PART I

SIZE OF NORMAL KIDNEYS IN ADULTS

In adults the kidneys are situated at a depth of 5-9 em. from the
skin of the back, and in two thirds of all persons the right kidney is more
caudal than the left (HELM 1896).
The cranial poles of the kidneys are situated 4-5 em. and the caudal poles
6-9 em. from the midline (RAUBER-KoPSCH 1955). COR~IKG (1931) gives
figures of 7 em. and 11 em. respectively. The longitudinal axis passes from a
point dorsal, cranial and medial to a point ventral, caudal and lateral.
The position of the kidneys as seen in the roentgenogram coincides largely
with that known from anatomic studies. As in the post mortem examinations,
the right kidney is as a rule situated lower than the left. Thus Mc CLELLAN
(1956) said that of "1.500 consecutive excretory urograms the left kidney was
found to be lower in 106 cases or 7.1 per cent". He also found "that in 29
instances the low-lying left kidney could probably be attributed either to a
specific disease entity or to an anatomical abnormality".
EDSMAN (1957) found that the centre of the right kidney was projected
0.2 unit cranial to the upper part of L II and the centre of the left kidney
0.5 unit caudal to the lower L I, where 1 unit was 1/3 of the height of the
vertebral body.
In a series of 100 normal males and 100 normal females MOELL (1961) found
a statistically significant difference between the positions of the kidneys: the
right kidney was situated lower than the left in males, and the right as well as
the left kidney was situated more laterally in males than in females.

ANATOMIC INVESTIGATIONS
LENGTH AND WIDTH OF NORMAL ADULT KIDNEYS

In a series consisting of 86 pairs of kidneys of normal appearance POUR-

TEYROK (1872, cit. HAUCH 1901) found the following values post mortem:

r
Length Width Length Width
A
l
right 6.5 pO.8 5.9
males females
left 12.0 6.7 11.6 6.0

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8

grams
300
280
260
240 ----- ---- ...- - ----- .....
'" '"............
220
,"
<,

--
"-
200 .

180
160
140
120
100
80
60
40
Kidney weight &-------
y"ars
20
0 10 20 30 40 50 60 70 80
Fig. 1. Weight of normal kidneys in males and females in different age groups.
(ROUSSLE & ROULET 1932).

HOFFMAN (1877), whose material consisted of 320 adults, found the right
kidney to be, on the average, 11.2 X 5.5 X 3.8 em. and the left 11.8 X 5.5 X 3.5.
VIERORDT (1906) quoted authors who reported values consistent with those
found by HOFFMAN. Their figures, however, were based on at most a
few observations. BRAUS (1934) gave 10 12 X 5-6 X 4 em., ROLNICK (1949)
12 X 6 X 3.9 em. and BOYD (1953) 11 X 6 X 3 em. They did not state the number
of cases studied, nor did they make any distinction between males and females.

WEIGHT OF NORMAL ADULT KIDNEYS

POURTEYRON (1872, cit. HAUCH 1901) found the right kidney to weigh on
the average 141 g. and the left kidney 152 g. in males, as compared with 115 g.
and 124 g. respectively in females (86 pairs of kidneys). THOMA (1882, cit.

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 9

Grams
bOO .-----_r_-...,.-~-___,--_r_-_,
Males Females
5001----+--+--+---1--+---1
•
· •
-.
.... ----
•
• • _... • .- •
• •• •
20'

-1a
"tI_, •••
· - .•
~ M
• • • 1

100 ~-+-+- -+- - -+- - - j

I
2 0'

40 50 00 10 30 40 so 00 'IO
Age in years Age in years
Fig. 2. Variations in weight of normal kidneys in both sexes, based on the means (M)
and standard deviation (0) for each decade. The original weights are indicated by dots.
(WALD 1937).

VIERORDT 1906) found the mean weight of both kidneys in males between 20
and 50 years of age to be 320 g., as against 277 g. in females within the same
age limits.
On the basis of a study of 128 males and 112 females, aged 20-25 years,
VIERORDT (1906) found the mean weights of both kidneys together to be 301 g.
and 276 g. respectively.
DE LEON, GARCIA & DE JESUS (1933) studied the weights of visceral organs
in adult Filipinos, aged 21 to 50 years. The mean weight of the right kidney
was 119 g. in 274 males and 112 g. in 47 females. The corresponding values for
the left kidney were 126 g. and 116 g.
ROESSLE & ROULET (1932) determined the kidney weights in different age
groups. Their material consisted of 719 males, of whom 437 were between 20
and 50 years of age, and 283 females, 88 of whom were in the same age group.
They found the mean weight of both kidneys in the 20-50 year group to be
276 g. in males and 253 g. in females with a standard deviation of 40 and 46 g.,
respectively (Fig. 1).
WALD (1937) determined the weights of 414 pairs of normal kidneys from 307
males and 107 females, aged 20 to 79 years. His series consisted exclusively of
kidneys from persons who had died within 24 hours of an accident and had no
history of recent illness or any distinct abnormality of the kidneys at autopsy
and in whom no gross haemorrhage had occurred (Fig. 2).
The mean weight of both kidneys in adults, aged 20-49 years, was 318 g.

