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Nigerian J Paediatrics 2018 vol 45 issue 2

Nigerian J Paediatrics 2018 vol 45 issue 2

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Renal sizes in healthy term newborns in Jos Nigeria
Niger J Paediatr 2018; 45 (2):106 - 111
ORIGINAL
Ogbe P
CC – BY
Renal sizes in healthy term
Ocheke IE
Bode-Thomas F
newborns in Jos, Nigeria
DOI:http://dx.doi.org/10.4314/njp.v45i2.6
Accepted: 23rd March 2018
Abstract : Introduction
pared using student’s t -test.
Knowledge of the range of normal
Results: Two hundred term new-
Ocheke IE (
)
measurements of body organs
borns consisting of 105 (52.50 %)
Ogbe P
including the kidneys in the
females and 95 (47.50%) males
Bode-Thomas F
healthy population is essential.
were enrolled. Their mean renal
Department of Paediatrics,
Such reference values provide a
length was 4.09(95% CI, 3.72,
University of Jos/ Jos University
quick guide for prompt and accu-
4.46) cm and 4.08 (95% CI, 3.72,
Teaching Hospital
rate evaluation of the abnormal.
4.44)cm for right and left kidneys;
Email: ieocheke@yahoo.com
This study sought to determine
width2.11 (95% CI, 1.89, 2.33) cm
renal size by ultrasound measure-
and 2.08 (95% CI, 1.85, 2.31) cm
ment in term neonates at the Jos
for right and left kidneys, and
University Teaching
Hospital
volume9.66(95% CI, 7.49, 9.87)
cm and 9.41 (95% CI, 7.23, 11.59)
3
(JUTH).
cm for right and left kidneys re-
3
Materials and Methods: Healthy
term neonates aged 12 to 72 hours
spectively. Renal dimensions in-
were consecutively enrolled. Ul-
creased consistently with birth
trasound measurements of their
weight. No significant difference
renal sizes were determined.
in renal dimensions between the
Mean renal dimensions and their
right and left kidneys was found.
95% confidence intervals (CI)
Conclusion: The mean renal di-
were computed. The renal sizes
mensions for right and left were
were correlated with the infants’
similar and correlated with birth
anthropometric parameters and
weight.
gestational ages using Pearson’s
correlation coefficient. Sizes of
Key Words: Healthy, Term,
left and right kidneys and of male
Newborn, Ultrasound, Renal Size,
and female subjects were com-
Introduction
Normal mean renal lengths reported for term neonates
range from 3.83 to 4.70 cm.
7, 11, 13, 15, 16
There are limited
Physical parameters at birth such as weight, length and
reports on kidney size from developing countries, in-
head circumference vary from one baby to another and
cluding Nigeria. This study was thus designed to de-
from one population to another. They are influenced by
scribe the renal size in healthy Nigerian term neonates
factors such as gestational age, genetics, environment
within the first 72 hours of life and to provide reference
and socioeconomic imperatives. These factors may also
values for the evaluation of this age group so that devia-
influence the sizes of body organs.
1,2
tion from the normal size can easily be identified.
Kidney sizes have been shown to increase throughout
foetal life as the neonate grows bigger. Preterm and
3
small for gestational age babies have small sized kid-
neys concurrent with their age and size.
4-7
These find-
Methods
ings support the notion of proportionate growth of body
organs with gestational age and other factors such as
This was a prospective, cross-sectional and descriptive
body weight, surface area and length.
study carried out at the Jos University Teaching Hospital
(JUTH) Jos, a tertiary health care facility in central Ni-
Reference values on physical and biochemical parame-
geria. Ethical approval for the study was obtained from
ters serve as quick standards for comparison so that de-
the Ethics Committee of the hospital. Informed oral con-
viation from the normal can easily be identified.
8- 11
Ul-
sents were obtained from mothers after they had been
trasound assessment of the kidney is an important step
given information about the study. Apparently healthy
in the evaluation of patients with renal pathology and its
babies whose maternal records showed no evidence of
use for prognostic purposes in certain conditions.
12
hypertension, diabetes or obesity and who had com-
Therefore, knowledge of the normal range of renal di-
pleted 37but did not exceed 42 completed weeks of ges-
mensions (length, width, thickness and volume) is es-
tation were recruited. All the babies were appropriate for
sential for such evaluation.
