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1 - Renal Cortical Thickness
1 - Renal Cortical Thickness
Beland et al.
Renal Function in Chronic Kidney Disease
Genitourinary Imaging
Original Research
T
filtration rate, renal cortex, renal failure, ultrasound raditional teaching is that renal that does not contain functioning renal tissue
length correlates with renal func- and does vary from patient to patient. These
DOI:10.2214/AJR.09.4104 tion in chronic kidney disease factors likely contributed to the findings in a
Received December 10, 2009; accepted after revision
(CKD), and therefore bipolar re- recent study that showed a positive, but weak
January 21, 2010. nal lengths are almost always reported at renal association between sonographically deter-
ultrasound [1]. Previous studies have shown mined kidney volume and various indices of
WEB that renal volume calculated at ultrasound is a glomerular filtration rate (GFR) [6].
This is a Web exclusive article.
more exact measurement of a functioning kid- A recent study showed renal volume, and
1
Department of Diagnostic Imaging, Rhode Island ney than renal length [2, 3]. A more recent specifically cortical volume, measured at CT
Hospital, Warren Alpert Medical School of Brown study showed that kidney length and volume had a strong positive relationship with renal
University, 593 Eddy St., Providence, RI 02903. Address significantly correlated with estimated glomer- function [7]. Additional studies have shown
correspondence to M. D. Beland (mbeland@lifespan.org). ular filtration rate (eGFR) in the elderly, but total renal volumes obtained at CT relate
2
Departments of Biostatistics and Research, Orthopaedics,
kidney length has a low specificity in predict- to renal function [8, 9]. However, there are
and Surgery, Rhode Island Hospital, Warren Alpert Medical ing renal impairment [4]. However, measuring drawbacks to using CT, including increased
School of Brown University, Providence, RI. the true kidney volume at ultrasound is diffi- cost and radiation exposure. In addition, Wi-
cult. Estimates of volume can be made on the djaja et al. [8] showed a significant corre-
AJR 2010; 195:W146–W149
basis of the ellipsoid formula, but this method lation between ultrasound-measured renal
0361–803X/10/1952–W146 has an inherent defect because the kidney is length and CT-measured renal volume.
not actually ellipsoid [5]. In addition, the ellip- In patients with CKD, the renal cortical
© American Roentgen Ray Society soid volume would include the central sinus fat echogenicity increases at ultrasound [10].
CG
CG
by Moghazi et al. [11]. The measurement was taken 50 50
Downloaded from www.ajronline.org by 129.208.101.56 on 02/01/19 from IP address 129.208.101.56. Copyright ARRS. For personal use only; all rights reserved
MDRD
and length were used in analyses. Statistical
50 50
analysis and visualization were performed using
Matlab (MathWorks). The relationship between
ultrasound measurements and renal function was
tested using linear regression. Significance was
considered at a p value < 0.05. 0
0 0.5 1 1.5
0
6 8 10 12 14
and lower poles may prove to be a better rep- dialysis efficacy rather than native renal func- cortical volume measured using automatic con-
resentation of functioning parenchymal vol- tion. Patients without known kidney disease touring software for computed tomography and its
ume in future studies. Despite these limita- also were not included in this study. It would relationship with BMI, age and renal function.
tions, we found the cortical thickness was be interesting to see if the correlation between Eur J Radiol [Epub 2009 Nov 13]
usually easy to measure on the PACS work- cortical thickness and eGFR is also identified 8. Widjaja E, Oxtoby JW, Hale TL, Jones PW, Hard-
station. The method used in our study also in these patients. Although this would be a en PN, McCall IW. Ultrasound measured renal
Downloaded from www.ajronline.org by 129.208.101.56 on 02/01/19 from IP address 129.208.101.56. Copyright ARRS. For personal use only; all rights reserved
likely reflects common practice in which ul- more difficult study to perform, evaluating the length versus low dose CT volume in predicting
trasound images are obtained by a technolo- applicability of measuring cortical thickness to single kidney glomerular filtration rate. Br J Ra-
gist and then interpreted by the radiologist healthy kidneys would be valuable. diol 2004; 77:759–764
after the patient has left the department. In summary, we have shown renal cortical 9. Herts BR, Sharma N, Lieber M, Freire M, Gold-
Another potential limitation of our study thickness measured at ultrasound appears to farb DA, Poggio ED. Estimating glomerular filtra-
is the use of computational estimates of re- relate to the degree of renal impairment in tion rate in kidney donors: a model constructed
nal function, rather than measured GFR. Al- patients with CKD, and routine reporting of with renal volume measurements from donor CT
though both formulas have been previously cortical thickness should be considered in scans. Radiology 2009; 252:109–116
validated and are widely used, there is contin- such patients who are not on dialysis. 10. Khati NJ, Hill MC, Kimmel PL. The role of ultra-
ued debate over which formula is best [14, 15]. sound in renal insufficiency: the essentials. Ultra-
A study by Rule et al. [16] in 2004 showed that References sound Q 2005; 21:227–244
the MDRD equation systematically underes- 1. American College of Radiology Website. ACR 11. Moghazi S, Jones E, Schroepple J, et al. Correla-
timated renal function. The underestimation practice guideline for the performance of an ultra- tion of renal histopathology with sonographic
was much more pronounced for healthy volun- sound examination of the abdomen and/or retro- findings. Kidney Int 2005; 67:1515–1520
teers (29% underestimation) than in patients peritoneum (in collaboration with the American 12. Levey AS, Coresh J, Greene T, et al. Chronic kid-
with CKD (6.2% underestimation). Howev- Institute of Ultrasound in Medicine AIUM). ney disease epidemiology collaboration. using
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of the MDRD equation before standardiza- quality_safety/guidelines/us/us_abdomen_retro. ification of Diet in Renal Disease study equation
tion of creatinine estimates between labora- aspx. Revised 2007. Accessed April 14, 2010 for estimating glomerular filtration rate. Ann In-
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able MDRD study equation that was used in Kidney dimensions at sonography: correlation 13. Adibi A, Adibi I, Khosravi P. Do kidney sizes in
our study has allowed the use of standardized with age, sex, and habitus in 665 adult volunteers. ultrasonography correlate to glomerular filtration
creatinine measurements and should mini- AJR 1993; 160:83–86 rate in healthy children? Australas Radiol 2007;
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accurate than the CG equation in patients with 4. Van Den Noortgate N, Velghe A, Petrovic M, et stratification. Ann Intern Med 2003; 139:137–147
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betic nephropathy [17]. Our study only evalu- of renal function in the elderly. J Nephrol 2003; sessing kidney function: measured and estimated
ated patients with CKD, which would mini- 16:658–662 glomerular filtration rate. N Engl J Med 2006;
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using the MDRD equation relative to patients measurements: accuracy and repeatability of US 16. Rule AD, Larson TS, Bergstralh EJ, Slezak JM,
without known kidney disease and suggests compared with that of MR imaging. Radiology Jacobsen SJ, Cosio FG. Using serum creatinine to
MDRD may be the more accurate estimate 1999; 211:623–628 estimate glomerular filtration rate: accuracy in
applied to our study population [16]. 6. Sanusi AA, Arogundade FA, Famurewa OC, et al. good health and in chronic kidney disease. Ann
Patients on dialysis were necessarily exclud- Relationship of ultrasonographically determined Intern Med 2004; 141:929–937
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creatinine and cortical thickness would be in- chronic kidney disease (CKD). Nephrol Dial nal Disease and Cockcroft-Gault equations in the
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