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10

for males and 255 g. for females with a standard deviation of 56.7 and 52.0 g.
respectively .
For comparison with the kidney weight in cases of myocardial infarction,
carcinoma or essential hypertension, LEE & THOMAS (1955) studied the weight
of normal kidneys (62 males and 38 females). The average age of this normal
group was 61 years and the average body-weight 64 kg (males) and 61 kg.
(females). They found 388 g. as an average weight of normal kidneys in males
and 355 g. in females in their material.
The foregoing data on the size of normal kidneys at post mortem examination
thus showed:
that the kidneys are on the average larger in males than in females;
that the left kidney is, as a rule, larger than the right; and
that the size of the kidneys is fairly constant between 20 and 50 years.

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 ROENTGEN EXAMINATIONS
EARLIER INVESTIGATIONS

In a study of roentgenographic data bearing on congenital and acquired

single kidney BRAASCH & MERRICKS (1938) measured the size of normal kid-
neys in 100 urograms and found an average length and width of 12 X 6 em.
Measurements were made, directly on the roentgenogram, of the long axis
and of greatest width of the kidney. They did not, however, distinguish between
males and females, or between the right and left kidney and recorded no
pertinent variations.
KOHLER (1939) gave a roentgenographic width of the kidneys of 6.5 em.,
but he did not mention the number of cases on which this figure was based.
SCHROEDER (1944) measured the size of the kidneys in urograms of 25
healthy males and 25 healthy females (focus-film distance-e. 100 em.) and found
the following figures (in em.):

Length Width Length Width

right (13.4 6.3 12.9 5.9

left
males t 13.7 6.2
females
{
12.9 6.0

This estimation of the roentgenographic size of kidneys was made for

evaluation of the size of the remaining kidney after nephrectomy.
KLEEBERG & DREYFUSS (1946) stated that the roentgenographic size of
normal kidneys agrees well with figures given by the anatomist BRAUS (1934),
namely, length: 10-12 em., width: 5- 6 em. They used these figures as normal
values when evaluating the roentgenographic size of the kidneys in 6 cases of
glomerulonephritis.
BILLING (1954), who was interested in the early diagnosis of polycystic
kidneys, measured the length of 100 "normal kidneys in the films (100 em.
focus-film distance)". He found the length of 99 of these kidneys to be 11-13
em., the remaining kidney measuring 14 em. In the two last-mentioned studies,
however, no distinction was made between males and females or between the
right and the left kidney.
MOELL (1956) measured the size of normal kidneys in plain roentgenograms

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12

of the abdomen to be used as controls in an investigation of changes in the

size of the kidneys in diseases involving the renal parenchyma. The material
consisted of 115 "apparently healthy soldiers" and 25 "normal" males and
25 "normal" females. The focus-film distance was 100 em. The area of the
kidneys on the roentgenograms was measured planimetrically and with the
formula 1t X half the length X half the width. No statistical difference was
found between the figures arrived at by using these two methods. The total
kidney area was also divided by m 2 body surface. The figures for the clinical
material are given in Table 1.
Table 1. Roentgenographic size of normal kidneys, measured in plain roentgenograms
of 25 males and 25 females, aged 20-55 (MOELL 1956).

total area
right left
I area area total
m 2 body
right left area
length width length width surface
I --
em
I
em em
I em em 2 em 2 ~I em 2

-
males x 12.4 5.9 12.8 6.1 58.1 61.2 119.3 72.2
s 0.66 0.37 0.77 0.38 5.3 6.4 9.7 6.6
females x 12.7 (1.3 13.2 6.4 62.8 66.8 129.6 70.1
s 0.78 0.49 0.82 0.55 7.1 7.6 13.8 5.4

The figures for the soldiers were practically the same as those given above
for the males.
In 1958, PANICHI & BONECHI determined the size of the kidneys of healthy
subjects in roentgenograms in a way very similar to that used by MOELL
(1956). Their material consisted of 38 males and 32 females, 18-49 years of
age. They used a focus-film distance of 110 em. Their figures are lower than
those given by SCHROEDER and by MOELL even after correction for the differ-
ence in focus-film distance.
In an investigation of "Hypertension of renal origin" HODSON (1960) reported
on a study of "a thousand normal kidneys". He made a general statement
"that there is a gradual increase of the kidneys from birth to the second half
of the second decade of life, that there is a very wide variation in size in the
normal and that in any given individual there is a marked tendency towards
symmetry in shape, size and thickness of renal substance between the two kid-
neys". The relationship between the radiographic image of the excised kidneys
directly on the film and their weight was also studied by Hodson and he found
that "kidneys of the same radiographic size and shape often differed in weight
as much as 20 per cent." The number of kidneys studied was not stated.

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 13

The general broad conclusion from his study was that "measurement of
any pair of kidneys against those of an individual of the same age, sex, height
and weight is subject to a fundamental error of something in the region of
20 per cent".
All the above examinations are, however, in one way or another incomplete,
not giving a definite clue to variations in normal kidney size, the size in males
and females and the relation of size to different factors in body-build.

PRESENT INVESTIGATIONS
DEFINITIONS

Roentgenographic length 01 the kidney is to be understood as the maximum

distance between the outline of the cranial and caudal poles of the kidney.
Roentgenographic width 01 the kidney is to be understood as the maximum
distance between the most lateral and medial parts of the kidney, including the
hilar region, at right angles to the roentgenographic length.
Measured roentgenographic area 01 the kidney is to be understood as the pro-
duct of the length and width of the kidney. In a previous study (MOELL 1956)
the area of the kidneys was measured planimetrically and also by means of
direct measurements on the films by using the formula ~ X length X width. No
statistical difference was found between the results obtained by these two
methods. Since these ways of measuring the area of the kidneys give only
relative figures of the size, it may be sufficient to use simply the product of
length and width.
Calculated renal mass is to be understood as the sum of T'" of each kidney,
where T is the measured roentgenographic area of each kidney.

