Remnant renal volume can predict prognosis of remnant renal function in kidney transplantation donors: a prospective observational study

Background Safety and survival during and after donor nephrectomy (DN) are one of the main concerns in living kidney donors (LKDs). Therefore, kidney (left/right) to be procured should be determined after considering the difficulty of DN, as well as the preservation of remnant renal function (RRF). In this prospective study, we investigated the roles of computed tomography volumetry (CTV) in split renal function (SRF) and established a predictive model for RRF in LKDs. Methods We assessed 103 LKDs who underwent DN at our institute. The Volume Analyzer SYNAPSE VINCENT image analysis system were used as CTV. RRF was defined as the estimated glomerular filtration rate (eGFR) 12 months after DN. The association between various factors measured by CTV and RRF were investigated, and a role of CTV on prediction for RRF was assessed. Results The median age and the preoperative eGFR were 58 years and 80.7 mL/min/1.73m2, respectively. Each factor measured by CTV showed an association with RRF. The ratio of remnant renal volume to body surface area (RRV/BSA) could predict RRF. In addition, RRV/BSA could predict RRF more accurately when used together with age and 24-h creatinine clearance (CrCl). Conclusions Our findings suggest that RRV/BSA measured by CTV can play an important role in predicting RRF, and a comprehensive assessment including age and CrCl is important to determine the kidney to be procured.

Differential Diagnosis and Prognosis of Fetuses with Bilateral Enlarged, Hyperechogenic Kidneys: Renal Volume and Amniotic Fluid Volume with Advancing Gestation

Introduction This study’s objective was to identify prenatal criteria helping differential diagnosis of bilateral enlarged, hyperechogenic kidneys, especially looking at development of renal volume and amniotic fluid volume with increasing gestational age. Method Retrospective analysis (single-center database) of all bilateral enlarged, hyperechogenic kidneys between 2000–2018. Renal enlargement was defined as renal volume>90th percentile. Evaluation included development of renal and amniotic fluid volume during pregnancy and fetal outcome. Results 23 cases fulfilled the inclusion criteria. 12 pregnancies were terminated. For 11 continued pregnancies, longitudinal information on amniotic fluid volume and renal volume were available. 4 cases with oligohydramnios showed a progressive reduction; 6 cases with normal/increased amniotic fluid volume remained stable; in 1 case amniotic fluid volume normalized from initially being oligohydramnios. Regarding renal volume, 4 cases showed exponential enlargement, 3 cases linear progression; in 2 cases renal volume stabilized after initial progression; 2 cases showed initial progression and secondary regression. 4 fetuses survived: 3 autosomal dominant polycystic kidney diseases, 1 Bardet-Biedl syndrome. Conclusion Progressive reduction of amniotic fluid volume with exponential increase of renal volume is highly suggestive for autosomal recessive polycystic kidney disease. Cases of autosomal dominant polycystic kidney disease show a linear progression of renal volume>90th percentile and mostly normal amniotic fluid volume.

Sonographic Assessment of Renal Volume in Normotensive Pregnant Women and Women With Pregnancy-Induced Hypertension in Enugu Metropolis

Objective: Renal volume (RV) assessment during obstetric sonography is rarely considered in our locality. Understanding the changes in RV in both normotensive pregnant (NP) and pregnancy-induced hypertensive (PIH) women is important in making correct diagnosis regarding pregnancy outcome. This study is aimed at determining the RV in NP and PIH women and correlating RV with fetal gestational age (FGA), body mass index (BMI), and parity in NP women. Materials and Methods: This cross-sectional study involved 450 patients recruited at a Tertiary Hospital. A pilot study was done to determine the interobserver variability in RV measurement. RV was calculated using the following formula: L × W × AP × 0.523. Parity, BMI, and blood pressure were documented, while FGA was calculated as an average of FGAs obtained from the measurements of fetal biometric parameters. Results: Mean RV of PIH women was significantly higher than that of NP women ( P < .05). RV shows a positive significant relationship with BMI and FGA, while it shows a negative relationship with parity in NP ( P < .05). Conclusion: Reference range values of RV were generated for clinical use in our locality, while there is statistically significant difference between RV in NP and PIH women.

Renal function estimation done by contrast enhanced computed tomography volume percentage: a better cost-effective alternate for renogram values

Background: For optimal management of obstructive uropathy the function of each renoureteral unit needs to be assessed precisely. Usage of nuclear scan for estimation of split renal function has been standard technique till now. Renal parenchymal volume percentage, which is calculated through multislice CT, used as a surrogate marker of split renal function. The aim of the study was to correlate the renal volume percentage calculated from contrast enhanced computed tomography (CECT) of kidney, ureter and bladder (KUB) with split renal function estimated by the gold standard 99mTc-DTPA (diethylene triamine pentaacetic acid) among obstructive uropathy patients.Methods: Patients who have been diagnosed as chronic unilateral renal obstruction and were requiring 99mTC-DTPA nuclear scan for functional assessment of kidneys were included as our study subjects. A total of 46 patients were taken as our study sample and for all these patients CECT KUB was done and the reports were collected and the renal volume percentage was obtained through those images. Correlation was made between the measurements made by nuclear scan and CECT images in unilateral renal obstruction patients.Results: A positive linear correlation was obtained between DTPA nuclear scan and CECT images in the detection of renal volume/renal function with r value 0.904 (p<0.05) in obstructive renal units and similarly among non-obstructive renal units the r value was 0.889 (p<0.001).Conclusions: Though 99mTc-DTPA renal scan is a safest choice by considering its less radiation exposure and no contrast requirement still cost and its universal availability make us to consider CECT as a better alternative.