Ministry of Higher Education Scientific Research University Sulaimani School of Medicine
COMPARATIVE ULTRASONOGRAPHIC MEASUREMENT OF RENAL SIZE AND ITS CORRELATION WITH AGE, GEDNDER AND BODY MASS INDEX IN NORMAL SUBJECTS IN SULAIMANI REGION.
A thesis Submitted to the Council of the School of Medicine – University of Sulaimani , in Partial Fulfillment of the Requirements for the Degree of Master of Science in Human Anatomy
By Bryar Ali Muhammed M.B.Ch.B
Supervised by Dr. Shilan Hussein Karim Ph.D Human Anatomy (Lecturer)
2014
2714
بسم ەللا الرمحن الرحمی قالوا س بحانک ال عمل لنا الا ماعلمتنا انک انت العلمی احلکمی سورة البقرة (ایة )٢٣
Supervisors Declaration
I certify that this thesis was prepared under my supervision at the School of Medicine, University of Sulaimani as a partial requirement for the degree of Master of Science in Human Anatomy.
Signature : Supervisor: Dr. Shilan Hussein Karim Date
:
In view of the available recommendations, I forward this thesis for debate by the Examining Committee.
I
Committee Declaration We, the Examining Committee, certify that we have read this thesis and have examined the student in its context and that in our opinion, it is adequate as a thesis for the degree of Master of Science in Human Anatomy
Dr. Aso Omer Rasheed
Dr. Paiman Jamal Mohamed
M.B.CH.B, FICMS (Uro)
Ph.D Human Anatomy
Assistant professor, (Chairman)
Lecturer, (Member)
Dr. Shilan Hussein Karim
Dr. Naser Abdullah Mohammed
Ph.D Human Anatomy
FIBMS Radiology
Lecturer, (Supervisor)
Lecturer, (Member)
Approved for the School Committee of Graduate Studies
Dr. Ari Sami Hussain Nadim Assistant professor in Neurosurgery Dean of Faculty of Medical Sciences Head of School of Medicine II
DEDICATION This thesis is dedicated to : all who helped me to complete this thesis, all who gets benefit from this thesis, and the soul of my mother
With my love and respect Bryar Ali muhammed
III
Acknowledgments Thanks to God for all graces and for planting the soul of patience and faith in me to complete this study. Many thanks are due to school of medicine for granting me this chance. I am grateful to my supervisor Dr. Shilan Hussein Karim for her valuable guidance and continuous interest throughout the period of the research, I wish to express my gratitude to her for this and also for her careful reading and constructive criticism of the manuscript. I would like to express my thanks to Dr. Naser Abdullah Mohammed for his kind support in taking the data. I should not forget Dr. Ismaeel H.A Aghaways for his continuous support. I am endebt to those who assisted me in my study; Dr. Bahar Abubakir and Dr. Khandan Mahmood because of their role in data collection I would like to thank Dr. Isra Khalil for her kind Arabic translation. Special thanks to all my friends in the Sulaimani Teaching hospital specially Dr. Saman Ahmed and Dr. Barzan Othman . Finally I would like to thank all the staff in the Anatomy department at university of Sulaimani for their support.
IV
Abstract The renal size of population are very useful diagnostic parameter in medicine practice, since the renal size is affected by various factors, it is necessary to first determine the normal value. The aim of this study is to provide an estimation of renal size in normal subjects in Sulaimani Teaching Hospital, and studying its relation with: age, gender and body mass index (BMI , hence forth) by ultrasonography , to provide a standard data to our locality as we are deficient of them. A cross sectional descriptive study was conducted in the Sulaimani Teaching Hospital during the period of (Jun-2013 to February-2014). (450) random volunteer person were included in the study aging between (18 - 96) years, without any known renal diseases. The sample of the study includes 450 person, 239 person (53%) were female, the rest 211 person (47%) were male. The mean of right renal size in male was (76553.9947 ) while the mean of left renal size was (94493.9 ). In female, the mean of right renal size was (68324.0292 ) while the mean of left renal size was (84150.43264 ). Mean renal size for the right kidney was (72210.9842 renal size for the left kidney was (89031.0296 ).
),While the mean
There was positive correlation between right and left kidney size with the left kidney size larger. There was also positive correlation between renal size and age, as renal size increased with age till 5th decade of life. While the male renal size was greater than female renal size with the same age group. There was positive correlation between renal size and body mass index (BMI).
V
LIST OF CONTENTS
Chapter One: Introduction and Review of literature 1 Introduction …………………………………...……………………… 1 1.1 Development of kidneys ……………………..…………………….. 3 1.2 Gross anatomy of kidney ……………….……..……...……………. 6 1.2.1 Relations of kidneys with abdominal organs ……………………..7 1.2.2 Coverings of the kidneys ………………….….…...…….………. 10 1.2.3 Kidney structure ………………….…………….…....…….…….. 11 1.2.4 Renal vasculature and lymphatics ……………..………………… 13 1.2.5 Histology of the kidney……………………………………………14 1.3 Ultrasound of the kidney ………………………….……..………… 16 1.4 Review of literature ………………………………..….…………… 18 The aim of the study .……………………………….……………… 23 Chapter Two: Subjects and methods 2.1 Plan of the study………………………………………….………… 24 2.2 Data Collection ………………………………………….………… 24 2.3 Statistical Analysis …………………………………………………. 25 VI
Chapter Three : Results 3.1 General Description………………………………………………….31 3.2 Correlation between right and left kidney size ………………...…… 34 3.3 Correlation between Age and Kidney size ………………….……… 37 3.4 Correlation between male and female kidney size …………………. 42 3.5 Correlation between body mass index and both kidney size ………. 47 Chapter Four : Discussion 4.1 Correlation between right and left kidney size……………………....75 4.2 Correlation between Age and Kidney size………………………. ….76 4.3 Correlation between male and female kidney size …………….. …..78 4.4 Correlation between body mass index and the size of both kidneys... 79 4.5Comparison of the data of current study with data of nearby areas.….80
Conclusions………………………………………………..…….82 Recommendation ………………………………………………..……….83 Bibliography……………………………………..………………..……. 84
VII
LIST OF TABLES
Number
Title
Page
Table 3.1
Gender distribution
31
Table 3.2
General characteristics and kidney dimensions
33
Table 3.3
Correlation between Rt and Lt kidney size
34
Table 3.4
Correlation coefficient between Rt and
35
Lt kidney size Table 3.5
Correlation between age and both kidney size
37
Table 3.6
Correlation between age and right kidney size
38
Table 3.7
Correlation between age and left kidney size
40
Table3.8
Correlation between male kidney size (Rt & Lt)
42
and female kidney size (Rt &Lt) Table 3.9
Correlation coefficient between two genders
43
Rt kidney size Table 3.10
Correlation coefficient between two genders Lt kidney size
VIII
45
Number
Title
Page
Table 3.11
Correlation between BMI and both kidney size
47
Table 3.12
Correlation coefficient between BMI and
48
right kidney size Table 3.13
Correlation coefficient between BMI and
50
left kidney size Table 3.14 Table 4.1
Row Data
52
Comparing current data with nearby areas data
IX
81
LIST OF FIGURES Number
Title
Page
Fig. (1.1) Origins and positions of the pronephros, mesonephros and metanephros……………………………………………………………...……... 4 Fig. (1.2) Origin of the ureteric bud from the mesonephric duct and the formation of the major and minor calyces and the collecting tubules………... 5 Fig. (1.3) Anatomy of kidneys and its relation with abdominal organs……...… 7 Fig. (1.4) Anatomy of kidneys in relation with ribs and abdominal muscles....... 9 Fig. (1.5) Right kidney , coronal section showing the cortex, medulla, pyramids, renal papillae and calyces……………………………...…………...12 Fig.(1.6) Kidneys with abdominal aorta, inferior vena cava……….………..…14 Fig. (2.1) Ultrasound machine, Philips(HD 11) ………………..………...…… 26 Fig. (2.2) Ultrasound probe, frequency ( C5-2) ………………………...…..… 27 Fig. (2.3) Sonogram shows measuring renal length …………................….…. 28 Fig. (2.4) Sonogram shows measuring renalwidth………………….……..….. 29 Fig. (2.5) Sonogram shows measuring renal cortex ……………..…………….30 Fig. (3.1 ) Scatter graph show (Correlation between Rt and Lt kidney size)…..36 Fig (3.2 ) Scatter graph show ( Correlation between age and the size of Rt kidney)………………………………………………………………………….39
X
Number
Title
Page
Fig .(3.3) Scatter plot show (Correlation between age and the size of Lt kidney)…………………………………………………………………………. 41 Fig.(3.4) Scatter plot show ( Correlation between male & female Rt kidney size)………….…………………………………………....44 Fig.(3.5) Scatter plot show ( Correlation between male & female Lt kidney size)………………………………………………..……..46 Fig.(3.6) Scatter plot show (Correlation between BMI and the size of Rt kidney)………………………………………………………………………... 49 Fig.(3.7) Scatter plot show (Correlation between BMI and the size of Lt kidney)..……………………………………………………………………….. 51
XI
LIST OF ABBREVIATIONS Abbreviation
Meaning
BMI
Body mass index
Rt KL
Right kidney length
Rt KW
Right kidney width
Rt KC
Right kidney cortex
Lt KL
Left kidney length
Lt KW
Left kidney width
Lt KC
Left kidney cortex
Rt K Size
Right kidney size
Lt K Size
Left kidney size
Std. Deviation
Standard deviation
HT
Hypertension
DM
Diabetes mellitus
SPSS
Statistical package of social science
US
Ultrasound
CT
Computed Tomography
MRI
Magnetic Resonance Imaging
XII
1.Introduction
Since the renal size is affected by various factors, it is necessary to first establish the normal values. The information available in the West may not be extrapolated to our population since the renal size may differ between ethnic groups and according to body size (Odita JC et al., 1982), (Sainpaio EJ et al.,1989) ,(Wang F et al., 1989), (Emamian Sa et al., 1993) Background knowledge of normal renal dimensions may help in the diagnosis of kidney diseases. Renal dimensional variation occurs in nephropathies due to hypertrophic process and/or atrophy (Elkin M, 1980). Thus, it is imperative to establish the pattern of normal renal dimensions ( MarioM.R.Fernandes et al., 2002) . The kidney size of a patient is a valuable diagnostic parameter in urological and nephrologic practice.While the leading anatomy text describes the adult kidney as12 cm long, 6 cm wide and 3 cm deep (Richard L. Darke et al., 1995), further review of the literature shows that renal size varies with age, gender, body mass index, pregnancy and co-morbid conditions. Renal size may be an indicator for the loss of kidney mass and kidney functions (Shcherbak Al, 1989) ,(Guzman RP et al., 1994). It is valuable in monitoring unilateral kidney disease through comparison with the other (Yamaguchi S et al.,1990) and for the discrimination between upper and lower urinary tract infections (Dinkel E et al.,1986). Renal infections and/or inflammations, nephrologic disorders, diabetes mellitus
1
and hypertension are the most important co-morbid conditions affecting renal size (Montague JP et al., 1982), (Yamada-H Hishida-A et al., 1992). Estimation of renal size by sonography can be performed by measuring renal length, renal width, cortical volume or thickness. The most accurate of these is provided by the renal size (Emamian SA et al., 1995),( Cheong B et al., 2007). However, due to its low inter-observer variation and better reproducibility, renal length, as measured in the longitudinal plane parallel to the longest renal axis, is the most clinically useful parameter (Emamian SA et al., 1995). Renal length as well as renal cortical thickness has been closely related to creatinine clearance in patients with chronic kidney disease (Sanusi AA et al., 2009 ). Similarly, medullary parenchymal thickness is pivotal for grading hydronephrosis especially in the pediatric age group and ultrasound remains the mainstay for diagnosis of hydronephrosis in adults (Webb JA. 1990) . To recognize anatomical deviations in individuals with renal diseases, it is important to have a set of standard sonographic measurements for appropriate comparison (Aga Khan. 2012). The evaluation of renal measurements is very important to the clinician as the results can be used to determine the health of the individuals and it can also visualize any abnormalities present in the kidneys ( E. Supriyanto et al., 2011). Many studies have shown that the renal size and measurements are influenced by many factors such as age, ethnicity, gender, weight and height ( Elkin M,1980 ), (J.J. Chen et al., 2002 ). It is also known that the 2
left kidney is larger than the right kidney, independent of gender (Mazzotta L et al., 2002),( Justo Oyuela-Carrasco et al., 2009).