8, 13, 14
gestational age. A complete clinical examination was
107
done for each baby, including birth anthropometry and
Table 1: Socio-demographic and physical characteristics of
their body surface areas calculated using the Du Bois
study population
formula. Neonates with obvious congenital malforma-
17
Variables
Frequency (n=200)
Percentage
tion (s), detectable by physical examination or organ
Gestational age (weeks)
abnormality detected by ultrasound assessment, sick
38
70
35.0
neonates, and those with birth weight greater than 4kg or
39
60
30.0
less than 2.5kgwere excluded. All babies recruited into
40
41
20.5
the study were subsequently re-evaluated between 12
41
23
11.5
and 72 hours of age and their weights, lengths and
42
6
3.0
BSAre-measured and recorded.
Birth weight (kg)
2.5-2.9
61
30.5
Each baby then had real time ultrasound scanning of the
3.0-3.4
104
52.0
3.5-4.0
35
17.5
abdomen with a 7.5MHz linear probe (AlokaProsound
Socio-economic class
SSD 3500 sv). Scanning was done in both the supine
Lower
21
10.5
and lateral decubitus positions.
18,19
Each kidney was
Middle
46
2.0
examined in its longitudinal and transverse axis from
Upper
133
66.5
which the bipolar length and width were determined in
Family history of kidney disease
centimeters (cm). At the same point with the transducer
Absent
194
97.0
now transversely oriented, a third measurement was
Present
6
3.0
taken to obtain the anterior- posterior diameter or thick-
Parental consanguinity
ness. The dimensions of each kidney were taken twice
Absent
191
95.5
Present
9
4.5
and the average of the two readings was recorded. The
ultrasound machine automatically calculated the volume
(cm ) using the formula for an ellipsoid.
3
20
Anthropometric indices of the study population
All babies were scanned after the first 12 and within 72
hours of birth when the transient hydronephrosis present
The overall mean birth weight was 3.15±0.35 kg, length
usually at birth would have resolved.
13,21,22
More so, the
49.33±2.48cm
and
body
surface
area
(BSA)
0.193±0.014 m . Male infants significantly had bigger
2
kidneys are best visualized in the first few days of life
before enteral feeding is well established as gas in the
weights and larger BSA than females (Table 2). The
gut makes precise measurements of renal images diffi-
anthropometric measurements at enrollment were as
cult.
4
follows: weight, 3.10±0.35kg; length, 49.34±2.48cm;
BSA, 0.19±0.01m . There was a statistically significant
2
difference between the birth weight and BSA at enroll-
The data was analysed using SPSS (Statistical Product
ment.
and Service Solutions, formerly known as Statistical
Package for the Social Sciences) VERSION 16 (SPSS,
Table 2: Anthropometric indices at birth and at enrollment
Chicago, IL). Sizes of left and right kidneys and renal
Birth
Enrollment
t-test
p-value
sizes of male and female subjects were compared using
Mean (95%
Mean (95%CI)
student’s t -test. Recommended reference ranges of renal
CI)
size for term newborns were derived from the 95% con-
All subjects
fidence intervals. Renal dimensions were correlated
23
Weight (kg)
3.15 (2.80-
3.10 (2.75-3.45)
9.517
<0.001*
with the infants’ anthropometric parameters and gesta-
3.50)
tional age using Pearson’s correlation coefficient. Linear
Length (cm)
49.33 (46.85-
49.34 (46.86-
0.576
0.565
regression analysis to determine the strength of correla-
51.58)
51.82)
BSA (m )
2
0.19
0.19 (0.18-0.20)
5.010
<0.001*
tion of anthropometric factors with renal dimensions
(0.179±0.207)
was done. Statistical significance was set at a p-value of
Males
<0.05.
Weight
3.22 (2.87-
3.17 (2-82-3.52)
7.093
<0.001*
(cm)
3.57)
Length (cm)
49.61 (47.02-
49.61 (47.04-
1.000
0.320
52.20)
52.18)
BSA (m )
2
0.20 (0.181-
0.20 (0.18-0.22)
3.680
<0.001*
Results
0.211)
Females
Weight (kg)
3.08 (2.75-
3.04 (2.69-3.39)
6.371
<0.001*
Two hundred (200)neonates were enrolled for the study,
3.41)
comprising 95 (47.5%) males and 105 (52.5%) females.