STATISTICAL METHODS AND SYMBOLS

Let Xl' X 2, ••• , X n denote a sample of n measurements made on n individuals.
Arithmetic mcan-e z

Standard error of mean E(X) = V~

Standard deviation=sz= Vn~ 1 E(x i - x )2, which also may be written sz=

= V_I
n-l
(EX 2- (EX)2).
n
In the following description of methods, X, y, z etc. may denote kidney-weight, body-
length, body-weight or other body-characteristics.
For brevity, we denote the sum of squares E(x i - x )2 by S=, the sum of products
E(llJi-x)(Yi-Y) by Sru' etc.
2 - Moell

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14

1. COMPARISON OF INDEPENDENT MEANS

Two means x and y, based on n 1 and n 2 measurements on individuals belonging to

two separate groups, were compared by means of the t-test
x-y
t= -(_ ---=-) where t has n 1 + n 2 - 2 degrees of freedom and
e X-Y
n
w = -1n2
--
n 1+n2

In the particular case where n 1 =n 2 , we have the more convenient expression

2. COMPARISON OF PAIRED MEANS

Two means x and y, based upon n pairs of measurements (xl' Yl)' ..., (x n, Yn) made on n
individuals, were compared by means of the t-test
X-Y
t= where t has n - 1 degrees of freedom,
-(_ -----=-)
/; X-Y
-
/; ( X-Y
-)
=Vn
8d

and 8 d is the standard deviation of the differences di=Xi-Yi'

Alternatively, a sign test was used. Then only the signs of the differences d, were
noted. Let a be the number of positive differences. If a differs considerably from n/2,
this indicates that the Xi are significantly different from theYi'
The significance was investigated with the aid of a table of critical values (see e.g,
Dixon & Massey, 1957).
The following levels of significance were used:
P>0.05 not significant
0.01 < P<0.05 *
0.001< P<O.OI **
P<O.OOI ***

3. SIMPLE REGRESSION

Let (Xi' Yi) be pairs of measurements and suppose that Yi depends linearly on Xi apart
from sampling fluctuations. The fitted regression line has the equation

y=a+bx
where the constants may be computed from the formulee

b= 8"", a=y-bx.
8""
The residual standard deviation 8 y o Z of the Yi (i.e. the variation which cannot be
"explained" by the Xi) is determined from the expression

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 15

We have approximately
8~ .~=82. (l-r 2 )
where r is the coefficient of correlation. r may also be defined directly from the expression

r=---
Sn
VS"",S ••
When n is large (> 30) approximate 95 % confidence limits for a single value y may
be obtained from the formula
a+bx±28v- ~
In the diagrams, these limits are given in the form of straight lines drawn on either
side of the regression line.

4. MULTIPLE REGRESSION

Let (Xi' Yi' Zi) be groups of three measured characters, and suppose that Zi depends,
on the average, linearly upon Xi and Yi' The fitted regression line has the equation
z=a+b 1x+b2Y
where
a=z-b1 x - b 2y
and b1 , b2 can be determined from the system of equations
b1 S"",+b~n=S~.
b1 S~.+b2S •• =S.,
The residual standard deviation 8 •• ~. is given by

f~ ,xv=n~3l:(Zi-a-blxi-b2Yi)2
which can also be written

Confidence limits may be determined as in 3.

MATERIAL

The material for estimating the size of normal kidneys consisted of plain
roentgenograms of the abdomen in 100 males and 100 females between 20
and 49 years of age (average 31 and 33 years respectively). The criteria used for
the selection of patients were stricter than in the investigation of the roent-
genographic size of normal kidneys carried out by the author in 1956.
The roentgen examination was performed for clinical reasons such as a
high E.S.R., abdominal pain, etc., and most of the cases were referred for
excretion urography. The use of ionizing radiation in the investigation of the

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16

size of the kidneys in adults was thus limited to cases with strictly medical
indications for the examination. The size of the kidneys was determined on
plain films, taken routinely prior to urography. The material included only
cases in which the kidneys were well defined. The roentgenologic and clinical
examinations revealed no abnormalities of the kidneys or urinary tract, there
was no history of any renal disease, no proteinuria, no pathological findings in the
urine sediment and the N.P.N. was normal. Patients with scoliosis of the lumbar
vertebral column were excluded. It is apparent from the diagram on paga 9
that the size of the kidneys does not vary significantly within the age limits
chosen.
The figures for body-height and body-weight of the patients were taken
from the clinical records. The mean body-height for males was 176.9 (s=6.7)
em. and for females 163.1 (s=5.7) em. The mean body-weight was 72.6 (s=9.3)
kg. and 62.8 (s=9.7) kg., respectively. The coefficient of correlation between
body-height and body-weight waa-l-D.Hl for males and-l-G.z l for females.
In order to determine to what extent body-height and body-weight in the
present material was representative of a normal series, the mean values found
for body-height and body-weight were compared with those given by LINDE-
GARD (1953). He studied 2 series, 243 males, all 20 years of age and 300 females,
whose average age was 24 years. Figures for body-height of the two sexes
were 175.6 and 162.8 respectively. The body-weight of the males was 68.0 kg.
and of the females 60.7 kg. There was, thus, good agreement between LINDE-
GARD'S data and those found in the present investigation.