1.1 Development of kidneys Functionally, the urogenital system can be divided into two entirely different components; the urinary system and the genital system. Embryologically and anatomically, however, they are intimately interwoven. Both develop from a common mesodermal ridge (intermediate mesoderm ) along the posterior wall of the abdominal cavity, and initially, the excretory ducts of both systems enter a common cavity, the cloaca (Richard S. Snell , 2008). Three sets of structures in the urinary system appear, known as the pronephros, mesonephros, and metanephros. In the human, the metanephros is responsible for the permanent kidney. The metanephros develops from two sources: the ureteric bud from the mesonephric duct and the metanephronic cap from the intermediate cell mass of mesenchyme of the lower lumber and sacral region (Richard S. Snell , 2008). Ureteric bud : The ureteric bud arises as an outgrowth of the mesonephric duct. Fig.(1.1) and Fig.(1.2) .It forms the ureter, which dilates at its upper end to form the pelvis of the ureter. The pelvis later gives off branches that form the major calyces, and these in turn divide and branch to form the minor calyces and the collecting tubules.(Richard S. Snell , 2012)
3
Fig.(1.1) The origins and positions of the pronephros, mesonephros and metanephros
Metanephrogenic Cap ; the metanephrogenic cap condenses around the ureteric bud and forms the glomerular capsules, the proximal and distal convoluted tubules, and the loops of Henle. The glomerular capsule becomes invaginated by a cluster of capillaries that form the glomerulars. Each distal convoluted tubules formed from the metanephrogenic cap tissue becomes joined to a collecting tubule derived from the ureteric bud. The surface of the kidney is lobulated at first, but after birth, this lobulation usually soon disappears. (Richard S. Snell , 2012)
4
Fig. (1.2) The origin of the ureteric bud from the mesonephric duct and the formation of the major and minor calyces and the collecting tubules.
The developing kidney is initially a pelvic organ and receives its blood supply from the pelvic continuation of the aorta, the middle sacral artery. Later, the kidney ascends up the posterior abdominal wall. This so-called ascent is caused mainly by the straightening of its curvature. The ureter elongates as the ascent continues. The kidney is vascularized at successively higher level by successively higher lateral splanchnic arteries, branches of the aorta. The kidney reaches their final position opposite the 2nd lumber vertebra. Because of the large size of the right lobe of the liver, the right kidney lies at a slightly lower level than the left kidney (Richard S. Snell , 2012). 5
1.2 Gross Anatomy of Kidney The bean-shaped kidneys are retroperitoneal in the posterior abdominal region. Fig.(1.3) They lie in the extraperitoneal connective tissue immediately lateral to the vertebral column. In the supine position, the kidneys extend from approximately 12 thorasic vertebra superiorly to lumber 3 vertebra inferiorly, with the right kidney somewhat lower than the left because of its relationship with the liver. Although they are similar in size and shape, the left kidney is longer and more slender organ than the right kidney, and nearer to the midline. The anterior surface of the right kidney is related to numerous structures, some of which are separated from the kidney by a layer of peritoneum and some of which are directly against the kidney, Fig. (1.3), (Richard L et al., 2005).
6
Fig. (1.3) Anatomy of kidneys and its relation with abdominal organs
1.2.1 Relations of kidneys with abdominal organs (anterior relation): right kidney; a small part of the superior pole of right kidney is covered by the right suprarenal gland. moving inferiorly, a large part of the rest of the upper part of the anterior surface is against the liver and separated from it by a layer of peritoneum. medially, the descending part of the duodenum is retroperitoneal and contacts the kidney.
7
the inferior pole of the kidney, on its lateral side, is directly associated with the right colic flexure and, on its medial side, is covered by a segment of the intraperitoneal small intestine (Richard L et al., 2005). left kidney; The anterior surface of the left kidney is also related to numerous structures, some with an intervening layer of peritoneum and some directly against the kidney, Fig. (1.3). a small part of the superior pole, on its medial side, is covered by the left suprarenal gland. the rest of the superior pole are covered by the intraperitoneal stomach and spleen. moving inferiorly, the retroperitoneal pancreas covers the mid-part of the kidney. on its lateral side, the lower half of the kidney is covered by the left colic flexure and the beginning of the descending colon, and, on its medial side, by the parts of the intraperitoneal jejunum (Richard L et al., 2005).
Posteriorly, the right and left kidneys are related to similar structures. Superiorly is the diaphragm and inferior to this, moving in a medial to lateral direction, are psoas major, quadratus lumborum,
8
and transversus abdominis muscles, Fig.(1.4).
Fig. (1.4) Anatomy of kidneys in relation with ribs and abdominal muscles
The superior pole of the right kidney is anterior to rib 12, while the same region of the left kidney is anterior to ribs 11 and 12. The pleural sacs, and specifically, the costodiaphragmatic recesses, therefore extend posterior to the kidneys(Richard L et al., 2005). Also passing posterior to the kidneys are the subcostal vessels and nerves and the iliohypogastric and ilio-inguinal nerves (Richard L et al., 2005) 9
1.2.2 Coverings of the kidneys : The kidneys are enclosed in and associated with a unique arrangement of fascia and fat. Immediately outside the renal capsule, there is an accumulation of extraperitoneal fat-the perinephric fat (perirenal fat), which completely surrounds the kidney . Enclosing the perinephric fat is a membranous condensation of the extraperitoneal fascia (the renal fascia). The suprarenal glands are also enclosed in this fascial compartment, usually separated from the kidneys by a thin septum. The renal fascia must be incised in any surgical approach to this organ (Richard L et al., 2005). At the lateral margins of each kidney, the anterior and posterior layers of the renal fascia fuse. This fused layer may connect with the transversalis fascia on the lateral abdominal wall (Richard L et al., 2005). Above each suprarenal gland, the anterior and posterior layers of the renal fascia fuse and blend with the fascia that covers the diaphragm. Medially, the anterior layer of the renal fascia continues over the vessels in the hilum and fuses with the connective tissue associated with the abdominal aorta and the inferior vena cava. In some cases, the anterior layer may cross the midline to the opposite side and blend with its companion layer (Richard L et al., 2005). The posterior layer of the renal fascia passes medially between the kidney and the fascia covering the quadratus lumborum muscle to fuse with the fascia covering the psoas major muscle. Inferiorly, the anterior and posterior layers of the renal fascia enclose the ureters (Richard L et al., 2005). In addition to perinephric fat and the renal fascia, a final layer of 10
paranephric fat (pararenal fat) completes the fat and fascias associated with the kidney. This fat accumulates posterior and posterolateral to each kidney (Richard L et al., 2005).
1.2.3 Kidney structure Each kidney has a smooth anterior and posterior surface covered by a fibrous capsule, which is easily removable except during disease. On the medial margin of each kidney is the hilum of kidney, which is a deep vertical slit through which renal vessels, lymphatics, and nerves enter and leave the substance of the kidney. Fig. (1.5) Internally, the hilum is continuous with the renal sinus. Perinephric fat continues into the hilum and sinus and surrounds all structures (Richard L et al., 2005). Each kidney consists of an outer renal cortex and an inner renal medulla. The renal cortex is a continuous band of pale tissue that completely surrounds the renal medulla. Extensions of the renal cortex (the renal columns) project into the inner aspect of the medulla (Richard L et al., 2005). The kidney cortex dividing the renal medulla into discontinuous aggregations of triangular-shaped tissue (the renal pyramids). The bases of the renal pyramids are directed outward, towards the renal cortex. Apex of each renal pyramid projects inward, towards the renal sinus. The apical projection (renal papilla) is surrounded by a minor calyx (Richard L et al., 2005).
11
Fig. (1.5) Right kidney, coronal section showing the cortex, medulla, pyramids, renal papillae and calyces
The minor calices receive urine and represent the proximal parts of the tube that will eventually form the ureter Fig. (1.5 ). In the renal sinus, several minor calices unite to form a major calyx, and two or three major calices unite to form the renal pelvis, which is the funnel-shaped superior end of the ureters (Richard L et al., 2005). 12
1.2.4 Renal vasculature and lymphatics A single large renal artery, a lateral branch of the abdominal aorta, supplies each kidney. These vessels usually arise just inferior to the origin of the superior mesenteric artery between vertebrae LI and LII. Fig. (1.6 ) The left renal artery usually arises a little higher than the right, and the right renal artery is longer and passes posterior to the inferior vena cava (Richard L et al., 2005). As each renal artery approaches the renal hilum, it divides into anterior and posterior branches, which supply the renal parenchyma. Accessory renal arteries are common. They originate from the lateral aspect of the abdominal aorta, either above or below the primary renal arteries, enter the hilum with the primary arteries or pass directly into the kidney at some other level, and are commonly called extrahilar arteries (Richard L et al., 2005). Multiple renal veins contribute to the formation of the left and right renal veins, both of which are anterior to the renal arteries. Fig. (1.6 ) Importantly, the longer left renal vein crosses the midline anterior to the abdominal aorta and posterior to the superior mesenteric artery and can be compressed by an aneurysm in either of these two vessels (Richard L et al., 2005). The lymphatic drainage of each kidney is to the lumbar nodes around the origin of the renal artery (Richard L et al., 2005).
13
Fig. (1.6) Kidneys with abdominal aorta and inferior vena cava
1.2.5 Histology of the kidney The histology and functional unit of the kidney is the nephron, and there are about one million in each kidney. Each nephron consists of a glomerulus and a tubule system. The glomerulus is a tuft of capillaries surrounded by very thin epithelial cells (podocytes), the whole forming a mass which projects into a rounded capsule (of Bowman). The epithelium covering the capillaries is continuous with that forming the boundaries of Bowmans
14
capsule, which in turn continuous in to the epithelium of tubule system. The part of the tubule adjacent to Bowmans capsule is the proximal convoluted tubule, and this leads into the thin walled loop of Henle and so to the distal convoluted tubule and finally to the collecting tubule and collecting duct. The glomeruli and convoluted tubules are in cortex, and the loop of Henle and collecting tubules and ducts in the medulla. The collecting ducts unite with one another, and the largest open at the tip of renal papilla in a minor calyx. The glomerular capillaries are supplied by an afferent arteriole, and leaving them is an efferent arteriole which breaks up into peritubular capillaries surrounding the proximal and distal convoluted tubules.Urine is a glomerular filtrate (deproteinized plasma) which passes into the space of Bowmans capsule and so into the tubule system where it is modified by selective absorption and secretion. Certain arteriolar cells and distal convoluted tubule cells constitute the juxtaglomerular apparatus which secret rennin ( Chummy S. Sinnatamby. 2006). The pelvis, like the ureter, is lined by transitional epithelium and there is smooth muscle in its wall. Specialized muscle cells in the walls of the minor calyces act as pacemakers that initiate contractile waves which pass down into the ureter ( Chummy S. Sinnatamby. 2006).
15
1.3 Ultrasound of the kidney Ultrasound is the term used to describe sound where frequencies are above 20 000 Hertz (Hz) and beyond the range of human hearing. Frequencies of 1–30 megahertz (MHz) are typical for diagnostic ultrasound. Diagnostic ultrasound imaging depends on the computerized analysis of reflected ultrasound waves, which non-invasively build up fine images of internal body structures. The resolution attainable is higher with shorter wavelengths, with the wavelength being inversely proportional to the frequency ( Lutz H et al.,2011). However, the use of high frequencies is limited by their greater attenuation (loss of signal strength) in tissues and thus shorter depth of penetration. For this reason, different ranges of frequency are used for examination of different parts of the body: 3–5 MHz for abdominal areas 5–10 MHz for small and superficial parts and 10–30 MHz for the skin or the eyes. ( Lutz H et al.,2011). Ultrasonography (US) replaced standard radiography (Emamian SA et al., 1993) and has become a standard imaging modality in the investigation of renal diseases ( Radermacher J,2005) due to its non- invasive nature and easy availability ( Rafique M,2006). It offers excellent anatomical details, does not require any special preparation of patients, is readily available, and does not expose the patient to radiation or contrast agents (Mujahid Raza et al., 2011). 16
Renal ultrasound is used to determine the site and volume of the kidneys and to detect any focal renal lesion ( Radermacher J,2005). It also help to evaluate pertinent anatomy and pathology especially during surgery in case of intraoperative US (Mehmood T,2003). In a study on donor kidneys, the measurements obtained by using US were more accurate than those based on plain radiographs, excretory urograms or renal angiograms (Emamian SA et al., 1993). However, underestimation of sonographic renal volume is found when compared with measurements by computed tomography (Widjaja E et al.,2004) ,(Kang KY et al., 2007) and magnetic resonance imaging ( Bakker J et al., 1998). Still, because of its safety, low cost and easy availability, ultrasound is widely accepted and considered as the tool of choice especially where repeated examinations are required (Buchholz NP et al., 2000), (Mujahid Raza et al.,2011). The right kidney is readily demonstrated through the right lobe of the liver. Generally, a subcostal approach displays the (more anterior) lower pole to best effect, while an intercostal approach is best for demonstrating the upper pole.The left kidney is not usually demonstrable sagittally because it lies posterior to the stomach and splenic flexure. The spleen can be used as an acoustic window to the upper pole by scanning coronally, from the patient’s left side, with the patient supine or decubitus (left side raised); however unless the spleen is enlarged, the lower pole must usually be imaged from the left side posteriorly ( Lutz H et al.,2011).
