Fischer Katherine, Li Chunming, Wang Huixuan, Song Yihua, Furth Susan, Tasian Gregory E
Division of Urological Surgery, Department of Surgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania.
Center for Biomedical Image Analysis, University of Pennsylvania, Philadelphia, Pennsylvania.
J Urol. 2016 Apr;195(4 Pt 2):1203-8. doi: 10.1016/j.juro.2015.08.097. Epub 2016 Feb 28.
Low renal parenchymal area, which is the gross area of the kidney in maximal longitudinal length minus the area of the collecting system, has been associated with increased risk of end stage renal disease during childhood in boys with posterior urethral valves. To our knowledge normal values do not exist. We aimed to increase the clinical usefulness of this measure by defining normal renal parenchymal area during infancy.
In a cross-sectional study of children with prenatally detected mild unilateral hydronephrosis who were evaluated between 2000 and 2012 we measured the renal parenchymal area of normal kidney(s) opposite the kidney with mild hydronephrosis. Measurement was done with ultrasound from birth to post-gestational age 10 months. We used the LMS method to construct unilateral, bilateral, side and gender stratified normalized centile curves. We determined the z-score and the centile of a total renal parenchymal area of 12.4 cm(2) at post-gestational age 1 to 2 weeks, which has been associated with an increased risk of kidney failure before age 18 years in boys with posterior urethral valves.
A total of 975 normal kidneys of children 0 to 10 months old were used to create renal parenchymal area centile curves. At the 97th centile for unilateral and single stratified curves the estimated margin of error was 4.4% to 8.8%. For bilateral and double stratified curves the estimated margin of error at the 97th centile was 6.6% to 13.2%. Total renal parenchymal area less than 12.4 cm(2) at post-gestational age 1 to 2 weeks had a z-score of -1.96 and fell at the 3rd percentile.
These normal renal parenchymal area curves may be used to track kidney growth in infants and identify those at risk for chronic kidney disease progression.
肾实质面积降低，即肾脏最大纵径时的总面积减去集合系统面积，与后尿道瓣膜症男孩儿童期终末期肾病风险增加相关。据我们所知，目前尚无正常参考值。我们旨在通过确定婴儿期正常肾实质面积来提高该指标的临床实用性。
在一项对2000年至2012年间接受评估的产前诊断为轻度单侧肾积水儿童的横断面研究中，我们测量了与轻度肾积水肾脏相对的正常肾脏的肾实质面积。测量采用超声检查，从出生至孕龄10个月。我们使用LMS方法构建单侧、双侧、左右侧和性别分层的标准化百分位数曲线。我们确定了孕龄1至2周时肾实质总面积为12.4平方厘米的z值和百分位数，该面积与后尿道瓣膜症男孩18岁前肾衰竭风险增加相关。
共使用975例0至10个月大儿童的正常肾脏创建了肾实质面积百分位数曲线。在单侧和单分层曲线的第97百分位数处，估计误差幅度为4.4%至8.8%。对于双侧和双分层曲线，第97百分位数处的估计误差幅度为6.6%至13.2%。孕龄1至2周时肾实质总面积小于12.4平方厘米的z值为-1.96，处于第3百分位数。
这些正常肾实质面积曲线可用于追踪婴儿肾脏生长情况，并识别有慢性肾病进展风险的婴儿。