TECHNIQUE

The patients were usually prepared for the examination with mild laxatives,
enema, and fasting of 12 hours' duration beforehand.
The examination was carried out with the patients supine, the beam directed
ventro-dorsally and the central ray about 10 em cranial to the iliac crest.
Oblique films, with the patient tilted about 20° to either side, were taken
routinely. The focus-film distance was 100 em. In most examinations, the mAs
was about 80 and the kV 80-100. The exposures were made while the patients
were holding their breath in slight expiration. The kidneys were measured in
the way described above. In most cases it was easy to delimit the kidneys.
It was found that the lower poles of the kidneys were more readily delimited
than the upper poles, where it was sometimes difficult to judge the border
between the kidney and the adrenal.
Since the axis of the kidney passes from a dorsal point to a ventral point,
the roentgenographic length of the kidneys is somewhat smaller than if the

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 17

axis of the kidney were in the same plane as the film. The rotation of the kidneys
tends to diminish their width in the roentgenogram. The roentgenographic
size of the kidneys is also influenced by the geometric enlargement (object-film
distance).
Since the focus-film distance was standardized at 100 em., the geometric
enlargement can easily be estimated, if the object-film distance is known.
As mentioned previously (page 7) the dorsal part of the kidneys is situated
5 - 9 em. from the skin of the back. In 10 cases checked post mortem the distance
from the cranial and caudal pole of the kidneys to the table was measured.
Though the distance could not be measured exactly, the measurements made
agreed with the figures given previously. In the supine position the distance
from the caudal pole of the kidney to the table was found to be 3-4 em.
more than that of the cranial pole.
Planigraphy (Siemens universal planigraph with simultaneous cassette) was
also used to estimate the kidney-film distance in a series consisting mainly of
normal kidneys (47 right, 51 left). The kidneys were best demonstrated at a
distance of 7.5±0.16 em. from the examination table (standard deviation = 1.0).
The focus-film distance was 140 em.
When taking the usual A.P. films the table-film distance was 8 em. and the
kidney-film distance thus about 15 em., giving a geometric enlargement of
about 17.5 % of the actual length.
PANICHI & BONECHI (1958), who studied 10 cases with retroperitoneal
pneumography and lateral planigraphy without due consideration to the
mobilisation of the kidneys, arrived at the conclusion that there was a decrease
in the roentgenographic length of the kidney by about 5 % owing to the
angle between the longitudinal axis of the kidney and the film. The actual
length of the kidney in a living subject can be estimated by considering the
geometric enlargement and the diminution due to the position of the kidney.
The accuracy of the measurements on the films in the present study was
judged by double determinations on the same film on two different occasions at
an interval of about two months. The length and width of the normal kidneys
in 20 males and 20 females in this material were again determined after all
marks and notes had been removed from the roentgen films. The error of
measurements for the total area (standard deviation of a single observation)
was 1.9 % (males) and 1.5 % (females) of the mean area. The Error of a single
observation of the total area of the kidneys was thus with a confidence of 95 %
about 4 %.

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 RESULTS
ROENTGENOGRAPHIC LENGTH, WIDTH AND AREA OF NORMAL
KIDNEYS IN ADULTS, 20-49 YEARS OF AGE

The results are given below in Tables 2 and 3.

Table 2. Roentgenographic length and width (in cm) of normal kidneys, measured in
plain roentgenograms of 100 males and 100 females, aged 20-49.

males females

right left I right left

I length
length
I width length
I
width
I length
I
width
I I width

-
x 12.9 6.2 13.2 6.3 12.3 5.7 12.6 5.9
s 0.80 0.45 0.79 0.49 0.79 0.46 0.77 0.42

Table 3. Roentgenographic area (product of length and width in ems) of normal kidneys
measured in plain roentgenograms of 100 males and 100 females, aged 20-49.

males females
I
right + left
right
I left
I right
I left
I right-j-tett

-
x 79.6 82.7 162.3 70.1 74.1 144.2
s 8.75 8.34 15.6 8.00 7.31 13.6

It is clear from Table 2 that both the right kidney and the left were longer
and wider in males than in females. These differences were statistically signi-
ficant.
Being significantly longer and wider, the kidneys also had larger areas in
males than in females (Table 3).
A comparison was also made between the two kidneys in the two sexes.
The results of this study are given in the tables below (Tables 4 and 5).
It is apparent from Table 4 that the left kidney was longer than the right
in males. In females there was a tendency for the left kidney to be both longer

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 19

cJ Q

Fig. 3. Roentgenographic length and width of normal kidneys measured in plain roent-
genograms (A.P. position) of 100 males and 100 females, aged 20-49. Dotted lines
represent twice the standard deviation.

Table 4. Comparison between roentgenographic length and width of right and left kidney,
measured in plain roentgenograms of 100 males and 100 females, aged 20-49.

Relationship between significance

males females
right and left kidney
males females
I
fright kidney longer 27 35
length (oth kidneys equal 1 5
left kidney longer 72 60 ••• •
total number of cases 100 100
I I
{'i'hl kidney wid" 36 32
I
width both kidneys equal 10 11
left kidney wider 54 57 ••
total number of cases 100 100
I I I I

and wider. In both sexes a highly significant difference was found between
the area of the right and of the left kidney, that of the left being larger.
The values found for the measured roentgenographic area (Table 3) gave
" (Table 6).
the following figures for the calculated renal mass (T')
The calculated renal mass in the males in this normal material was thus
about 20 % larger than in the females.

