft mass on the clinical outcome of kidney transplants. J Am Soc Nephrol 2005;16:261-8.  Back to cited text no. 2
[PUBMED]    
3.
Ahmad Raji AA, Sayf A, Najafi I. Kidney and Urinary Tract Diseases. Arjemand Publication, Tehran. Second volume 2. 2008;5:134-304.  Back to cited text no. 3
    
4.
Levey AS, Coresh J, Balk E, et al. National kidney foundation practice guidelines for chronic kidney disease: Evaluation, classification, and stratification. Ann Intern Med 2003;139:137-47.  Back to cited text no. 4
[PUBMED]    
5.
Rule AD, Larson TS, Bergstralh EJ, Slezak JM, Jacobsen SJ, Cosio FG. Using serum creatinine to estimate glomerular filtration rate: Accuracy in good health and in chronic kidney disease. Ann Intern Med 2004;141:929-37.  Back to cited text no. 5
[PUBMED]    
6.
Poggio ED, Wang X, Greene T, Van Lente F, Hall PM. Performance of the modification of diet in renal disease and Cockcroft-Gault equations in the estimation of GFR in health and in chronic kidney disease. J Am Soc Nephrol 2005;16:459-66.  Back to cited text no. 6
[PUBMED]    
7.
Cockcroft DW, Gault MH. Prediction of creatinine clearance from serum creatinine. Nephron 1976;16:31-41.  Back to cited text no. 7
[PUBMED]    
8.
Poggio ED, Nef PC, Wang X, et al. Performance of the Cockcroft-Gault and modification of diet in renal disease equations in estimating GFR in ill hospitalized patients. Am J Kidney Dis 2005;46:242-52.  Back to cited text no. 8
[PUBMED]    
9.
Davis CL, Delmonico FL. Living-donor kidney transplantation: A review of the current practices for the live donor. J Am Soc Nephrol 2005;16:2098-110.  Back to cited text no. 9
[PUBMED]    
10.
2002 Annual Report of the U.S. Scientific Registry for Transplant Recipients and the Organ Procurement and Transplantation Network: Transplant Data, 1989-2002; 2002.  Back to cited text no. 10
    
11.
Rockville MD. Department of Health and Human Services, Health Resources and Services Administration, Office of Special Programs, Division of Transplantation. Richmond, VA: United Network for Organ Sharing; 2002.  Back to cited text no. 11
    
12.
Smith PA, Ratner LE, Lynch FC, Corl FM, Fishman EK. Role of CT angiography in the preoperative evaluation for laparoscopic nephrectomy. Radiographics 1998;18:589-601.  Back to cited text no. 12
[PUBMED]    
13.
Schold JD, Kaplan B, Baliga RS, Meier-Kriesche HU. The broad spectrum of quality in deceased donor kidneys. Am J Transplant 2005;5(4 Pt 1):757-65.  Back to cited text no. 13
    
14.
Kuszyk BS, Heath DG, Ney DR, et al. CT angiography with volume rendering: Imaging findings. AJR Am J Roentgenol 1995;165:445-8.  Back to cited text no. 14
[PUBMED]    
15.
Platt JF, Ellis JH, Korobkin M, Reige K. Helical CT evaluation of potential kidney donors: Findings in 154 subjects. AJR Am J Roentgenol 1997;169:1325-30.  Back to cited text no. 15
[PUBMED]    
16.
Poggio ED, Hila S, Stephany B, et al. Donor kidney volume and outcomes following live donor kidney transplantation. Am J Transplant 2006;6:616-24.  Back to cited text no. 16
[PUBMED]    
17.
Clase CM, Kiberd BA, Garg AX. Relationship between glomerular filtration rate and the prevalence of metabolic abnormalities: Results from the Third National Health and Nutrition Examination Survey (NHANES III). Nephron Clin Pract 2007;105:178-84.  Back to cited text no. 17
    
18.
Stevens LA, Coresh J, Greene T, Levey AS. Assessing kidney function - Measured and estimated glomerular filtration rate. N Engl J Med 2006;354:2473-83.  Back to cited text no. 18
[PUBMED]    
19.
Coresh J, Byrd-Holt D, Astor BC, et al. Chronic kidney disease awareness, prevalence, and trends among U.S. adults, 1999 to 2000. J Am Soc Nephrol 2005;16:180-8.  Back to cited text no. 19
    
20.
Cirillo M, Laurenzi M, Mancini M, Zanchetti A, Lombardi C, De Santo NG. Low glomerular filtration in the population: Prevalence, associated disorders, and awareness. Kidney Int 2006;70:800-6.  Back to cited text no. 20
[PUBMED]    
21.
Hallan SI, Coresh J, Astor BC, et al. International comparison of the relationship of chronic kidney disease prevalence and ESRD risk. J Am Soc Nephrol 2006;17:2275-84.  Back to cited text no. 21
[PUBMED]    
22.
Nitsch D, Felber Dietrich D, von Eckardstein A, et al. Prevalence of renal impairment and its association with cardiovascular risk factors in a general population: Results of the Swiss SAPALDIA study. Nephrol Dial Transplant 2006;21:935-44.  Back to cited text no. 22
[PUBMED]    
23.
Otero A, Gayoso P, Garcia F, de Francisco AL; EPIRCE Study Group. Epidemiology of chronic renal disease in the Galician population: Results of the pilot Spanish EPIRCE study. Kidney Int Suppl 2005;99:S16-9  Back to cited text no. 23
    
24.
Verhave JC, Gansevoort RT, Hillege HL, et al. An elevated urinary albumin excretion predicts de novo development of renal function impairment in the general population. Kidney Int Suppl 2004;92:S18-21.  Back to cited text no. 24
[PUBMED]    
25.
Viktorsdottir O, Palsson R, Andresdottir MB, Aspelund T, Gudnason V, Indridason OS. Prevalence of chronic kidney disease based on estimated glomerular filtration rate and proteinuria in Icelandic adults. Nephrol Dial Transplant 2005;20:1799-807.  Back to cited text no. 25
    
26.
Haghighi AN, Broumand B, D'Amico M, Locatelli F, Ritz E. The epidemiology of endstage renal disease in Iran in an international perspective. Nephrol Dial Transplant 2002;17:28-32.  Back to cited text no. 26
    
27.
Herts BR, Sharma N, Lieber M, Freire M, Goldfarb DA, Poggio ED. Estimating glomerular filtration rate in kidney donors: A model constructed with renal volume measurements from donor CT scans. Radiology 2009;252:109-16.  Back to cited text no. 27
[PUBMED]    
28.
Tsushima Y, Blomley MJ, Kusano S, Endo K. Use of contrast-enhanced computed tomography to measure clearance per unit renal volume: A novel measurement of renal function and fractional vascular volume. Am J Kidney Dis 1999;33:754-60.  Back to cited text no. 28
[PUBMED]    
29.
Hackstein N, Wiegand C, Rau WS, Langheinrich AC. Glomerular filtration rate measured by using triphasic helical CT with a two-point Patlak plot technique. Radiology 2004;230:221-6.  Back to cited text no. 29
[PUBMED]    
30.
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 (CKD). Nephrol Dial Transplant 2009;24:1690-4.  Back to cited text no. 30
[PUBMED]    

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Correspondence Address:
Sima Kamal
Department of Radiology, Isfahan University of Medical Sciences, Isfahan
Iran
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DOI: 10.4103/1319-2442.185222

PMID: 27424682

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