17
1.4 REVIEW OF LITERATURE Much has been done on finding renal dimensions in many different countries. The most reliable one is finding renal length, renal width and renal cortex by ultrasonographic measurement and its correlation with age, gender and body mass index (BMI). A study conducted by Lina Fahmi Hammad ,(2012) on sonographic study of kidney dimensions on Saudi’s population showed that left kidney found to be longer but thinner than right kidney . Both right and left kidneys dimensions and volume in the male group were larger than that of the female group. In another study conducted by Adeela Arooj et al., (2011) on comparison of renal size among different ethnicities in Malaysia showed that the renal size is different among different ethnicities. A study conducted by Seyed Alireza Emamian1et al.,(1993) on kidney dimensions at sonography, correlation with age, sex, and habitus on Denmark population showed that the measurements differed only slightly between different age groups. Renal size was significantly larger in men than in women. For all age and sex groups, renal measurements except renal width and parenchymal thickness were smaller for the right kidney than for the left kidney. Renal length and renal volume showed only slight differences between volunteers 30 to 60 years old and were distinctly decreased in volunteers 70 years old. In all age groups except the 70-yearolds, a significant correlation was found between kidney length and body height, for both kidneys and both sexes. 18
Other study performed by Agnes Dominguez-Mejia et al., (2001) on kidney measurements by sonography and influence of age, sex and habitus on Filipino adults showed that left kidney was significantly larger than the right for mean length but not for width or thickness. Except for cortical thickness, renal length, width, and thickness were significantly larger in males compared to females. With advancing age, there was minimal shortening but significant increases in width and thickness (renal shape index). Kiw-Yong Kang et al., (2007) performed A comparative study of methods of estimating kidney length in kidney transplantation donors in Korea showed that Males had greater body indexes (height, weight, body surface area ) and kidney sizes, kidney weights and kidney volumes than females. Kidney length is correlated significantly and positively with weight, height, BMI Other study conducted by J. Oyuela et al., (2009) on renal length by ultrasound in Mexican adults showed that left renal length was significantly greater than right renal length and both renal lengths were greater in men than in women. Renal size and height were shorter in Mexican adults in comparison with European populations. A fall in the renal length was observed with age, especially after 60 years, but significantly after the age of 70 years. Both renal length, correlated positively with weight, the BMI and height. A study conducted by Zeb Saeed et al ., (2012) on measurement of renal dimensions in adults and its correlates in Pakistan showed that height, 19
weight and body area; left kidney, male gender, a larger body habitus and age <70 years being strong positive indications of renal size. A study conducted by Wellington Ivbolagbe Ohikhokhai et al., (2010) on effect of patient height and weight on sonographically measured renal sizes in a sample of Nigerian adults showed that there was a significant positive correlation between the kidney dimensions and weight of individuals, heavier individuals have longer, wider, and thicker kidneys than their lighter counterparts. The right and left kidney length, width and thickness also showed a significant direct positive correlation with height. A study conducted by A.I. Udoaka et al., (2013) on ultrasound evaluation of the liver, spleen and kidneys in an adult Southern Nigerian population showed that the bipolar length of the left kidney was greater than the right kidney, a slender but longer left kidney than the right. Relatively stronger correlation with the physical parameters of age, height, weight and BMI in the kidneys than the liver and spleen. A study conducted by Hekmatnia et al., (2004) on sonographic measurement of absolute and relative renal length in healthy Isfahani adults showed that the length of left kidney was longer than the right one. Renal length was significantly greater in males compared to females. Renal length decreased with age and the rate of decrease was accelerated at the age of 60 years and up. There was a significant correlation between kidney length and the subject's height. A study conducted by Mujahid Raza et al., (2011) on ultrasonographic assessment of renal size and its correlation with body mass index in adults 20
without known renal disease in Pakistan population showed that renal length and renal size have a direct relationship with body mass index. Mean renal size is related to side, age, gender, hight and weight as well . A study done by Werner S Harmse. (2011) on normal variance in renal size in relation to body habitus in South Africa showed that renal size varies according to persons’ body habitus. This variation can be expressed as a function of body weight and height, kidneys were generally larger in the white population than in the black, and also in males than females. A study conducted by Sandeep Gupta et al., (2013) on ultrasonographic renal dimensions in normal adult population of North-East India showed that the renal size is related to age, side, sex and the individual’s height and weight. A study performed by Niels-Peter Buchholz et al., (2000) on ultrasonographic renal size in Individuals without having renal disease in Karachi showed that the kidney length, width and cortical thickness were significantly larger in male than in female, and not significant differences of kidney length between right and left side, except for renal length all other renal dimensions were significantly larger on the left than on the right side. The age of individual has an important bearing effect on the kidney size, the kidney size increases till the 3rd decade which remain stable through middle age and then declines. It showed a strong correlation between renal size and body mass index (BMI), the renal size increases correspondingly with an increasing BMI.
21
A study conducted by O. BIRCAN et al., (1993) on estimation of kidney size in Turkish population showed that there is a positive and significant correlation between kidney length and body mass index in age 9-19 years. It also showed that kidneys reach to their mature sizes at the 3rd decade of life and remain without significant changes until 60 years of age. No significant changes in the length of left and right kidney and no relation to sex were observed. A study conducted by Nicholas Gourtsoyiannis et al., (1990)on the thickness of the renal parenchyma showed that it decreases with age on Greece population and showed that a good negative correlation exists between renal parenchymal volume and patient age for all measurements and for each level through each kidney. Differences in the amount of renal parenchyma between the sexes showed that for each decade there was no significant difference between the two sexes. In a study done by Mario M. R. Fernandes et al., (2002) on normal renal dimensions in a specific population in Brazil showed that adjusting the data by height, gender, and body weight did not influence renal dimensions , however , the left kidney was bigger than the right kidney. A study conducted by A. Adibi et al., (2008) on renal cortical thickness in adults with normal renal function measured by ultrasonography in Isfahan showed that there was significant positive correlations between renal cortical thickness and renal length and the patients’ height, but such a correlation was not observed between renal cortical thickness and age, BMI, and the patients’ weight 22
Aim of the study The aim behind conducting this study is to provide an estimation of renal size in normal subjects in Sulaimani region, to study its relation with age, gender and body mass index (BMI) by ultrasonography and to provide a standard database to our locality as we lack them.
23
24
Subjects and Methods 2.1 Plan of the Study A cross sectional descriptive study was conducted in the Sulaimani Teaching Hospital during the period of (Jun-2013 to February-2014). (450) random volunteers were included, aging between (18 - 96) years, without any known renal diseases. Pregnant female, diabetic patient, hypertensive patient, patient who had history of previous surgical operation or trauma to the kidneys and any renal congenital anomalies or pathologies and other systemic diseases observed during U/S examination, were excluded from the study.
2.2 Data Collection Starting by history taking and explanation, then recording age, gender , weight (kg) , height (cm ) by using an electronic scale and tape measure to calculate body mass index BMI by this calculation: ( BMI =
)
(Agenes Dominguez et al., 2001),(Mujahid Raza et al., 2011),(Zeb Saeed et al., 2012). Preparing the subject lying in supine position and ultrasound (U/S) examination by (Philips HD11) Fig. (2.1), by using lubricating jell and an abdominal probe (frequency C5-2) Fig. (2.2 ) curved array and ultrasound (U/S) visualizing the right kidney by the radiologist and checking for any abnormality then taking the measurements as following in mm : 24
1- Renal length (measuring the distance from pole to pole). Fig. (2.3) 2- Renal width (measuring maximum distance between medial & lateral border of kidney). Fig. (2.4) 3- Cortical thickness (measuring the distance between outer renal margin and renal sinus in transverse plane). Fig. (2.5) If difficulties occur in visualizing the kidney especially in obese subject then the subject is asked to lying on the left side (or go to decubitus position )for better view of right kidney. Then the same procedures are repeated for left kidney.
2.3 Statistical Analysis The renal sizes of both kidneys are measured by the following formula: ( Length x Width x Cortical thickness = Renal size
) (O.Bircan
et al., 1993), (Niels-Peter Buchholz et al., 2000) ,(Wellington I. O. et al., 2010), (Adeela Arooj et al., 2011), (Werner S Harmse, 2011), (Mujahid Raza et al., 2011). Using SPSS program, mean value for right and left kidneys, mean value for male and female with S.D for right and left kidney were determined. Correlation of the size of kidney with; age, sex and body mass index were done by using statistical package of social science (SPSS) program for statistical analysis using Pearson correlation .
25
Fig. (2.1) Ultrasound machine, Philips (HD 11)
26
Fig. (2.2) Ultrasound probe, frequency (C5-2) curved array
27
Fig. (2.3) Sonogram shows measuring renal length (Measuring the distance from pole to pole)
28
Fig. (2.4) Sonogram shows measuring renal width (Measuring maximum distance between medial & lateral border of kidney)
29
Fig. (2.5) Sonogram shows measuring renal cortex (Measuring the distance between outer renal margin and renal sinus in transverse plane)
30
31
3.1 General Description The study includes 450 person, out of which 239 (53%) were female and the rest 211 (47%) were male in the Teaching Hospital in Sulaimani. The whole subjects were volunteers ranging between (18-96) years old.
Table ( 3.1) Gender distribution
Frequency Percent Valid
Relative
Cumulative relative
frequency
frequency
female
239
53
0.53
0.53
male
211
47
0.47
1
Total
450
100
1
31
Both height and weight of each individual have been taken and body mass index (BMI) is calculated by this calculation: ( BMI =
)
(Agenes Dominguez et al., 2001),(Mujahid Raza et al., 2011),(Zeb Saeed et al., 2012). Renal length, width and cortex of both kidneys for each individual have been taken by ultrasound. Then, the renal size for each kidney has been calculated by the following equation: Renal size
= Length x Width x Cortical thickness (O.Bircan et
al., 1993), (Niels-Peter Buchholz et al., 2000) ,(Wellington I. O. et al., 2010), (Adeela Arooj et al., 2011), (Werner S Harmse, 2011), (Mujahid Raza et al., 2011).
32
Table (3.2 ) General characteristics and kidney dimensions N
Minimum Maximum
Mean
Std. Deviation
Age (year)
450
18.00
96.00
38.9845
13.75491
Height (m)
450
1.40
1.89
1.6413
0.10516
Weight(kg)
450
40.00
135.00
73.0622
15.45431
BMI (kg/m²)
450
16.11
45.31
27.1622
5.51293
RtKL (mm)
450
84.00
142.00
106.9967
8.73314
RtKW (mm)
450
28.00
61.00
42.2044
5.35243
RtKC (mm)
450
9.00
25.00
15.8024
2.56994
LtKL (mm)
450
86.00
139.00
108.5789
8.42423
LtKW (mm)
450
34.00
66.00
47.2111
6.18982
LtKC (mm)
450
11.00
26.00
17.2502
2.59801
RKSize
450
27846.00 165625.00
72210.9842
18681.46873
LKSize
450
43560.00 171741.00
89031.0296
22025.83057
Valid N (listwise)
450
33
3.2 Correlation between right and left kidney size The mean left kidney size was (89031.0296
) with standard deviation
of (22025.83057). Mean of right kidney size was (72210.9842
) with
standard deviation of (18681.46873).
Table (3.3) Correlation between Rt and LT kidney size Rt Kidny Size
Lt Kidny Size
Mean
72210.9842
89031.0296
Std.