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20

Table 5. Comparison between roentgenographic area of right and left kidney, measured
in plain roentgenograms of 100 males and 100 females, aged 20-49.

Relationship between significance

males females
right and left kidney
males
I females

I I right kidney larger 27 32

I
area(oth kidneys equal 1 1
I
left kidney larger 72 67 ••• • ••
I
total number of cases 100 100
I I I I

Table 6. Calculated renal mass (T~) of normal kidneys in 100 males and 100 females,
aged 20-49.

I males I females

right
I left
I right + left
I right
I left
I right-l-Ief't

-
x I 709.7 I 751.1 I 1460.8 I 586.4 I 638.3 I 1224.7

CORRELATION BETWEEN ROENTGENOGRAPHIC AND

ANATOMIC VALUES
ROENTGENOGRAPHIC LENGTH AND WIDTH OF KIDNEYS AND LENGTH
AND WIDTH POST MORTEM

To assess the reliability of the measurements made on the roentgenograms,

values found were compared with measurements made post mortem. The
material consisted of 68 right and 63 left kidneys in patients above 20 years
of age and examined roentgenologically within the last 4 weeks before death.
Only films in which the kidneys could be clearly delimited were accepted
for this comparison. (Post mortem measurements were made after the kidneys
had been extirpated and freed from the fat capsule.) In order to check any
variation in the size of the kidney due to the interval between the last roentgen
examination and death, the cases were classified into groups in which the
intervals were 0-7 days, 8-14 days and 15-30 days respectively. There
were about the same number of observations in each group. No such variation
was found.
Complete agreement cannot be expected between the measurements of the
kidneys as seen in the roentgen film and measurements made post mortem.
In situ the kidneys are slightly tilted and rotated, and their image on the film
is enlarged owing to the object-film distance.

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 21

em em
Bjght kidneY..
Bjght kidneY..
15 y=O,78 x + 1.5 10
y"O.82x+0.9
5y .• =0.63

10 5

..
n=68 n= 68
em em

5 10 15 20 0 5 10

Fig. 4. Roentgenographic length and width of the right kidney, measured in plain
roentgenograms (x-axis), and length and width of same kidneys measured post mortem
(y-axis). n=number of observations.

em em
Left kidney,
v> 0.7Sx. 2.0 Left kidney.
15 10
~'0=8~::07&
y.x

. ~ :
10 5
~ ..

n=63 n=63
em em

10 15 20 o 10

Fig. 5. Roentgenographic length and width of the left kidney, measured in plain roent-
genograms (x-axis), and length and width of same kidneys measured post mortem (y-axis).
n=number of observations.

The result of this comparison between roentgenographic and post mortem

measurements is given graphically in Figs. 4 and 5.
On the basis of the diagrams given above it is possible from roentgenographic
measurements to predict the post mortem length and width of the kidneys
with a fair degree of accuracy. Thus, if the length of the right kidney in the
roentgenograms is found to be 13 em., the predicted "true length" is about
11.5 em, for example.

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22

ROENTGENOGRAPHIC AREA AND WEIGHT OF KIDNEYS POST MORTEM

In individuals with healthy kidneys there is presumably a close correlation

between the weight and the volume of the kidneys.
A question that then presents itself is whether a close correlation also exists
between the volume and weight of kidneys with various diseases involving
the renal parenchyma. If so, the weight of the kidneys can be taken as a
measure of their volume.
To check this possibility, 37 right and 37 left kidneys were weighed, and
their volumes determined. The material included a few macroscopically normal
kidneys, but consisted mainly of kidneys with different kinds of diseases
involving the parenchyma ("acute renal failure", glomerulonephritis of different
kinds, pyelonephritis, nephrosclerosis). Hydronephrotic kidneys were excluded.
The kidneys were weighed in the usual way, i.e. the portion of the vessels
and fat situated within the hilum and sinus was left intact, and the volume
was determined according to Archimedes' principle.
The results are given diagrammatically below. Judging from the diagram,
the weight of the kidneys can be taken as a measure of their volume.

<roms

ff/
30 Right and lett kidn!')l
y:::.1.018x+2.0 /

m \ •.• =5.4

250

225 ~/
/
200

'"
'50

125

'00

75

50

25 n=74

om'

,SO azs m
'"
25 50 75 '00 125 200 250 300

Fig. 6. Comparison between weight and volume of 74 kidneys.

In their study of the size of the kidneys, as measured on plain roentgenograms

in acute leukaemia, BESSE, LIEBERMAN & LUSTED (1958) found a- directrela-
tionship between kidney size (measured by plain radiography) and the kidney
mass (kidney weight post mortem). The median examination time of the series

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 23

500 grams grams

500
Righi kidney Lell kidney
y=1.319x - 0.353 y=1.293.-0.295
400 400
S y.• =0.073

300 300

20 200

150 150

100 ll}O

90 90

80 80

70 70

60 60

50 50

n =38 40
40
/
/ /
30
30 40 50 60 7 BO 90 100 40 50 60 70 80 90 100 150 cm2

Fig. 7. Roentgenographic area of right and left kidney and post mortem weight of
same kidneys (logarithmic scale). n=number of observations.