Length (cm)
49.07 (46.72-
49.07 (46.71-
0.000
1.000
The mean age at ultrasound scanning was 20.84±13.16
51.44)
51.43)
BSA (m )
2
hours (range 12 - 72 hours). Seventy (35%) of the 200
0.19 (0.179-
0.19 (0.18-0.20)
3.544
0.001*
0.203)
babies were born at 38 weeks of gestation, 60 (30%) at
39 weeks and 41(20.5%) at 40 weeks. Twenty three
*statistically significant, BSA- body surface area, CI- Confidence
Interval
(11.5%) and 6 (3%) babies were born at 41 and 42
weeks respectively. The socio-demographic characteris-
tics of the study population are shown in Table 1. A his-
Renal Dimensions
tory of parental consanguinity was found in 9 (4.5%)
subjects (Table 1).
The mean renal length was 4.09±0.37 cm(95% CI, 3.72,
4.46) and 4.08±0.36 cm (95% CI, 3.72, 4.44) for right
108
and left respectively. The mean renal width was
There was also no significant difference in the renal
2.11±0.22 cm (95% CI, 1.89, 2.33) and 2.08±0.23 cm
dimensions between the right and the left sides.
(95% CI, 1.85, 2.31)also for right and left kidneys in
(Table 3).
that order. Renal thickness was 2.10±0.29 cm and
The renal dimensions did not vary significantly with
2.22±0.22 cm on the right and on the left, while the
gestational age between 37 and 42 weeks (Table 4) but
mean renal volume was 9.65±2.21 cm on the right and
3
did with increasing birth weight and not with birth
9.4±2.18 cm on the left. There was no significant dif-
3
length (Table 5).
ference in these parameters between the genders.
Table 3: Renal dimensions of study population according to gender
Variable
All subjects
Male
Female
t-test
p-value
Mean (95% CI)
Mean±SD
Mean±SD
Right Length (cm)
4.09 (3.72-4.46)
4.10±0.37
4.08±0.37
0.372
0.710
Left length (cm)
4.08 (3.72-4.44)
4.08±0.31
4.09±0.40
0.218
0.828
Right Width (cm)
2.11 (1.89-2.33)
2.13±0.21
2.10±0.23
0.755
0.451
Left Width (cm)
2.08 (1.85-2.31
2.08±0.24
2.08±0.23
0.037
0.971
Right Thickness (cm)
2.10 (1.82-2.39)
2.09±0.31
2.10±0.27
0.323
0.747
Left Thickness (cm)
2.11 (1.89-2.33)
2.12±0.22
2.09±0.23
1.105
0.271
Right Volume (cm³)
9.66 (7.49-9.87)
9.72±2.22
9.59±2.20
0.397
0.692
Left Volume (cm )
3
9.41(7.23-11.59)
9.40±2.13
9.37±2.24
0.225
0.822
CI- Confidence Interval
Table 4: Renal dimensions of study population according to gestational age
Gestational age
38(n=70) Mean
39(n=60)
40 (n=41)
41(n=23) Mean
42(n=6) Mean
f-test
p-
(weeks)
(95% CI)
Mean (95%
Mean (95%
(95%CI)
(95%CI)
value
CI)
CI)
Right length (cm)
4.14
4.09
4.07
4.02
3.91
0.956
0.433
(3.75-4.53)
(3.75-4.43)
(3.72-4.42)
(3.63-4.41)
(3.58-4.24)
Left length (cm)
4.08
4.09
4.08
4.08
3.98
0.139
0.968
(3.67-4.49)
(3.71-4.47)
(3.81-4.35)
(3.74-4.42.0)
(3.66-4.30)
Right width (cm)
2.11
2.12
2.08
2.20
2.03
1.310
0.268
(1.87-2.35)
(1.92-2.32)
(1.88-2.28)
(1.91-2.49)
(1.89-2.17)
Left width (cm)
2.08
2.09
2.08
2.08
1.99
0.233
0.920
(1.82-2.34)
(1.86-2.32)
(1.87-2.29)
(1.86-2.30)
(1.83-2.15)
Right thickness
2.03 c (1.66-2.40)
2.12
2.12
2.15
2.12
0.980
0.420
(cm)
(1.89-2.350
(1.90-2.340
(1.93-2.37)
(1.85-2.39)
Left thickness (cm)
2.10
2.09
2.11
2.20
2.05
1.252
0.290
(1.87-2.33)
(1.86-2.32)
(1.92-2.30)
(1.98-2.42)
(2.02-2.08)
Right volume (cm )
3
9.68
9.66
9.45
10.07
8.90
0.465
0.761
(7.28- 12.08)
(7.70-11.62)
(7.20-11.70)
(7.66-12.48)
(7.12-10.68)
