Nigerian Journal of Paediatrics

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)

(JUTH).

cm for right and left kidneys re-

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

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.

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-

Variables

Frequency (n=200)

Percentage

tion (s), detectable by physical examination or organ

Gestational age (weeks)

abnormality detected by ultrasound assessment, sick

35.0

neonates, and those with birth weight greater than 4kg or

30.0

less than 2.5kgwere excluded. All babies recruited into

20.5

the study were subsequently re-evaluated between 12

11.5

and 72 hours of age and their weights, lengths and

3.0

BSAre-measured and recorded.

Birth weight (kg)

2.5-2.9

30.5

Each baby then had real time ultrasound scanning of the

3.0-3.4

104

52.0

3.5-4.0

17.5

abdomen with a 7.5MHz linear probe (AlokaProsound

Socio-economic class

SSD 3500 sv). Scanning was done in both the supine

Lower

10.5

and lateral decubitus positions.

18,19

Each kidney was

Middle

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

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

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.

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

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.

follows: weight, 3.10±0.35kg; length, 49.34±2.48cm;

BSA, 0.19±0.01m . There was a statistically significant

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

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 )

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 )

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 )

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

did with increasing birth weight and not with birth

9.4±2.18 cm on the left. There was no significant dif-

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

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 )

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

(weeks)

(95% CI)

Mean (95%

(95%CI)

value

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

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

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

2.15

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 )

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 )

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)

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 )

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 )

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

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 )

0.252

<0.001*

0.058

0.412

0.242

0.001*

-0.010

0.887

Left volume (cm )

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

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

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

is similar to the 3.92 cm and 3.83 cm for right and left

kidneys reported by Sultana et al among term Bangla-

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,

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.

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.

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.

in studies of adolescents and adults, kidney length has

This finding is also similar to the 9.7and 9.8cm for right

been found to be significantly bigger in males than fe-

1, 36-38

and left kidneys respectively, reported in Bangladesh.

males.

This has been attributed to ultimate gender

Holloway et al on the other hand found a slightly larger

differences in body size, with the male gender having a

renal volume of 10.0cm among Caucasians for both

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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