(16 adults and 22 children) was 14 days prior to death, and examinations
performed earlier than 90 days before death were excluded.
In this study the material used to correlate renal area determined roentgen-
ographically with renal weight post mortem included many of the cases em-
ployed to determine the dimensions of the kidneys on the roentgenogram and
post mortem. Additional cases selected on the basis of the same criteria (good
roentgenographic definition of the kidneys and early post mortem examination)
were also studied. The weight of 38 right and 38 left kidneys, and of 119 pairs
of kidneys were correlated with the roentgenographic area of each kidney and
with the area of both kidneys taken together.
The equation, which satisfies this correlation in the present material was
Y= 1.319 X -0.353 for the right kidney and Y= 1.293 X -0.295 for the left and
Y= 1.206 X -0.180 for both kidneys. The results are given in diagrams (Figs.
7 and 8).
With the help of these diagrams it is thus possible to predict the post mortem
weight of each or both kidneys from the measured roentgenographic kidney
area.

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24

1000 grams
900
800 Right + lell kidney
700 y=1.2oS,-0.11lll

SOD 5 y., =0.075

50

400

300

200

150

'00
90
80
70

/.
50

n=119
40

3D 2
40 50 50 70 BD 90 !<Xl '50 200 lOO
cm

Fig. 8. Roentgenographic area of right-c-left. kidney and post mortem weight of same
kidneys (logarithmic scale). n=number of observations.

Table 7. Calculated roentgenographic area (product of length and width in omt) for
males and females in age-groups 50-59, 60--69, 70--79 years, using the values found
for the roentgenographic area between 20-49 years and the weight of the kidneys
(in g.) found post mortem by WALD (1937).

males females
age in years
weight Iobservations
number of I area weight I number of
observations
I area

20-49 318 208 162.3 255 71 144.2

50-59 294 46 154 254 13 144
60-69 293 36 154 218 17 130
70-79 253 17 139 236 5 137

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 25

I
d
600--.--------,-----~-r_r-~,
I
grams
..--t------+--------/'-+--,,~---.,I

I _500

----
4 00
25
........
I---
-
3 00

M
I--
2 00
//
25

1O O - + - - - F - - - + - - - - 1 - - - - - j - - - - - - j

0
20 30 40 50 60 70 BO a IQ !O 100 150 200 2 300
years em
Fig. 9. Diagram for estimating weight of both kidneys from roentgenographic area and
comparison between the estimated weight and kidney weight in different ages in males.

960 O - - - , - - - - - - , - - - - - r _ r - - " . . ,
gr ams
5 00

/' 00

2s
- - ~}
00

M 2 00

25
10

0
20 30 5 60 70 BO 150 200 2 300
years em
Fig. 10. Diagram for estimating weight of both kidneys from the roentgenographic area and
comparison between the estimated weight and kidney weight in different ages in females.

The reliability of the 3 diagrams in Figs. 7 and 8 can be checked by predicting

the weight of each kidney from the previously measured area for normal kidneys,
right and left, and comparing the sum of the values obtained with the figures for

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26

the weight of the kidneys arrived at by using the total area for normal kidneys.
For males the predicted normal weight of the right kidney will be about 145 g.
and that of the left 165 g., which gives a total weight of 310 g. for both kidneys,
while the predicted weight, using the diagram for the total area, will be about
310 g. For females the figures will be 120, 140, 260 and 270 respectively.
Very good agreement was thus found with the figures for weights of normal
kidneys in adults, 20-49 years, given by WALD (1937).
The present discussion is based on roentgen examinations of patients, 20-49
years of age. There is, however, a decrease in kidney weight due to physiologic
shrinkage with age, which is shown by the diagrams of ROESSLE & ROULET
(1932) and WALD (1937).
From the figures for the area of normal kidneys in adults, 20-49 years of
age, it is possible, with the aid of the values given by WALD for the weight of
normal kidneys in higher age groups, to calculate the normal kidney area also
in the age groups 50-59, 60-69 and 70-79 years of age (Table 7).
By modifying WALD'S diagram, shown on page 9, and combining it with
the diagram on page 24, it is thus possible to estimate the weight of kidneys
from the measured area found in the roentgenograms and to ascertain whether
or not the estimated weight will fall within twice the standard deviation in
the different age groups. This is shown diagrammatically in Figs. 9 and 10.

ROENTGENOGRAPHIC AREA OF NORMAL KIDNEYS AND SOME

BODY·BUILD FACTORS

In this material for measuring the roentgenographic area of normal kidneys,

the differences in stature and body-weight between males and females are
apparent from the correlation coefficient between stature and weight in the
two sexes (+0.61 for males and +0.21 for females). In a previous study (MOELL
7t
1956) the area of the kidneys, calculated according to the formula - X length X
4
X width, was divided by the m 2 body surface of the individual, and it was
found that the statistically significant differences between the kidney areas
in the two sexes was then no longer demonstrable.
In a similar investigation PANIC HI & BONECHI (1958) treated the data in
the same manner. They coined the term "nephrosomatic index" for the quotient.
But such a quotient only shows the existence of a correlation between the area
of the kidneys and the body-surface area and does not show to what extent
it is possible to diminish the standard deviation of the roentgenographic size
of normal kidneys when taking the body-surface area into account.
One might, of course, choose parameters other than those related to body-

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 27

build (i.e. blood volume or plasma volume) for correlation with the roentgeno-
graphic size of the kidney. For such a study to be useful, the data must be
applicable to the findings in diseases involving the renal parenchyma. The
parameters chosen must therefore be influenced at most slightly or not at all
by renal disease. Furthermore, they must be easy to determine, even in the
presence of renal affections.
In 1913 GREENWOOD & BROWN made a study of the weight, variability and
correlation of human viscera. Their material consisted of 79 males, aged 25-55
years, with "healthy" kidneys and the mean kidney weight for these carefully
selected cases was 10.67 ozs=302.5 g.
The coefficients of correlation for this material are given in Table 8.