18681.46873
22025.83057
450
450
Deviation N
Later on, finding the correlation coefficient between right and left kidney by Pearson correlation and the results were significant correlation between right and left kidney, with left kidney size was greater than right kidney size.
34
Table (3.4) Correlation coefficient between Rt and Lt kidney size
Rt kidny
Pearson
Size
Correlation
Rt kidny Size
Lt kidny Size
1
.798**
Sig. (2-tailed)
.000
N
450
450
Lt kidny
Pearson
.798**
1
Size
Correlation Sig. (2-tailed)
.000
N
450
450
**. Correlation is significant at the 0.01 level (2-tailed).
35
Fig. (3.1 ) Scatter graph shows (Correlation between Rt and Lt kidney size, there is a positive correlation with left kidney size greater than right kidney size)
36
3.3 Correlation between Age and Kidney size The mean age of all subjects were (38.9845 years) with standard deviation of (13.75491). The mean of right renal size was (72210.9842 kidney size (89031.0296
) and left
).
Table (3.5) Correlation between age and both kidney size Mean
Std. Deviation
N
Age
38.9845
13.75491
450
Rt kidney size
72210.9842
18681.46873
450
Lt kidney size
89031.0296
22025.83057
450
Then finding the correlation coefficient between age and the size of right kidney by Pearson correlation and the result showed that there was weak positive significant correlation between age and the size of right kidney.
37
Table (3.6) Correlation between age and the size of right kidney
Age
Pearson
Age
Rt Kidney Size
1
.160**
Correlation Sig. (2-tailed) N Rt kidney Pearson Size
.001 450
450
.160**
1
Correlation Sig. (2-tailed)
.001
N
450
450
**. Correlation is significant at the 0.01 level (2-tailed).
38
Fig (3.2 ) Scatter graph shows ( Correlation between age and the size of Rt kidney, there is weak positive correlation between age and the size of Rt kidney)
39
The same calculation by SPSS done for the relation between age and left kidney size, the result showed that there was weak positive significant correlation between age and the size of left kidney.
Table (3.7) Correlation between age and the size of left kidney
Age
Pearson
Age
Lt kidney size
1
.013
Correlation Sig. (2-tailed) N Lt kidney Pearson size
.777 450
450
.013
1
Correlation Sig. (2-tailed)
.777
N
450
450
**. Correlation is significant at the 0.01 level (2-tailed).
40
Fig .(3.3) Scatter plot shows (Correlation between age and the size of Lt kidney, there is weak positive correlation between age and the size of Lt kidney) 41
3.4 Correlation between male and female kidney size The mean for both kidneys in both genders were calculated. The mean of right renal size in male was (76553.9947 size was (94493.9 (68324.0292
) while the mean of left renal
). In female the mean of right renal size was ) while the mean of left renal size was
(84150.43264
).
Table(3.8) Correlation between male kidney size (Rt & Lt) and female kidney size (Rt &Lt) Male
Female
Rt kidney size
Lt kidney size
Rt kidney size
Lt kidney size
Mean
76553.9947
94493.9
68324.0292
84150.43264
Std.
19303.11412
23263.09514
17214.5998
19607.67767
Deviatio n N
211
239
42
The correlation coefficient between right kidney size in males and right kidney size in females have been found by Pearson correlation. The results was weak positive significant with right kidney size greater in male than female.
Table (3.9) Correlation coefficient between male and females Rt kidney size Rt kidney size in male Pearson Correlation Rt kidney size in male
1
Sig. (2-tailed)
.025** 0.007
N Pearson Correlation Rt kidney size in female
Rt kidney size in female
Sig. (2-tailed)
211
239
.025**
1
0.007
N
211
**. Correlation is significant at the 0.01 level (2-tailed).
43
239
Fig.(3.4) Scatter plot shows ( Correlation between male & female Rt kidney size, there is weak positive correlation between them with Rt kidney size greater in male than female )
44
The same calculation done to find the correlation coefficient between left kidney size in male and left kidney size in females by Pearson correlation and the result was weak positive significant with left kidney size greater in male than female.
Table (3.10) Correlation coefficient between two genders Lt kidney size left renal size in male Pearson Correlation left renal size in male
1
Sig. (2-tailed)
.051** 0.004
N
left renal size in female
left renal size in female
Pearson Correlation Sig. (2-tailed)
211
239
.051**
1
0.004
N
211
**. Correlation is significant at the 0.01 level (2-tailed).
45
239
Fig.(3.5) Scatter plot shows ( Correlation between male & female Lt kidney size, there is weak positive correlation between them with Rt kidney size greater in male than female )
46
3.5 Correlation between body mass index and both kidney sizes Mean BMI of all subjects are (27.1622 kg/
) with a standard deviation
of (5.51293).
Table (3.11) Correlation between BMI and both kidney sizes Mean
Std. Deviation
N
BMI
27.1622
5.51293
450
Rt kidny Size
72210.9842
18681.46873
450
Lt kidney Size
89031.0296
22025.83057
450
The correlation coefficient between BMI and the size of right kidney has been found by Pearson correlation. The result showed that there was a strong positive significant correlation between BMI and the size of right kidney.
47
Table (3.12) Correlation coefficient between BMI and the size of right kidney
BMI
Pearson
BMI
Rt Kidney Size
1
.491**
Correlation Sig. (2-tailed) N Rt kidney Pearson Size
.000 450
450
.491**
1
Correlation Sig. (2-tailed)
.000
N
450
450
**. Correlation is significant at the 0.01 level (2-tailed).
48
Fig.(3.6) Scatter plot shows ( Correlation between BMI and the size of Rt kidney, there is a strong positive correlation between BMI and the size of Rt kidney)
49
The same calculation is done by Pearson correlation for finding the relation between body mass index and the size of left kidney, the result show that there was a strong positive significant correlation between BMI and the size of left kidney. Table (3.13) Correlation coefficient between BMI and the size of left kidney
BMI
Pearson
BMI
Lt Kidney Size
1
.550**
Correlation Sig. (2-tailed) N Lt kidney Pearson Size
.000 450
450
.550**
1
Correlation Sig. (2-tailed)
.000
N
450
450
**. Correlation is significant at the 0.01 level (2-tailed).
50
Fig.(3.7) Scatter plot shows ( Correlation between BMI and the size of Lt kidney, there is a strong positive correlation between BMI and the size of Lt kidney )
51
Table (3.14) Shows Row Data No
Age
Gender
(years)
BMI (kg/
Rt Renal Size
Lt Renal Size
)
1
30
Male
23.92486
70490
89046
2
31
Male
28.73467
85680
103341
3
30
Male
27.99036
94367
92340
4
30
Male
26.54321
86445
100800
5
29
Male
28.03792
80960
107525
6
30
Male
26.54321
71552
91392
7
31
Male
29.73704
85527
105203
8
31
Male
24.35542
78045
87232
9
40
Male
20.97117
95680
93600
10
30
Male
23.67125
61776
65520
11
32
Male
29.38776
88740
104720
12
29
Male
21.96786
58608
78752
13
32
Male
24.75546
70500
85995
14
33
Male
33.59368
100980
123192
15
34
Male
22.94812
62608
81120
16
34
Male
25.94548
74412
88920
17
34
Male
19.35021
52920
61370
18
28
Male
20.90239
42840
49200
19
30
Male
27.46481
46640
57200
20
31
Male
25.96305
76544
83904
21
29
Male
25.76298
48972
58176
52
No
Age
Gender
(years)
BMI (kg/
Rt Renal Size
Lt Renal Size
)
22
38
Male
22.05805
68432
79500
23
35
Male
22.77319
67821
77550
24
40
Male
20.0692
70500
84048
25
25
Female
18.66201
41800
67410
26
49
Male
20.07733
45276
63840
27
51
Male
25.68956
71487
89700
28
37
Female
20.9042
57960
66105
29
29
Female
19.72387
47040
54756
30
42
Female
26.5625
82432
93906
31
32
Male
22.34352
67704
81000
32
41
Male
26.57313
70800
97104
33
49
Male
23.80869
53352
73500
34
49
Female
18.73049
27846
49392
35
43
Female
21.92886
43200
61740
36
36
Male
26.57313
83148
89964
37
45
Female
19.17458
42042
58080
38
48
Male
26.29758
58136
89856
39
26
Male
19.86852
59085
70848
40
36
Male
20.8307
56238
69264
41
45
Female
19.3685
40293
58520
42
40
Female
20.07733
46728
51467
53
No
Age
Gender
(years)
BMI (kg/
Rt Renal Size
Lt Renal Size
)
43
35
Female
20.39542
59976
65600
44
44
Female
18.55288
50076
56459
45
31
Female
21.75547
61152
76320
46
40
Female
20.17455
52644
63167
47
47
Female
18.08021
49440
50400
48
25
Male
30.79338
86016
109242
49
33
Male
25.50362
78120
90160
50
28
Female
18.6115
43008
45780
51
31
Female
18.97453
47268
55200
52
40
Female
24.87772
75264
85065
53
43
Male
27.17063
60348
89088
54
32
Male
25.61728
76300
98235
55
56
Female
26.91273
54612
71162
56
48
Female
18.66667
38880
52640
57
52
Female
24.97399
62328
65520
58
42
Male
21.84701
70800
91584
59
20
Female
18.75
63840
72114
60
31
Female
25.55556
63630
85176
61
35
Female
19.31295
56544
62604
62
38
Female
24.4646
57165
83385
63
48
Male
27.08416
85436
90160
54
No
Age
Gender
(years)
BMI (kg/
Rt Renal Size
Lt Renal Size
)
64
33
Female
22.15102
46550
62608
65
42
Female
36.57133
81432
96444
66
47
Male
27.74475
72570
91885
67
33
Male
29.31986
99220
109956
68
32
Male
24.44728
83600
93312
69
25
Female
27.30997
90880
99060
70
24
Male
24.03441
73710
82517
71
40
Female
28.51563
79968
94350
72
37
Female
25.23634
74120
88236
73
36
Female
29.31986
91770
100320
74
29
Female
26.43807
73920
83600
75
45
Male
26.53376
70400
86292
76
25
Female
29.77778
80500
91124
77
59
Female
31.5011
79394
88192
78
38
Female
25.87606
38380
43560
79
40
Female
25.10388
79350
88689
80
36
Female
22.82688
62720
74992
81
22
Male
25.46939
67410
79458
82
31
Female
29.39469
85608
104550
83
31
Female
19.7777
45474
53856
84
53
Female
23.37258
45955
56560
55
No
Age
Gender
(years)
BMI (kg/
Rt Renal Size
Lt Renal Size
)
85
49
Female
28.08433
50388
71760
86
30
Female
23.6304
69120
81810
87
35
Female
26.63892
77520
93955
88
29
Female
31.84417
55080
65664
89
32
Male
23.93899
71791
89488
90
37
Female
23.42356
64200
79488
91
27
Male
29.24149
75276
97850
92
43
Female
27.30344
69300
87300
93
60
Female
29.34129
46620
88274
94
52
Female
26.27135
73920
66215
95
55
Female
28.56648
52632
69825
96
45
Male
30.47797
87975
110330
97
22
Female
24.69041
63168
70560
98
41
Female
29.66655
82603
136080
99
38
Female
30.38502
83936
95081
100
30
Male
23.99946
74412
86602
101
22
Female
16.3847
37479
57456
102
50
Female
30.22222
71400
81855
103
48
Male
30.08383
90240
104940
104
52
Male
36.33218
93456
171741
105
66
Male
27.12032
94500
136800
56
No
Age
Gender
(years)
BMI (kg/
Rt Renal Size
Lt Renal Size
)
106
66
Female
27.11777
65246
72488
107
23
Male
20.82094
63529
77862.4
108
29
Female
28.80441
78660
98960.4
109
61
Female
33.77778
48412
83600
110
23
Male
24.03461
65192.4
80410
111
27
Female
23.61275
61880
78000
112
59
Male
31.55556
98440
171600
113
42
Male
30.79585
90882
105028
114
52
Female
31.16137
49608
80370
115
45
Female
32.04588
80325
104076
116
60
Female
21.98989
69768
108570
117
20
Female
23.30905
66105
73185
118
32
Female
25.29938
73260
86108
119
28
Male
27.41445
67116
89301
120
37
Female
41.02525
97020
116842
121
42
Male
29.99671
90252
104860
122
61
Male
27.26801
63648
93518
123
42
Female
35.02926
62244
77280
124
80
Female
16.22921
88290
54264
125
63
Male
24.53896
36764
57974
126
52
Female
44.85454
40800
72240
57
No
Age
Gender
(years)
BMI (kg/
Rt Renal Size
