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      Variations in renal morphometry: A hospital-based Indian study

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          Abstract

          Introduction:

          The currently available standard renal nomograms for comparison of renal dimensions in India are based on the measurements made in the Western population. The objectives of our study were to identify variations in renal morphometric parameters in subjects with no known renal disease in a hospital-based Indian population and to find out any correlation between renal volumes with split renal functions and body mass index (BMI).

          Materials and Methods:

          One hundred and fifty-one subjects undergoing contrast-enhanced computerized tomography (CT) scan for various purposes, including donor nephrectomy, from June 2012 to August 2014 were included in the study. The renal and ureteral dimensions were assessed from the contrast-enhanced CT scan images of these patients.

          Results:

          The mean length, width, thickness and volume of the left kidney were 11.02 ± 1.13 cm, 5.21 ± 0.75 cm, 4.65 ± 0.84 cm and 138.22 ± 29.81 mL, respectively, and those for the right kidney were 10.86 ± 1.12 cm, 5.13 ± 0.77 cm, 4.73 ± 0.95 cm and 137.54 ± 34.48 mL, respectively. The mean length of the left ureter was 23.51 ± 1.48 cm and that of the right ureter was 23.24 ± 1.93 cm. The mean volume of the kidneys in males and females was also different. The volume of the kidney did not statically correlate with the split glomerular filtration rate (( P = 0.12) and BMI ( P = 0.52)).

          Conclusions:

          Our study revealed that there exist differences in various morphometric parameters of the kidney and ureter in different subsets of the Indian population attending our hospital as compared with the standard values quoted in the world literature.

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          Most cited references13

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          Normal values for renal length and volume as measured by magnetic resonance imaging.

          The objective of this magnetic resonance imaging (MRI) study was to (1) test the validity of the ellipsoid formula for estimating kidney volume using ex vivo and in vivo models and (2) establish a normal range of values for kidney length and volume in patients with no known history of renal disease. The volumes of five excised porcine kidneys were measured by (1) disc-summation method, (2) ellipsoid formula, and (3) water displacement method. In a retrospective, consecutive group of clinically referred patients (n = 150; 300 kidneys), individual kidney volume and length were calculated by the disc-summation method and by multiplanar reformation of MRI data, respectively. For comparison, kidney volumes also were calculated using the ellipsoid formula in all patients. Renal volume that was obtained by MRI using the disc-summation method was within 5% of the volume that was determined by the water displacement method, independent of the spatial resolution of the MRI technique used. Data from both the in vivo and the ex vivo models revealed that the ellipsoid formula that commonly is used in ultrasonography underestimates renal volume by 17 to 29% compared with the disc-summation method (P < 0.05). As measured by MRI (mean +/- SD), kidney lengths were 12.4 +/- 0.9 cm for men and 11.6 +/- 1.1 cm for women, and kidney volumes were 202 +/- 36 ml for men and 154 +/- 33 ml for women. The results from the ex vivo MRI study show that the kidney volume that was obtained using the disc-summation method is within 5% of the true kidney volume as measured by the water displacement method. The ellipsoid formula consistently and significantly underestimates the true kidney volume. The length and the volume of kidneys that are obtained by MRI in patients with no known history of intrinsic renal disease are greater than the commonly quoted reference values that are obtained by ultrasonography.
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            Sonographic measurement of absolute and relative renal length in adults.

            The aim of this study was to evaluate sonographically measured absolute and relative lengths of normal kidneys according to subject height, sex, and age. Real-time sonography was performed on 202 subjects. Measurements of longitudinal renal diameter represented absolute renal length. Relative renal length was calculated using the kidney length: body height ratio (KBR). Statistical analyses were done on findings in 175 subjects without renal impairment (104 men and 71 women) whose ages ranged from 17 to 85 years (mean +/- SD, 46.3 +/- 17.1). The mean heights of the subjects were 176 +/- 7 cm for men and 167 +/- 6 cm for women. The left kidney was absolutely (mean +/-SD, 112 +/- 9 mm) and relatively (mean KBR +/- SD, 0.655 +/- 0.042) longer than the right kidney (absolute length, 110 +/- 8 mm; KBR, 0.641 +/- 0.038), regardless of sex (p 0.05). Renal length decreased with age, and the rate of decrease seemed to accelerate at 60 years and older. When height and age were included in the multivariate regression analysis, sex was not a significant predictor of kidney length. Relative renal length better represents kidney size than absolute renal length because it eliminates sex and height differences.
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              A comparative study of methods of estimating kidney length in kidney transplantation donors.

              Knowledge of kidney size is important for clinical assessment of renal disease. However, there are few studies on methods of assessing kidney size. The purpose of this study was to determine the usefulness of body index and radiological measurements for prediction of kidney size. One hundred and twenty five donors were enrolled. The sizes of donor kidneys obtained after nephrectomies for kidney transplantations were documented and the correlation coefficient between kidney length and body index was calculated. Kidney length was estimated from the distance between the first and third lumbar vertebrae (L1-3), intravenous pyelograms (IVPs), abdominal ultrasonography (US), and abdominal computed tomography (CT). Normal adult kidneys were 11.08 +/- 0.96 cm long, 6.25 +/- 0.67 cm wide, 4.73 +/- 0.65 cm thick and weighed 196.3 +/- 41.0 g. Correlation coefficients between kidney length and body height, body weight, body surface area and total body water content were 0.29, 0.31, 0.26, and 0.32, respectively. The difference between actual and predicted kidney lengths was -0.6 cm for L1-3, +1.2 cm for IVPs, -0.7 cm for abdominal US, -0.8 cm for transverse CT section, and -0.5 cm for coronal CT section. Abdominal coronal CT section predicted kidney length more accurately than other radiological methods, but all radiological methods were associated with prediction errors. As kidney length was correlated with body index, it is suggested that body index is the most useful and simplest method of estimating kidney size as an adjunct to treatment decisions concerning renal disease.
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                Author and article information

                Journal
                Indian J Urol
                Indian J Urol
                IJU
                Indian Journal of Urology : IJU : Journal of the Urological Society of India
                Medknow Publications & Media Pvt Ltd (India )
                0970-1591
                1998-3824
                Jan-Mar 2016
                : 32
                : 1
                : 61-64
                Affiliations
                [1]Department of Urology, Lourdes Hospital, Kochi, India
                Author notes
                For correspondence: Dr. H. Krishnamoorthy, Department of Urology, Lourdes Hospital, Kochi - 682 012, kerala, India. E-mail: dr.moorthy65@ 123456gmail.com
                Article
                IJU-32-61
                10.4103/0970-1591.173115
                4756554
                26941497
                3735d6af-972e-48ae-b217-3a1236473c79
                Copyright: © 2016 Indian Journal of Urology

                This is an open access article distributed under the terms of the Creative Commons Attribution-NonCommercial-ShareAlike 3.0 License, which allows others to remix, tweak, and build upon the work non-commercially, as long as the author is credited and the new creations are licensed under the identical terms.

                History
                Categories
                Original Article

                Urology
                computerized tomography,ellipsoid formula,kidney volumes,renal dimensions
                Urology
                computerized tomography, ellipsoid formula, kidney volumes, renal dimensions

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