Table 8. Coefficients of correlation between body-weight, body-height, weight of the heart

and weight of the kidneys (GREENWOOD & BROWN, 1913).

body-height heart kidneys

I I I
body-weight
I
O.52±O.O6 O.65±O.O4 O.37±O.O7
body-height O.42±O.O6 O.28±O.O7
heart O.56±O.O5

Me KAY (1932) is of the opinion that body surface is a good reference for
renal weight in man. He showed that the expected kidney weight might be
predicted in man from the surface area as a measure of body size.
SMITH (1955) concludes "that there is a priori no basis upon which to select
anyone standard reference (body weight, body length, basal metabolic rate,
surface area or kidney weight) for comparing individuals of different sizes and
their renal function, except that the kidney weight would be the most direct".
The body-surface area is generally calculated according to the well known
formula ef Du BOIS & Du BOIS (1916). Other equations and diagrams have
been constructed in an attempt to arrive at more accurate figures of the body
surface (BOYD 1935 and BANERJEE & SEN 1955). From the empirical relation-
ships of height plus weight (in em. and kg. respectively) and the "shape"
factor of the ratio of weight to height, SENDROY & CECCHINI (1954), con-
structed a chart for estimating the body surface area, which is regarded as
being more accurate than those of earlier authors. SMITH, for instance, has
used the chart of SENDROY & CECCHINI for estimating the surface area of the
human body in his "Principles of renal physiology" (1956).
In the present study the measured roentgenographic area of the kidneys was
correlated with body-height, body-weight, m 2body-surface (estimated according

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28

to the chart of SENDROY & CECCHINI), and the area of the second lumbar
vertebral body, since this area may be taken as a measure of the sturdiness of
the skeletal frame (according to the concept of LINDEGARD 1953).
The coefficients of correlation are given in Table 9.

Table 9. Coefficients of correlation between roentgenographic area of normal kidneys

and factors in body-build of 100 males and 100 females.

males females

Ln Ln
H W m" H W m2
I I I
area
I I I area

T 0.15 0.37 0.35 0.33 0.36 0.33 0.38 0.23

H 0.61 (0.76) 0.46 0.21 (0.42) 0.44
I
I W (0.98) 0.42 (0.97) 0.27

I m" 0.47 0.35

T=kidneyarea; H=body-height; W=body-weight; m"=square meter body surface; L n area

= area of second vertebral body measured in plain roentgenograms.

The standard error of the coefficient of correlation can be estimated by the

1-r 2
formula e(r)= Vn and gives for r between 0.23 and 0.38 values around 0.09.

It is seen that in males the coefficients of correlation are practically the

same when correlating the measured kidney area with body-weight, m 2 body-
surface and area of the second vertebral body, while in females the coefficients
of correlation are of the same magnitude when correlating the kidney-area with
stature, body-weight and m 2 body-surface.
It is of interest to compare coefficients of correlation for 100 males between
20-49 years of age in this study and those given by GREENWOOD & BROWN
for 79 males between 20-55 years of age.

Table 10. Coefficients of correlation between body-height, body-weight, weight of

normal kidneys and roentgenographic area of normal kidneys.
Figures from GREENWOOD & BROWN in brackets.

weight of kidneys area of kidneys

body-height (0.28) 0.15

body-weight (0.37) 0.37
-----'-------------'------------'

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 29

The most interesting figures are the coefficients of correlation for body-
weight and area and weight of the kidneys, which provide further evidence that
the measured roentgenographic area is a true measurement of the size of the
kidneys.
It is clear that there is a correlation between the area of the kidneys and
various physical factors. But the main point is to ascertain whether it is possible
to diminish the standard deviation of the roentgenographic area of normal
kidneys in the present material when relating the measured roentgenographic
kidney area to the above mentioned body-build factors.
An attempt to do so is summarised in the following table. The table refers
to males.
Table 11. Equations of regression and residual standard deviation of roentgenographic
area of normal kidneys in 100 males and 100 females with due allowance for differences
in body-height (H), body-weight (W) and roentgenographic area of second vertebral
body (area L u ). Residual standard deviation with 2 variables is also given. The total
standard deviation was 15.6.

residual standard
variables equations
I I deviation

H 1'=0.344 H+101 15.5

W 1'=0.618 W+1l8 14.5
L u area 1'=2.883 L n area j Ltf 14.8

H+W 1'=0.738 W-0.277 H+60 14.5

\V +L n area 1'=0.474 W+1.839 L u area+98 14.3

Similar results will be found for females.