Lt Renal Size
)
127
71
Male
31.57756
109620
123192
128
20
Female
27.55556
65520
76626
129
36
Female
20.07733
56160
65520
130
51
Male
40.81441
72864
81216
131
35
Female
29.34004
82110
99008
132
57
Female
27.85201
66000
67680
133
24
Male
22.40879
74900
83160
134
40
Female
21.23057
50400
66640
135
43
Female
34.01764
89856
122400
136
34
Female
25.39063
75924
90687
137
39
Female
32.88889
84262.5
119028
138
26
Female
24.09297
68445
86445
139
39
Female
41.33333
81270
108790
140
22
Male
29.41176
89040
102312
141
34
Male
24.03461
73062
86108
142
19
Female
20.06095
57528
70110
143
28
Male
20.80856
68376
74250
144
18
Female
19.04432
58968
72369
145
37
Male
32.19154
92820
101898
146
29
Male
32.78592
88366
114300
147
18
Female
17.07708
46332
55426
58
No
Age
Gender
(years)
BMI (kg/
Rt Renal Size
Lt Renal Size
)
148
50
Female
18.40134
114696
74448
149
50
Male
39.25653
92928
89280
150
28
Female
20.47827
48360
61404
151
32
Male
23.45856
72772
88200
152
47
Female
23.23346
59296
75816
153
18
Female
23.06805
57330
74448
154
50
Male
25.50362
84000
112860
155
58
Male
27.42857
69090
86240
156
50
Male
35.05886
94016
81536
157
47
Male
25.2092
66528
85284
158
19
Female
17.08744
54880
72000
159
31
Male
27.15271
87462
99360
160
61
Male
25.97012
83072.5
125280
161
38
Female
29.24211
83520
96514.5
162
46
Male
31.57207
90720
128520
163
25
Male
34.01361
87984
132000
164
20
Male
23.18367
64200
73440
165
35
Female
23.93606
74936
79200
166
56
Female
26.61934
87984
81200
167
23
Female
27.47563
69552
91800
168
23
Female
21.88513
54390
73710
59
No
Age
Gender
(years)
BMI (kg/
Rt Renal Size
Lt Renal Size
)
169
51
Male
28.9461
49434
57498
170
96
Male
27.84879
50869
58996
171
35
Female
29.90303
89880
104481
172
58
Female
44.38776
63210
95480.5
173
24
Female
18.66201
38454
61152
174
35
Male
29.24149
123120
126198
175
56
Male
30.12048
53500
120510
176
30
Male
23.56663
68880
82368
177
30
Male
28.40111
77112
114912
178
31
Male
24.07407
74970
82800
179
32
Male
23.71961
74592
87890
180
18
Female
19.28938
46761
56924
181
42
Female
37.25365
87120
113724
182
23
Male
24.54346
68672
71190
183
39
Female
40.90066
54612
63840
184
27
Female
31.64429
81360
112860
185
52
Female
21.46194
77175
56700
186
49
Male
26.67276
59254
81620
187
30
Female
26.34649
47736
66521
188
41
Male
27.34375
84600
99000
189
48
Female
26.95313
79722
87768
60
No
Age
Gender
(years)
BMI (kg/
Rt Renal Size
Lt Renal Size
)
190
60
Female
28.19428
95920
116160
191
52
Female
26.39798
57974
69120
192
19
Female
17.10291
52440
82764
193
35
Female
29.99671
58824
82800
194
40
Male
22.5183
71060
85500
195
37
Male
26.76978
79800
89082
196
35
Female
25.43748
71400
86700
197
50
Male
35.41913
80224
81900
198
43
Female
30.17882
80136
92120
199
43
Female
28.76397
66640
76950
200
25
Male
22.14533
74340
84240
201
50
Male
34.01361
165625
154813
202
41
Male
21.43461
53460
72720
203
19
Female
19.04432
63630
72000
204
58
Male
27.08416
122298
107961
205
35
Female
25.46198
73008
86688
206
49
Male
29.04182
82320
102080
207
18
Male
40.85671
111804
128520
208
45
Male
32.04588
62320
72828
209
36
Female
23.23346
68670
77760
210
45
Female
40.05735
58860
71904
61
No
Age
Gender
(years)
BMI (kg/
Rt Renal Size
Lt Renal Size
)
211
32
Male
20.66116
64528
78880
212
25
Female
27.12032
71262
87768
213
41
Female
30.78091
86520
90405
214
47
Female
32.03896
82892
91485
215
39
Female
32.89474
96140
108864
216
37
Female
33.33183
87516
115128
217
38
Female
24.80159
62208
76398
218
38
Male
28.73563
85238
101650
219
55
Female
20.28123
88366
107692
220
20
Female
23.61275
66600
76320
221
70
Male
35.88363
121524
155001
222
35
Female
27.18163
78045
94622
223
42
Female
27.81588
87516
95904
224
28
Female
20.56881
56160
67260
225
42
Male
27.33564
90712
99750
226
48
Male
35.43667
66768
68068
227
39
Female
27.81588
65550
83674
228
71
Male
27.04164
84150
101504
229
70
Male
27.14158
60333
71036
230
30
Female
23.19109
52123.5
74970
231
30
Female
25.30693
68096
87912
62
No
Age
Gender
(years)
BMI (kg/
Rt Renal Size
Lt Renal Size
)
232
67
Male
37.03561
92276
144753
233
26
Male
23.93899
74100
88236
234
43
Male
26.3958
70864
84240
235
25
Female
19.31295
57120
69360
236
58
Male
29.40292
80442
112784
237
38
Female
29.27099
84672
97584
238
67
Male
34.31252
104400
116480
239
29
Female
19.31295
50925
64640
240
39
Female
26.12861
82992
88830
241
29
Female
25.5367
75600
84048
242
43
Female
39.55556
97470
132888
243
54
Female
33.56352
65600
104652
244
31
Female
30.48316
75924
107910
245
30
Female
31.61579
84150
115128
246
19
Male
22.86237
76670
81016
247
32
Female
24.9199
66600
82892
248
24
Male
25.43647
76000
86592
249
45
Female
33.26707
95030
122388
250
43
Female
34.15416
86184
111132
251
26
Male
26.91273
86400
89046
252
69
Male
20.98765
65268
107100
63
No
Age
Gender
(years)
BMI (kg/
Rt Renal Size
Lt Renal Size
)
253
42
Male
29.56195
86020
109890
254
67
Male
28.73563
87300
122430
255
79
Male
29.41076
76000
78795
256
69
Male
24.91349
77744
120897
257
42
Male
27.74887
81328
95950
258
66
Male
29.06593
87300
122430
259
54
Male
27.76343
56392
86580
260
32
Female
26.89767
80325
97920
261
43
Female
26.12861
68598
87696
262
28
Female
31.2213
59364
64980
263
42
Male
34.81612
101439
113904
264
54
Female
37.59238
96600
109512
265
24
Female
30.8642
84252
102600
266
60
Male
33.32052
71910
98532
267
39
Female
19.97919
45390
51600
268
34
Female
35.05886
72080
76368
269
23
Male
18.937
50440
73575
270
23
Female
31.24876
76032
97520
271
25
Male
25.76571
82404
89053
272
38
Male
30.47052
95795
124545
273
45
Female
23.01118
60192
75114
64
No
Age
Gender
(years)
BMI (kg/
Rt Renal Size
Lt Renal Size
)
274
31
Female
23.53037
63140
81141
275
33
Female
20.17264
59514
77760
276
52
Female
33.98438
34884
47520
277
18
Female
25.23634
58240
77112
278
52
Male
43.4385
67210
112914
279
30
Male
25.30693
72000
78400
280
38
Female
23.53304
69156
80142
281
45
Female
23.04688
57330
79100
282
39
Female
45.3125
99960
126477
283
37
Male
26.81359
77490
88236
284
30
Male
28.71972
95472
106488
285
63
Female
40.90066
67266
79420
286
49
Female
33.9624
64350
75264
287
39
Female
28.56648
80892
90992
288
39
Male
35.5665
114240
146853
289
60
Female
29.77778
58464
62832
290
27
Female
35.62902
91080
113373
291
29
Female
26.05835
79040
90720
292
54
Female
42.46114
120414
110352
293
40
Female
24.16716
74579
81120
294
22
Female
32.89474
83790
98000
65
No
Age
Gender
(years)
BMI (kg/
Rt Renal Size
Lt Renal Size
)
295
31
Male
25.79592
90896
98440
296
55
Male
28.39373
112455
120840
297
49
Female
31.20256
46968
91200
298
26
Female
30.04326
57876
87550
299
25
Male
29.39622
79679
100548
300
18
Female
32.89329
65280
79040
301
48
Female
32.89329
89680
104895
302
43
Female
37.34187
89964
113088
303
26
Male
23.76543
62006
87465
304
48
Female
26.21882
74205
84240
305
23
Female
26.03749
74556
82800
306
55
Female
38.86603
72576
116840
307
36
Female
25.63117
75924
87024
308
32
Female
27.88519
84960
96354
309
20
Male
30.96173
88500
103615
310
56
Female
25.23634
60564
69696
311
28
Female
26.92744
69264
83592
312
41
Male
22.59814
65892
78480
313
35
Male
28.57796
91872
116280
314
30
Male
25.86451
77568
90168
315
25
Male
33.53147
86526
118335
66
No
Age
Gender
(years)
BMI (kg/
Rt Renal Size
Lt Renal Size
)
316
28
Male
23.833
41106
67680
317
34
Male
25.01352
73831
91200
318
53
Female
35.92684
74970
105450
319
36
Female
33.22653
86848
111264
320
21
Male
22.30547
55341
65962
321
21
Male
25.39343
69960
81900
322
21
Male
21.60494
50616
65805
323
21
Male
21.22449
48020
55484
324
20
Male
20.59861
54366
64896
325
21
Male
18.5132
50050
70840
326
20
Male
23.66144
75012
77952
327
21
Male
22.46003
65550
75525
328
21
Male
23.38869
67932
80136
329
21
Male
25.14286
72000
81664
330
21
Male
19.44579
53040
75460
331
21
Male
19.81768
50440
75525
332
32
Female
30.07813
84744
104880
333
29
Female
27.5802
78540
98176
334
40
Male
37.32403
104720
125460
335
31
Female
30.35925
84132
107272
336
65
Male
30.02324
136640
160776
67
No
Age
Gender
(years)
BMI (kg/
Rt Renal Size
Lt Renal Size
)
337
34
Male
31.56167
86010
108976
338
34
Male
21.46194
68992
77040
339
30
Female
30.44384
113420
129426
340
22
Female
25.80645
51604
58368
341
53
Male
27.74475
71400
159390
342
53
Female
33.33333
55692
98576
343
45
Male
32.02837
105196
135904
344
25
Female
26.29172
61488
83776
345
34
Female
20.82094
56576
72930
346
57
Male
28.36752
87912
108570
347
48
Female
35.29555
89012
118440
348
43
Female
32.05128
92232
101520
349
50
Female
33.59375
32670
71904
350
36
Female
25.39022
61800
82800
351
22
Female
22.94812
60480
81972
352
42
Female
28.71972
93564
100912
353
51
Female
30.44384
59052
97416
354
18
Male
29.30313
68704
98560
355
70
Male
20.56933
52992
78705
356
50
Male
31.57207
85238
108750
357
27
Male
26.98962
75328
87567
68
No
Age
Gender
(years)
BMI (kg/
Rt Renal Size
Lt Renal Size
)
358
31
Female
20.37121
64448
73440
359
24
Male
25.30693
75735
82800
360
70
Male
23.62029
79040
126000
361
18
Female
25.40282
60600
81000
362
31
Female
25.40282
71550
82800
363
30
Male
25.28257
74880
89930
364
40
Female
26.83518
106267
127050
365
60
Male
22.58955
63360
69084
366
60
Male
32.548
98857
102120
367
32
Female
23.66524
57750
69312
368
30
Female
32.02037
51520
55212
369
37
Female
30.68256
82080
97293
370
30
Male
28.88889
41616
65296
371
44
Female
29.64269
86240
95598
372
20
Female
22.52151
56610
81328
373
33
Female
25.1559
77004
89964
374
43
Female
44.12071
112320
124488
375
46
Female
27.05515
68224
97240
376
72
Male
26.95984
69888
72037.5
377
27
Female
24.9199
61008
50076
378
71
Male
27.01686
72800
89131
69
No
Age
Gender
(years)
BMI (kg/
Rt Renal Size
Lt Renal Size
)
379
31
Female
45.16542
120384
146916
380
76
Female
34.29355
81885
96152
381
54
Male
30.82483
138768
141372
382
46
Male
28.36035
72800
74256
383
23
Male
19.88385
51840
63308
384
47
Female
45.10675
95598
96800
385
38
Male
27.17063
80500
139100
386
43
Male
34.80875
91770
100320
387
55
Female
29.24211
79380
81600
388
40
Female
37.10938
71680
84456
389
56
Female
30.0621
49896
61180
390
46
Male
31.63458
93860
132573
391
39
female
34.04903
54390
75924
392
47
Male
28.3737
93330
144612
393
33
Male
26.17383
82944
96824
394
22
Female
18.67093
49062
62130
395
30
Female
27.23922
62920
69264
396
65
Female
23.58833
47424
50635
397
72
Female
26.12495
80036
78217
398
29
Female
31.63371
80625
108800
399
50
Female
38.5948
94905
135700
70
No
Age
Gender
(years)
BMI (kg/
Rt Renal Size
Lt Renal Size
)
400
36
Female
23.04688
72450
80000
401
45
Male
25.10239
74800
87584
402
35
Male
28.04038
80640
87808
403
33
Female
24.60938
69768
79552
404
31
Male
29.33741
80256
95400
405
31
Female
22.37568
47936
59940
406
62
Male
27.5802
46550
74730
407
54
Male
24.22145
76544
111888
408
60
Female
33.32725
59904
64944
409
45
Female
18.19548
40222
55016
410
20
Male
21.60494
73616
86355
411
19
Male
21.06674
73248
85272
412
33
Female
29.40227
90797
98600
413
64
Male
31.04769
143418
149760
414
42
Male
32.83061
100548
113300
415
45
Male
22.94409
58240
80032
416
44
Male
23.2438
48204
80640
417
50
Male
16.10588
30305
51060
418
50
Male
22.83737
77600
83104
419
47
Female
32.44672
69184
93840
420
32
Male
24.02381
69696
88689
71
No
Age
Gender
(years)
BMI (kg/
Rt Renal Size