Left volume (cm )
3
9.37
9.38
9.37
9.83
8.65
0.404
0.806
(6.82-11.92)
(8.28-10.48)
(7.20-10.98)
(7.39-12.27)
(6.43-10.87)
CI- Confidence Interval
Table 5: Renal dimensions of 200 term newborns according to birth weight
Birth weight (kg)
2.50-<3.00(n=61)
3.00-<3.50 (n=104)
3.50-4.00(n=35)
F-test
p-value
Mean (95%CI)
Mean (95%CI)
Mean (95%CI)
Right length (cm)
4.05(3.69-4.41)
4.06(3.71-4.41)
4.25(3.88-4.62)
4.280
0.015*
Left length (cm)
4.01(3.60-4.42)
4.08(3.77-4.39)
4.22(3.85-4.59)
3.667
0.027*
Right width (cm)
2.08(1.84-2.32)
2.12(1.90-2.34)
2.16(1.96-2.36)
1.664
0.102
Left width (cm)
1.99(1.76-2.22)
2.11(1.87-2.35)
2.14(1.96-2.32)
6.412
0.002*
Rt.thickness (cm)
1.99(1.65-2.33)
2.13(1.91-2.35)
2.21(1.97-2.45)
8.192
<0.001*
Left thickness (cm)
2.03(1.81-2.25)
2.13(1.91-2.35)
2.17(1.95-2.39)
5.659
0.004*
Right volume (cm )
3
9.08(6.89-11.27)
9.7(7.53-11.87)
10.58(8.50-12.66)
5.393
0.005*
Left volume (cm )
3
8.51(6.42-10.60)
9.7(8.3-11.1)
10.15(8.15-12.15)
8.816
<0.001*
* statistically significant ; CI= confidence interval; Rt. =right
the subjects’ length and gestational ages and at enroll-
Correlation of renal dimensions with anthropometric
ment (Tables 6,7). On multiple linear regression analysis
variables
however, the strength of association was strongest with
birth weight therefore the anthropometric measurements
There was a significant positive correlation between all
at birth were subsequently used for analysis.
the renal dimensions and the weight and BSA of the
subjects at birth and at enrollment. No significant corre-
lation was observed between the renal dimensions and
109
Table 6: correlation of renal dimensions with anthropometric indices at birth
Weight
Length
BSA
Gestational age
Renal dimensions
r
p-value
R
p-value
r
p-value
r
p-value
Right length (cm)
0.180
0.011*
0.094
0.186
0.178
0.012*
-0.133
0.060
Left length (cm)
0.224
0.001*
0.084
0.238
0.206
0.003*
-0.018
0.795
Right width (cm)
0.168
0.018*
0.000
0.995
0.140
0.049*
0.014
0.841
Left width (cm)
0.280
<0.001*
0.638
0.498
0.229
0.001*
-0.019
0.792
Right thickness (cm)
0.248
<0.001*
0.034
0.630
0.219
0.002*
0.116
0.102
Left thickness (cm)
0.237
0.001*
-0.015
0.835
0.142
0.045*
0.082
0.250
Right volume (cm )
3
0.252
<0.001*
0.058
0.412
0.242
0.001*
-0.010
0.887
Left volume (cm )
3
0.322
<0.001*
0.047
0.511
0.257
<0.001*
-0.014
0.845
* statistically significant; r- Pearson’s correlation coefficient
Table 7: correlation of renal dimensions with anthropometric indices at enrollment
Weight
Length
BSA
Renal dimensions
R
p-value
r
p-value
r
p-value
Right length (cm)
0.169
0.0170 *
0.96
0.178
0.170
0.016*
Left length (cm)
0.222
0. .002*
0.802
0.251
0.206
0.003*
Right width (cm)
0.154
0.030*
0.003
0.966
0.137
0.053*
Left width (cm)
0.245
<0.001*
0.047
0.505
0.206
0.003*
Right thickness (cm)
0.222
0.002*
0.037
0.604
0.205
0.004*
Left thickness (cm)
0.209
0.003*
-0.010
0.890
0.127
0.073
Right volume (cm3)
0.231
0.001*
0.061
0.391
0.232
0.001*
Left volume (cm3)
0.297
<0.001*
0.048
0.502
0.238
0.001*
* statistically significant , r-Pearson correlation coefficient, BSA- body surface area
Renal dimensions in our study consistently increased
with increasing birth weight, corroborating previous
studies among different populations.