DISCUSSION
Any conclusions about the size of kidneys in renal diseases require proper
knowledge of the size of normal kidneys and its variations. In order to secure
adequate baseline data, the length and width and the measured roentgeno-
graphic area (product of length and width) of normal kidneys were studied.
Comparison between the estimated length and width of kidneys and the length
and width of the same kidneys post mortem showed a constant difference
between these figures. This difference is due in part to the geometric enlarge-
ment (object-film distance) and to the fact that the cranial pole of the kidneys
is located more dorsally than the caudal pole. This angle between the longi-
tudinal axis of the kidney and the film results in a decrease of the length of
the kidney on the roentgenogram in the usual A.P. position.
3 - l"IoiU

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30

From the object-film distance and from the comparison between the roent-
genologic length and the length of the kidney found post mortem, however,
the angle between the longitudinal axis and the film can be determined.
In this study, the mean object-film distance was 15 em. and therefore a
kidney length of 13 em. indicates an "actual" length of 11.1 em., if only the
geometric enlargement is taken into consideration. From the diagram on page
21 (right kidney), however, which is based on a comparison between roentgeno-
logic length and length found post mortem, it is seen that the "true" length will
be 11.6 em. This discrepancy of 0.5 em. is due to the angle between the
longitudinal axis of the kidney and the film in the A.P. position. The figures,
11.6 and 11.1 are the hypotenuse and the longer side, respectively, of a right-
angled triangle, while the third side and the angle between the longitudinal
axis of the kidney and the film can be easily calculated. The values will then
be in full agreement with the post mortem studies mentioned earlier.
The figures for the length and width of normal kidneys, published in 1956
by MOELL, are practically the same as those found in this investigation.
It is generally accepted, that "a large body naturally harbours larger kid-
neys than a small one and the shape of the kidneys like, for example, the heart,
correspond to the general body-build" (KLEEBERG & DREYFUSS 1946).
Since the investigation of LYSHOLM, NYLIN & QVARNA (1934) and others,
the body surface has been used in the roentgenologic assessment of the relative
volume of the heart. In their series, consisting of 47 normal cases, 33 adults
and 14 girls, 10-14 years of age, they found a correlation of +0.84±0.04
between the absolute heart volume and body-surface and a correlation of
+0.82±0.05 between the absolute heart volume and body-weight.
But in 1939, LILJESTRAND, NYLIN & ZACHRISSON, in a material of 101 males,
aged 21-27, only found a correlation of 0.48±0.08 between absolute heart
volume and body-surface and a correlation of +0.52±0.07 between heart
volume and body-weight.
From these references it was considered worthwhile to evaluate the correla-
tion between the roentgenologically estimated area of normal kidneys and
factors in the body-build. The factors chosen were body-length, body-weight,
m 2 body-surface and, as a measure of skeletal sturdiness according to LINDE-
G1RD (1953), the area of the second vertebral body, measured on the roent-
genogram. It was found that there existed a significant correlation between
the roentgenographic area of the kidneys and these factors of body-build.
The standard deviation of the normal value for the roentgenographic kidney
area of 100 males, however, decreased only slightly, when these body-build fac-
tors were taken into consideration. When using body-weight, for instance, the
standard deviation was reduced from 15.6 to 14.5 em". With twice the standard

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 31

deviation, as the range for the variation of the roentgenographic area of normal
kidneys in males, the figures were 191.3 cm 2 and 133.3 cm 2 instead of 193.5
and 131.1 respectively. This reduction in the range values is not large enough
to indicate correction for differences in body-build variables in practice.

SUMMARY
In a series of 100 males and 100 females the size (length, width and measured
area) of normal kidneys was estimated on plain roentgenograms of the abdomen.
In males the right kidney was found to measure 12.9 (s=0.80) X 6.2 (s=0.45)
em. and the left 13.2 (s=0.79) X 6.3 (s=0.49) em. The measured roentgen-
ographic areas (product oflength X width) were 79.6 (s=8.75) and 82.7 (s=8.34)
cm 2 respectively. The total area was 162.3 (s= 15.6) cm'', In females the figures
for the right kidney were 12.3 (s=0.79) X 5.7 (s=0.46) and for the left 12.6
(s=O.77) X 5.9 (s=0.42) em. The areas were 70.1 (s=8.00) and 74.1 (s=7.31)
respectively and the total area 144.2 (s= 13.6) em", The right and left kidneys
were significantly larger in males than in females and in both sexes the left
kidney was larger than the right.
A comparison between the roentgenographic length and width of the kidneys
and the length and width found post mortem showed a constant difference,
if due consideration be given to the object-film distance and to the angle
between the longitudinal axis of the kidneys and the film. Good agreement was
found with the figures for length and width given by the anatomists.
The area of the kidneys was correlated with the weight of the kidneys found
post mortem and from the results found, kidney-weight can be predicted with a
fair degree of accuracy.
From the post mortem weight of the kidneys the area of the kidneys in higher
age-groups, 50-59, 60-69 and 70-79 years, was calculated.
A positive correlation was found between the measured area of the kidneys
and factors in body-build (body-length, body-weight, m 2 body-surface and the
area of the second vertebral body as measured on plain roentgenograms) in
100 males and 100 females, 20-49 years of age. The coefficients of correlation
were for males +0.15, +0.37, +0.35 and +0.33 and for females +0.36,
+0.33, +0.38 and +0.23, respectively.
In an attempt to diminish the standard deviation of the area in 100 males
with normal kidneys between 20 and 49 years it was found that when the area
was related to body-weight, there was only a decrease in the standard deviation
from 15.6 ern" to 14.5 om", This decrease was rather small and of no significance
from a practical point of view.

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