Lt Renal Size
)
421
70
Male
21.19274
38640
59220
422
60
Female
26.61934
44954
81872
423
63
Male
24.16716
60632
110250
424
41
Male
28.01022
63630
124526
425
23
Male
21.15529
47294
55944
426
31
Male
21.22449
50760
65280
427
45
Female
28.30533
54320
75293
428
23
Male
25.92593
72828
117420
429
18
Male
21.22449
63840
74800
430
40
Female
28.80441
106640
113216
431
46
Female
33.26707
51714
68400
432
18
Female
28.57796
55125
94772
433
34
Male
28.54828
92400
102410
434
66
Female
24.39482
65280
70406
435
33
Female
27.54821
76014
112404
436
35
Female
24.52435
68264
80784
437
29
Female
21.09619
53560
85536
438
24
Male
21.60494
65790
90900
439
45
Female
30.4272
60270
76048
440
39
Female
32.89329
52644
72930
441
32
Female
32.27079
47500
63336
72
No
Age
Gender
(years)
BMI (kg/
Rt Renal Size
Lt Renal Size
)
442
57
Female
28.72008
84224
84480
443
24
Male
21.2963
70656
77760
444
18
Female
19.37716
50310
96050
445
37
Female
25.77778
87462
105280
446
50
Male
26.21641
89856
83250
447
31
Male
29.33741
82620
84240
448
65
Male
20.95727
95040
81432
449
41
Female
25.67452
53560
104040
450
45
Female
34.23269
60840
82560
27.1622
72210.9842
89031.0296
5.51293
18681.46873
22025.83057
Male =207
Mean 38.9845
Female=243
S.D 13.75491
73
Discussion Fear of undergoing any invasive investigation makes the patient reluctant to undergo the test comfortably. Among all the imaging modalities, ultrasound has been regarded as an imaging technique of choice in most of the clinical survey for being non invasive, safe, reliable, cost effective and easy availability, even though underestimation has been noted in calculated renal size by ultrasound ( Mujahid Raza et al., 2011). Ultrasonography is one of the most common imaging methods used in routine practice for visualizing the normal anatomy and it is also simple and reliable to visualize pathological changes in the abdominal organs (A.I. Udoaka et al., 2013). The objective of this study was to define mean kidney dimensions in adult volunteers, correlating the measurements with age, BMI and gender and compare the values with those of other nationals from earlier studies. Renal dimensional measurements is clinically relevant, serving as surrogates for renal functional reserve, and is used frequently as the basis for making clinical decisions. Serial measurements can also provide information regarding disease progression or stability. Renal disease can increase or decrease renal size, and may or may not be accompanied by changes to the normal organ structure (Sandeep Gupta et al., 2013). Many studies in different countries have been done for renal dimensions including renal length, width, cortex and renal size. Those studies showed the measurement vary between men and women, between people of different ethnic backgrounds and even between kidneys of the same individual (Bakker J et al., 1998). The normal size of a kidney is variable and is 74
affected by age, gender, BMI, as well as the side. The size provides a rough indication of the renal function (Shcherbak Al.1989). Decrease of size and function are seen with chronic renal failure (Yamaguchi S et al., 1990), renal arterial occlusion (Shcherbak Al.1989 ), renal artery stenosis (Paul S. Watson et al., 2000) and late stage renal venous thrombosis (Montague JP et al., 1982). However, the kidney size seems to be related to a number of vascular diseases, there is no correlation with blood pressure (Raunan GV et al., 1998). On the other hand, there is an increase in kidney size in early stage renal venous thrombosis (Montague JP et al., 1982), early stage diabetes mellitus (Tuttle KR et al., 1991), (Andrew S. O’Connor et al.,2005) and renal inflammation (Hiraoka M et al., 1996). A physiological increase of kidney size can be observed in pregnancy (Christensen T et al., 1989).
4.1 Correlation between Right and Left Kidney Size Renal size for both kidneys has been measured, the mean renal size for right kidney was (72210.9842
) and the left kidney was ( 89031.0296
). The correlation was significance with the left kidney larger than right kidney regarding age and gender, as showed in the Fig. (3.1). The renal size in this study was greater when compared with Saudian [right renal size =1032 ±0.69 size=744680.88±0.18 =6552±0.12
, left renal ], Pakistan [right renal size
, left renal size =8064±0.12
]. When the data of
present study compared with North-East India [right renal size =76500 ± 75
30.1
, left renal size=80700 ± 26.0
], it has been found that
right renal size in current study is smaller while the left one is greater and the renal size of Denmark [right renal size =8884.59±39 size=9679.04 ±30
, left renal
] show that the renal size of both kidneys are
greater than our population and those differences reveal that the renal size is different among different ethnicities Adeela Arooj et al., (2011). There is in agreement with current results and the results of the study done by ( Seyed Alireza Emamian1et al.,1993) ,( Agnes Dominguez-Mejia et al., 2001), (A. Hekmatnia et al., 2004) ,( J. Oyuela-Carrasco et al., 2009) , (A.I. Udoaka et al., 2013) , ( Lina Fahmi Hammad ,2012). So, there are differences between right and left renal size according to most of the literature and the left renal size is larger than right renal size. This may be due to the hepatic mass which does not allow comparable vertical growth of the right kidney to that which is attained by the left kidney.
4.2 Correlation between Age and Kidney size The mean age of current sample was (38.9845) years and both kidney sizes showed in table (3.5). Calculation of correlation for both kidneys with age has been done separately and the result showed that there was weak positive significant correlation between age and kidney size, as showed in the Fig. (3.2)(3.3). A fall in the renal length was observed with age, especially after 50 years.
76
Comparing with international data presented by (Agnes Dominguez-Mejia et al., 2001) ,( Mujahid Raza et al., 2011),( A.I. Udoaka et al., 2013),( Sandeep Gupta et al., 2013), the result showed that there are positive relation between age and renal size. A fall in the renal size with age was noticed , especially after 50 years while studies done by( Seyed Alireza Emamian1et al.,1993), (J. OyuelaCarrasco et al., 2009),( Zeb Saeed et al ., 2012), on Denmark, Mexican and Pakistan population respectively showed that a fall in the renal length was observed with age after 70 years. Other studies done by ( O. BIRCAN et al., 1993), (A. Hekmatnia et al., 2004), on Isfahani and Turkish population respectively showed that a fall in the renal length was observed with age after 60 years. While a study done by (Niels-Peter Buchholz et al., 2000), in KarachiPakistan , showed that kidney size increases till the 3 rd decade and it remains stable through middle age and then declines. Studies have shown that aging lead to progressive decrease in kidney size after middle age (Miltec D et al., 1998),(Buchholz NP et al., 2000),(Fernandes MM et al., 2002),(Akpinar IN et al., 2003) at rate of 0.5 Cm per decade, especially due to reduction of about 1% per year in blood flow after 3rd decade (McLachlan M et al., 1981)According to these comparison the fall in the renal size with age differs according to ethnic groups and locality, which may be due to body built, environment and other factors.
77
4.3 Correlation between Male and Female Kidney Size Renal size for both kidneys has been measured separately for both sexes. The mean of right renal size in male was (76553.9947 of left renal size was (94493.9 was (68324.0292 (84150.43264
), while the mean
). In female the mean of right renal size
), while the mean of left renal size was ). The mean of right renal size in both sexes and also the
mean of left renal size in both genders were compared so as to find whether there is a difference in the size or not, the correlation was significant. The right and left kidney sizes were larger in male than right and left kidney size in females as showed in the Fig. (3.6)(3.7). Probably because of the difference in height or body mass index , renal size have been found slightly larger in male in most of the studies(Wang F et al., 1989), (Emamian SA et al., 1995), (Miletic D et al., 1998),(Buchholz NP et al., 2000),(Niels-Peter Buchholz et al., 2000),(Agnes Dominguez-Mejia et al., 2001),(Fernandes MM et al., 2002),(Okoye IJ et al., 2005), (Kang KY et al., 2007),(Kiw-Yong Kang et al., 2007),(Werner S Harmse 2011),(Lina Fahmi Hammad 2012) . The same is confirmed in the current study which shows a statistically significant larger kidney size in male. While some studies reported that there was no difference in renal size in the two genders (Rasmussen SN et al 1978), (Tajima M ,1987),(Nicholas Gourtsoyiannis et al., 1990),(O. BIRCAN et al., 1993).
78
This may be due to larger weight or body mass index in male than female , as renal size increases when body mass index increase.
4.4 Correlation between Body Mass Index and the Size of Both Kidneys Height and weight of every subject has been taken using tape measure and bathroom scale to calculate body mass index, then finding the correlation between body mass index and both kidney size. Mean of body mass index was (27.1622). The correlation coefficient between BMI and the size of both kidneys showed that there was significant correlation between BMI and the size of both kidneys. As showed in the Fig. (3.4)(3.5 ). Many studies confirm our results, studies done by(Niels-Peter Buchholz et al., 2000),(A. Hekmatnia et al., 2004), (Kiw-Yong Kang et al., 2007) , (J. Oyuela-Carrasco et al., 2009), (Wellington Ivbolagbe Ohikhokhai et al., 2010), ( Mujahid Raza et al., 2011),( Werner S Harmse. 2011), ( Zeb Saeed et al ., 2012),( A.I. Udoaka et al., 2013), (Sandeep Gupta et al., 2013), shows a strong correlation between renal size and body mass index (BMI), the renal size increased correspondingly with an increasing BMI. So as all organs of the body, the renal size is changed according to body mass index, as shown by many studies which has been mentioned in the current study.
79
4.5 Comparison of the Data of Current study with Data of nearby Areas Data of current study has been compared with renal dimensions of other countries and the differences were shown bellow in table (4.1). After comparing the results of current study with results of studies conducted in other countries, it has been found that the current study results were nearer or similar to those of nearby countries. There are results which are smaller or larger than ours and this indicates that the variation in the body mass index, ethnic group even environment may affect the renal size. Limitations of this study were the unavailability of the data from different age groups (range store). Time of the study was limited, Diabetes mellitus (DM) and Hypertension (HT) as most of the subject above 5 th decade of life complaining from one of them. Renal stone and urinary tract infection (severe one that cause hydronephrosis ).