3,15,24,27
However,
Discussion
we found no significant increase in renal dimensions
with gestational age, within the narrow gestational age
Our study showed that the mean renal length of term
range(38-42 weeks) studied. This is not surprising since
Fitzsimons noted that renal length does not increase
30
newborn babies in Jos, Nigeria is 4.09cm and 4.08 cm
for the right and left kidneys respectively. This finding
significantly after 36 weeks’ gestation. Gupta and col-
leagues reported a positive correlation between renal
31
is similar to the 3.92 cm and 3.83 cm for right and left
kidneys reported by Sultana et al among term Bangla-
15
length and gestational age, a finding that contrasts with
deshi newborns. However, our figure differs from that
ours, but their study evaluated renal parameters in both
reported by Adeyekun et al in Benin, southern Nigeria,
24
term and preterm babies. The inclusion of preterm neo-
who noted greater mean renal lengths, of 4.49 and 4.44
nates in their final analysis may have contributed to this
cm for the right and left kidneys respectively. This dif-
finding.
ference may be attributable to geographic location.
Whereas, Jos the capital city of Plateau state is situated
We did not find any significant difference in size be-
at a higher altitude, Benin is situated in the lower region
tween the right and left kidneys, though the right was
of Nigeria. It has been shown that babies born at higher
consistently larger. Several other studies have reported
similar findings.
4,5,13,15,24,32
altitudes have relatively smaller birth weight, and since
Some studies however, found
the left to be longer than the right kidney.
2,7,11,23,33
renal size correlates with body weight, it may explain
It has
why this variation exist.
3,23,25-27
The mean birth weight of
been suggested that this could be due to a localized
our study subjects was 3.15Kg, a value much lower than
bulge that is present sometimes on the left kidney called
previously reported mean birth weight from Benin
the dromedary hump. It gives an increased convexity on
city.
28
the lateral aspect of the kidney. This hump might also be
due to the adjoining spleen and its impression on the
Among Caucasians, mean renal length range from 4.2 to
superolateral aspect of the left kidney or may be due to
fetal lobulations or both.
34
4.5cm, while mean length of4.7 cm has been reported
among Arabs.
11,13,23,29
These variations most likely sug-
gest that race could be a determinant of neonatal renal
Our findings also did not show any gender variation as
has been demonstrated in other studies.
2,24,25,35
dimensions. Renal volumes in the present study were
However,
9.65and 9.42 cm for right and left kidneys respectively.
3
in studies of adolescents and adults, kidney length has
This finding is also similar to the 9.7and 9.8cm for right
3
been found to be significantly bigger in males than fe-
1, 36-38
and left kidneys respectively, reported in Bangladesh.
15
males.
This has been attributed to ultimate gender
Holloway et al on the other hand found a slightly larger
20
differences in body size, with the male gender having a
renal volume of 10.0cm among Caucasians for both
3
larger body mass than the female counterpart.
right and left kidneys, a value which is different from
our study and that from Bangladesh, suggesting invaria-
bly the influence of race on overall renal size.
110
Conclusion
measured the renal dimensions reported here. Even
though multiple measurements were taken and only the
In conclusion, the mean renal length was 4.09(95% CI,
mean was recorded, chances of human error is still pos-
3.72, 4.46) cm and 4.08 (95% CI, 3.72, 4.44)cm for right
sible. Independent measurements by two individuals
and left kidneys respectively. Our study also demon-
would have overcome such possible error. On the whole
strated that renal dimensions correlated significantly
however, the data presented here offers baseline guide-
with birth weight but not with length and BSA in the
line for quick assessment of renal dimensions among
early neonatal life. The gender of the child did not influ-
healthy term neonates in Nigeria.
ence significantly the renal dimensions.
As much as possible, it is recommended that values
should be determined and used for the race and locality
Conflict of Interest: None
in evaluating renal sizes in normal term newborns.
Funding: None
This study is not without limitation as only one observer
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