80
Table (4.1) Comparing Current Data with Nearby Areas Data Right kidney
Left kidney
Length (mm)
Width (mm)
Cortex (mm)
Size
Length (mm)
Width (mm)
Cortex (mm)
Size
106.99 67 103.2 ±6.9 97±7.9
42.204 4 50.7±6. 8 38±5.2
15.8024
72210.9 842 64356.5 52± 17
108.57 89 107.7 ±8.7 99±9.6
47.211 1 51.6±9
17.2502
89031. 0296 74468. 088±18
Current data Saudi’s population Malaysian population Korea Isfahanian Adults Nigeri Male an adults Female Mexica Male n adults Female
Brazil Turkis h
Male
Female
12.3±1.5
102±12
105±8
109 ± 8.4 107 ±10 104 ±9 105.74 ± 5.74 102.99 ± 6.85 120.25 ±7 104.91 25±10. 41 102.44 25±9.6
111 ± 9.8 110 ±9
13.4±2.3
44±5.9
108 ±9 107.16 ± 6.97 104.6 ± 7.96 55.6±4. 6
Pakistan
104 ±9
42±7
15±2
North-East India
89±9
47±8
18 ± 4
Denmark
109±11
57±6
14.3±6
65520± 12 76500 ± 30.1 88845.9 ±39
81
126.5± 7 105.24 5±10.2 5 101.88 25 ±10.37 105±9
60 ±4.2
48±7
16±2
91±9
47±6
18 ± 3
112±11
58±7
14.91± 4
80640± 12 80700 ± 26.0 96790. 4 ±30
Conclusions From the overall results it is concluded that :
1. Right renal size is smaller than left renal size. 2. There is weak positive correlation between age and renal size up to 5 th decade of subject’s life. 3. Renal length, width, cortex and size are significantly larger in male than in female. 4. The renal size increased correspondingly with an increasing body mass index (BMI). 5. The renal size in current study is larger than Saudian, Pakistanian populatios renal size. While North-East Indians right renal size is greater and their left renal size is smaller than current study renal size. While it is smaller than Denmark populations renal size.
6.The renal length in current study is larger than Turkish, Saudian, NorthEast Indian, Malaysian, Korean, Mexican population’s renal length, while it is smaller than Isfahanian, Brazilian and Denmark populations’ renal length. Nigerian population’s right renal length is smaller and their left renal length is greater than renal length in current study .
82
Recommendation The following points are recommended: 1. To increase the sample size and studies to be done in other places of Kurdistan to be more representative. 2. To conduct the same study using CT and MRI. 3. To do the same study in infant and children. 4. To do the same study with effect of hypertension (HT) and diabetes mellitus (DM).
83
Bibliography: Adibi, A. EmamiNaini , H. Salehi, M. Matinpour,( 2008). Renal Cortical Thickness in Adults with Normal Renal Function Measured by Ultrasonography. Iran J Radiol , 5,p: 3. Ablett MJ, Coulthard A, Lee RE, (1995). How Reliable are Ultrasound Measurements of Renal Length in Adults? Br. J. Radiol ;68,p:1087-89. Adeela Arooj, Jostinah Lam, Yeoh J.Wui, Eko Supriyanto.( 2011). Comparison of Renal Size among Different Ethnicities.International journal of Biology and Biomedical Engineering ,4,p:5. Aga Khan,(2012). Sonographic Measurement of Renal Dimensions in Adults and its Correlates.International journal of collaborative research , 4, p: 9. Agnes Dominguez-Mejia,Danny Yu, Virginia Quilop-Biteng,Rafael Sy, Arlene Cabotaje-Crisostomo, Girlie Jao, Hilario Able Gomez, Socorro Maravilla, Josephine Valdez, Lucilyn Bautista, Esther Jane Hernandez, Melvi Tay, Remedios Tomas, Imee Veluz, Mary Grace Cajilig-Azucena, Nonette Cupino, Helen de Garriz, Vilma de la Cruz, Lisa Mercado, and Gigi Lim, (2001).Kidney Measurements by Sonography on Normal Filipino Adults Influence of Age, Sex and Habitus. Philippine Journal of Internal Medicine, 39, p:38-41. A.I. Udoaka, C. Enyi and C.E. Agi,(2013 ) .Sonological Evaluation of the Liver, Spleen and the Kineys in an Adult Southern Nigerian Population. Asian Journal of Medical Sciences, 5, 2, p: 33-36.
84
Akpinar IN, Altun E, Avcu S, Tuney D, Ekinci G, Biren T, (2003). Sonographic measurement of kidney size in geriatric patients. J Clin Ultrasoubd, 31, p:315-8. Andrew S. O’Connor, Jeffrey R. Schelling, (2005). Diabetes and the Kidney. American Journal of Kidney Diseases,46,4, p:766-773. Bakker J, Olree M, Kaatee R, Lange de EE, Beek FJ,(1998). In vitro Measurement of Kidney Size. Comparision of Ultrasonography and MRI. Ultrasound Med Biol, 24, p: 683-84. Buchholz NP, Abbas F, Biyabani SR, Afzal M, Javed Q, Rizvi I, (2000). Ultrasonographic Renal Size in Individuals without Known Renal Disease. J Pak Med Assoc,50, p:12- 6. Cheong B, Muthupillai R, Rubin MF, Flamm SD,(2007) .Normal Values for Renal Length and Volume as Measured by Magnetic Resonance Imaging. Clin J Am Soc Nephrol, 2, p: 38-45. Christensen T, Klebe JG, Bertelsen V., (1989). Change in Renal Volume During Normal Pregnancy. Acta. Obestet. Gvnecol. Scand ,68, p:541-43. Chummy S. Sinnatamby, (2006) .LASTS ANATOMY. Eleventh edition, Churchill Livingstone, London. Dinkel E, Ortit S, Dittrich M, (1986). Renal Sonography in the Differentiation of Upper front Lower Urinary Tract Infection. Am. i. Roentgenol,146, p:775-777. Elkin M,(1980). Radiology of the Urinary System. edition, Boston , Little, Brown and Company.
85
Emamian SA. Nielsen MB, Pedersen JF, Ytte L, (1993). Sonographic Evaluation of Renal Appearance in 665 Adult Volunteers, Correlation with Age and Obesity. Acta Radiol,34, p:482-5.
Emamian S A, Nielsen MB. Pedersen iF,(1993). Kidney Dimensions at Sonography Correlation with Age, Sex and Habitus in 665 Adults Volunteers. Am. J. Rocntgenol,160, p:83-84.
Emamian SA, Nielsen MB, Pedersen JF,(1995). Intraobserver and Interobserver Variations in Sonographic Measurements of Kidney Size in Adult Volunteers, A Comparison of Linear Measurements and Volumetric Estimates. Acta Radiol, 36, p: 399-401. E. Supriyanto., Nurul A.T., Syed M.N., (2011). Automatic Ultrasound Kidney’s Centroid Detection System, ISBN: 978-161804-019-0 ,P: 160-16. Fernandes MM, Lemos CC, Lopes GS, Madeira EP, Santos OR, Dorigo D, (2002). Normal Renal Dimensions in a Specific Population. Int Braz J Urol ,28, p:510-5. Guzman RP, Zierler RE, Isaacson JA, (1994). Renal Atrophyand Arterial Stenosis. A Prospective Study with Duplex Ultrasound. Hypertension, 23, p:346-47. Hekmatnia , M. Yaraghi,(2004) . Sonographic Measurement of Absolute and Relative Renal Length in Healthy Isfahani Adults. Journal of Research in Medical Sciences , 2, p:1-4. Hiroka M.1-Ion C, ruchida S, ( 1996). Ultrasonographic Findings of Acute Tubulonephritis. AM. J . Nephrol,16, p:154.
86
J.J. Chen, J. Pugach, M. Patel, A. Luisiri and G.F. Steinhardt, (2002). The Renal Length Nomogram: a multivariate approach. J Urology, 168, p: 2149-2152. J. Oyuela-Carrasco, F. Rodriguez-Castellanos, E. Kimura, R. Delgado-Hernandez, J.P. Herrera-Felix, (2009). Renal length by ultrasound in Mexican adults. Nefrologia, 29,p: 30-34. Justo Oyuela-Carrasco, Franciso Rodriguez-Castellanos, Eric Kimura, Rosa Elena Delgado, Juan Pablo Herrera-Felix,( 2009). Renal Length by Ultrasound in Mexican adults. Nefrologia,29,1, p: 30-34. Kang KY, Lee YJ, Park SC, Yang CW, Kim YS , Moon IS, (2007).A Comparative Study of Methods of Estimating Kidney Length in Kidney Transplantaion Donors. Nephrol Dial Transplant.,22, p:32227. Kiw-Yong Kang, Young Joon Lee, Soon Chul Park, Chul Woo Yang, Yong-Soo Kim ,In Sung Moon, Yong Bok Koh, Byung Kee Bang and Bum Soon Choi, (2007). A Comparative Study of Methods of Estimating Kidney Length in Kidney Transplantation Donors. Nephrol Dial Transplant,22, p: 2322–2327. Lina Fahmi Hammad, (2012). A Sonographic Study of Kidney Dimensions in Saudi’s University Students. Pak J Med Sci, 28, 3, p: 395-399.
Lutz H,Buscarini E , (2011). Manual of diagnostic ultrasound. Second edition, Gutenberg Press , Switzerland.
87
Mario M.R. Fernandes, Carla C.S. Lemos, Guilherme S.Lopes, Eugenio P.Q. Madeira, Omar R. Santos, David Dorigo, Raquel Bregman, (2002). Normal Renal Dimensions in a Specific Population.International Braz Urol, 28,6, p:510-515. Mazzotta L, Sarteschi LM, Carlini A, Antonelli A,(2002). Comparison of Renal Ultrasonographic and Functional Biometry in Healthy Patients and in Patients with Chronic Renal Failure. Arch Ital Urol Androl, 74,4, p: 206-209. McLachlan M, Wasserman P, (1981). Changes in sizes and distensibility of the aging kidney. Br J Radiol, 54, p:488-91. Mehmood T , (2003). Experience of Intraoperative Ultrasound Compared to CT,MR and Percutaneous Ultrasound. J Surg Pak, 8, p:35-8. Miletic D, Fuckar 7 Stistic A, (1998). Sonographic Measurement of Absolute and Relative Renal Length in Adults. J. Clin. Ultrasound ,26,p:185-87. Montague JP, Neuenschwander S, Duguet-Lannes ,( 1982). Renal Venous Thrombosis in Infants. Arch. Fr. Pediatr ,39, p :67-68. Mujahid Raza, Amina Hameed, M Imran Khan,(2011). Ultrasonographic Assessment of Renal Size and its Correlation with Body Mass Index in Adult without Known Renal Disease. J Ayub Med Coll Abbottabad, 23, p:3. Nicholas Gourtsoyiannis , Panos Prassopoulos , Dionisis Cavouras , Nicholas Pantelidis, (1990). The Thickness of the Renal Parenchyma
88
Decreases with Age: A CT Study of 360 Patients. AJR ,155, p:541544 . Niels-Peter Buchholz,Farhat Abbas,Syed Raziuddin Biyabani,Qaiser Javed,Jamsheer Talati , The Aga Khan, Masood Afzal,lmtiaz Rizvi,( 2000). Ultrasonographic Renal Size in Individuals without known Renal Disease. JPMA,50, p:12 . O. BIRCAN, G. ONER, O. SAKA, T. KAVASOGLU, M. AKAYDIN, (1993). The Estimation of Kidney Size in Turkish Population. Journal of Islamic Academy of Sciences, 6,3, p: 197-201. Odita JC. Ugbodaga Cl, (1982). Roentgenologic estimation of kidney size in adult Nigerians. Trop. Geogr. Med , 34, p: 177-79. Okoye IJ, Agwu KK, Idigo FU,(2005). Normal Sonographic Renal Length in Adult Southeast Nigerians. Afr J Med Sci ,34, p:129-31. Paul S. Watson, Peter Hadjipetrou, Stephen V. Cox,(2000). Effect of Renal Artery Stenting on Renal Function and Size in Patients with Atherosclerotic Renovascular Disease. Circulation,102,p:1671-1677. Radermacher J., (2005). Ultrasonography of the kidney and renal vessels.I. Normal findings, inherited and parenchymal diseases. Urologe A ,44, p:1351-63. Rafique M,(2006). Value of Routine Renal and Abdominal Ultrasonography in Patients Undergoing Prostatectomy. Int Urol Nephrol,38,p:153-6. Rasmussen SN, Haase L, Kjeldsen H, Hancke S, (1978). Determination of Renal Volume by Ultrasound Scanning. J Clin Ultrasound , 6, p:160-4. 89
Raunan GV, Clark A. Campbell S., (1998). Is Blood Pressure Related to Kidney Size and Shape ? Nephrol. Dial. Transplant ,13, p:728. Richard L. Darke , Wayne Vogl , Adam W. M. Mitchell, (1995).Grays Anatomy for medical Students. 38th edition, Churchill Livingstone, U.K. Richard L. Darke , Wayne Vogl , Adam W.M.Mitchell ,( 2005). Gray’s Anatomy for medical students,18thed , Elsevier Churchill Livigstone, Spain. Richard S. Snell , (2012) . Clinical Anatomy By Region , 9th ed , Lippincott Williams & a Wolters Klwer business, Philadelphia. Richard S. Snell , (2008). Clinical Anatomy By Region , 8th ed , Lippincott Williams & a Wolters Klwer business, Philadelphia. Sainpaio EJ. Mandarun de Lacerda Ca, (1989). Morphometry of the Kidney. Applied study in urology and imaging. J. Urol. Paris, 989,95, p:77-78. Sandeep Gupta, N Damayanti Devi, Sekharjit Singh Sinam, Somarendra Khumukcham, Akoijam Kaku Singh,(2013). Ultrasonographic Renal Dimensions in Normal Adult Population of North-East India. Int J Med Health Sci, 2, p:4. Sanusi AA, Arogundade FA, Famurewa OC, Akintomide AO, Soyinka FO, Ojo OE, (2009). Relationship of Ultrasonographically Determined Kidney Volume with Measured GFR, Calculated Creatinine Clearance and Other Parameters in Chronic Kidney Disease (CKD). Nephrology Dialysis Transplantation, 24, p:169094. 90
Seyed Alireza Emamian, Michael Bachmann Nielsen, Jan Fog Pedersen ,Lars Ytte,(1993). Kidney Dimensions at Sonography: Correlation with Age, Sex, and Habitus in 665 Adult Volunteers. AJR ,160, p:83-8. Shcherbak Al,(1989). Angriographic Criteria in the Determinati on of Indications for Organ Preserving Surgery in Renal Artery Occlusion. Klin. Khir, 2, p: 5. Tajima M, (1987). Ultasonic Renal Size Measurement in Normal Adolescent. Hinyokika Kiyo, 31, p:315-8. Tuttle KR, Bruton JL., L erusek MC, ( 1991). Effect of Strict Glycemic Control on Renal Hemodynamic Response to Amino Acids and Reital Enlargement inIinsulin-Dependent Diabetes Mellitus. N. EngI. J. Med,324,p:1626-29. Wang F, Cheok SP. Kuan BB, (1989). Renal Size in Healthy Malaysian Adults by Ultrasonography. Med. J.Malaysia,44, p:45-46. Webb JA,(1990). Ultrasonography in the Diagnosis of Renal Obstruction. BMJ,301, p:944-6. Wellington Ivbolagbe Ohikhokhai ,Osesogie Usuale Ogbeide , Adenike Akhigbe,(2010). Effect of Patient Height and Weight on Sonographically Measured Renal Sizes in a Sample of Nigerian Adults without known Renal Disease. Pak J Med Sci, 26, p:4. Werner S Harmse,( 2011). Normal Variance in Renal Size in Relation to Body Habitus. SA JOURNAL OF RADIOLOGY. Widjaja E, Oxtoby JW , Hale TL,Jones PW , Harden PN, McCall IW,(2004). Ultrasound Measured Renal Length Versus Low Dose CT 91
Volume in Predicting Single Kidney Glomerular Filtration Rate. Br J Radiol,77, p:759-64. Yamada-H Hishida-A, Kumagai-H. et al,(1992). Effects of Age, Renal Diseases and Diabetes Mellitus on the Renal Size Reduction Accompanied by the Decrease of Renalfunction. Nippon-JinzoGakkai-Shi, 34, p:1071-75. Yamaguchi S. Fujii H, Kaneko S. et al,(1990). Ultrasonographic Study in Patients with Chronic Renal Failure,Part 1. Ultrasonic Measurement of Renal Size and Analysis of Renal Ultrasonotomograms. Nippon Hinyokika Gakkai Zasshi ,81, p:117577. Zeb Saeed , Waseem Mirza , Raza Sayani , Adil Sheikh , Iffat Yazdani , Syed Ather Hussain , (2012). Sonographic Measurement of Renal Dimensions in Adults and its Correlates. International Journal of Collaborative Research on Internal Medicine & Public Health, 4, p:9.
92
لێکۆڵینەوەیەک دەربارەی پێوانەی قەبارەی گورچیلەکان بە ئامێری سۆنەر لە شاری سلێمانی و پاشان بەراوردکردنی لەگەڵ تەمەن ،ڕەگەز وپێڕستی بارستەی لەش
توێژینەوەیە کە ئاڕاستەی کۆلێژی پزیشکی گشتی – زانکۆی سلێمانی کراوە کە وەک بەشێک لە پێداویستی یەکانی وەرگرتنی پلەی ماجستێر لە بواری زانستی توێکاری مرۆڤدا
لە الیەن بڕیار علی محمد
بە سەرپەرشتی: دکتۆر شیالن حسین کریم دکتۆرا لە زانستی توێکاری مرۆڤ
پوختە : زانینی قەبارەی گورچیلە لە کۆمەڵگادا زۆر بەسوودە بۆ دیاری کردنی گەلێک نەخۆشی لە مەشقە کردارەکانی هەردوو بەشەکانی میزومیزەڕۆ وە لە بەشی گورچیلە زانیدا .لە کاتێکدا قەبارەی گورچیلە ئەگۆڕدرێت بە هۆی هۆکارگەلێکی جۆراوجۆرەوە بۆیە پێویستە سەرەتا بزانین قەبارەی گورچیلەی ئاسایی لە کۆمەڵگادا چەندە. ئامانج لەم لێکۆڵینەوەیە زانینی قەبارەی گورچیلەیە لە تاکی ساغدا لە نەخۆشخانەی فێرکاری سلێمانی ودۆزینەوەی پەیوەندی نێوان قەبارەی گورچیلە لەگەڵ هەریەک لە تەمەن،ڕەگەزو پێڕستی بارستەی لەش بە بەکارهێنانی ئامێری سۆنەر. لە نێوان حوزەیرانی ٣١٠٢تا شوباتی ٣١٠٢لە نەخۆشخانەی فێرکاری سلێمانی ٢٥١کەسی ساغی خۆبەخ ش وەرگیران بۆ ئەنجامدانی ئەم لێکۆڵینەوەیە کە تەمەنیان لە نێوان ( )٦٩- ٠١ساڵدا بوو ٣٢٦ ، تاکیان مێ و ٣٠٠تاک نێر بوون ،بە ڕێژەی %٥٢و %٢٤بۆ هەردوو ڕەگەز بە دوای یەکدا . دەرکەوت لەڕەگەزی نێردا تێکڕای قەبارەی گورچیلەی ڕاست (٤٩٥٥٢٣٦٦٢٤ملم )ە ،وە تێکڕای قەبارەی گورچیلەی چەپ (٦٢٢٦٢٣٦ملم )یە .بەاڵم لە ڕەگەزی مێ دا تێکڕای قەبارەی گورچیلەی ڕاست ( ٩١٢٣٢٣١٣٦٣ملم )ە و تێکڕای قەبارەی گورچیلەی چەپ (١٢٠٥١٣٢٢٣٩٢ملم )ە. لە ئەنجامدا کۆی تێکڕای قەبارەی گورچیلەی ڕاست (٤٣٣٠١٦١٢٣ملم ) ە و کۆی تێکڕای قەبارەی گورچیلەی چەپ (١٦١٢٠٣٣٦٩ملم )ە لەم ئەنجامانەوە بۆمان دەردەکەوێت کە پەیوەندیەکی ڕاستەوانە هەیە لە نێوان هەردوو گورچیلەکاندا و قەبارەی گورچیلەی چەپ گەورەترە لە قەبارەی گورچیلەی ڕاست .هەروەها پەیوەندیەکی ڕاستەوانە هەیە لە نێوان قەبارەی گورچیلەکان و تەمەندا ،تا تەمەن زی اد بکات قەبارەی هەردوو گورچیلەکان زیاد دەکەن تا پەنجاکانی تەمەن قەبارەی گورچیلەکان بەردەوام دەبن لە زیادکردن .لە ئەنجامی بەراوردکردنی قەبارەی گورچیلەکانی لە نێوان هەردوو ڕەگەزدا بۆمان دەرکەوت کە قەبارەی گورچیلەی ڕەگەزی نێر گەورەترە لە قەبارەی ڕەگەزی مێ .و ە هەروەها پەیوەندیەکی ڕاستەوانە هەیە لە نێوان قەبارەی گورچیلەکان و پێڕستی بارستەی لەش تاوەکو پێڕستی بارستەی لەش زیاد بکات قەبارەی گورچیلەکان زیاد دەکەن .
قیاس حجم الکلیة بالموجات فوق الصوتیة (السونار) وعالقته مع العمر والجنس و مٶشر کتلة الجسم االشخاص الطبیعیین في مدینة السلیمانیة
رسالة مقدمة الی مجلس کلیة الطب بجامعة السلیمانیة ،و هی جزء من متطلبات نیل درجة ماجستیر علوم التشریح
من قبل بریارعلی محمد بکالوریوس طب و جراحة عامة ٤١٠٢
اشراف د.شیالن حسین کریم دکتورا فی علم التشریح
الخالصة-: ان الحجم الكلوي للسكان هي معلو مة تشخیصیة مفیدة جدا في التطبیقات العملیة للمسالك البولیة و كذلك التراكیب الكلویة .بما ان الحجم الكلوي یتأثر بعوامل مختلفة فمن الضروري ان نأخذ بنظر االعتبارالقیمة الطبیعیة اوال. الهدف من هذه الدراسة هو ان نقدم تقییما للحجم الكلوي في االشخاص الطبیعیین (الغیر المرضى) في المستشفى التعلیمي في منطقة السلیمانیة ,ودراسة عالقتها مع العمر و الجنس و مؤشر كتلة الجسم عن طریق الموجات فوق الصوتیة لتوفیر البیانات القیاسیة في هذه الرقعة الجغرافیة و التي تعاني من نقص في هذه البیانات. وقد اجریت دراسة وصفیة مقطعیة في مستشفى السلیمانیة التعلیمي في الفترة من ( حزیران -3102شباط , )3102شملت هذه الدراسة ( )251متطوع تم اختیارهم بشكل عشوائي یتراوح اعمارهم بین ( )69-01سنة ال یعانون من ایة امراض كلویة معروفة. من مجموع 251حالة تضمنتها الدراسة )%52( 326كانوا من االناث و )%24( 3٠٠كانوا من الذكور.كان متوسط الحجم الكلوي االیمن في الذكور ( ٧٤٩٩.٣٥٥٢٧ملم ) بینما كان متوسط الحجم الكلوي االیسر (٥٢٢٥.٣٥ملم ) اما في االناث كان متوسط الحجم الكلوي االیمن ( ٤٩.٤٢٣١٤٥٤ملم ) بینما بلغ متوسط الحجم الكلوي االیسر (٩٢٠٩١٣٢.٤٤٢ملم ). في النتیجة كان متوسط الحجم الكلوي للكلیة الیمنى (٧٤٤٠١٥٩٢٤ملم ) ,في حین كان متوسط الحجم الكلوي للكلیة الیسرى (٩٥١.٠٣٤٥٤ملم ). اظهرت النتائج ان هناك عالقة ایجابیة بین حجم الكلیة الیمنى و الكلیة الیسرى مع االخذ بنظر االعتبار ان حجم الكلیة الیسرى هو االكبر ,ایضا كان هناك ارتباط ایجابي بین الحجم الكلوي و العمر حیث ان الحجم الكلوي یزداد مع تقدم العمر حتى العقد الخامس من الحیاة .عندما قارننا الحجم الكلوي لكال الجنسین من نفس العمر وجدنا بأن الحجم الكلوي للذكور اكبر من الحجم الكلوي لالناث .اتضح ان هناك ارتباط ایجابي بین الحجم الكلوي و مؤشر كتلة الجسم.
