Hoi Shotaro, Takata Tomoaki, Fujino Yudai, Kageyama Kana, Taniguchi Sosuke, Yoshida Yukina, Mae Yukari, Iyama Takuji, Sugihara Takaaki, Isomoto Hajime
Division of Gastroenterology and Nephrology, Faculty of Medicine, Tottori University, Nishi-cho 36-1, Yonago, Tottori, 683-8504, Japan.
School of Health Science, Major in Clinical Laboratory Science, Faculty of Medicine, Tottori University, Nishi-cho 36-1, Yonago, Tottori, 683-8504, Japan.
J Nephrol. 2025 Sep 8. doi: 10.1007/s40620-025-02417-z.
Chronic kidney disease (CKD) is a public health concern; kidney size correlates with kidney function, except in diabetic kidney disease (DKD), where the kidney enlarges, limiting morphological measurement applications in CKD management. However, cortical size changes in DKD along with CKD progression remain understudied. We investigated kidney morphology alterations in patients with and without diabetes and established a regression equation for kidney function incorporating morphological alterations.
We included 312 patients who underwent kidney morphological measurements at Tottori University Hospital between 2018 and 2024. After excluding 34 subjects, 278 patients were divided into derivation and validation groups. Ultrasonography was used to assess kidney morphology including parenchymal, cortical, and medullary thicknesses, length, and kidney and cortical volumes. The non-diabetic and diabetic groups were compared at each CKD stage. Multivariate linear regression generated renal function equations.
In the derivation group (247 patients), height-adjusted cortical volume was strongly associated with kidney function in patients without diabetes (r = 0.513, p < 0.001) and with diabetes (r = 0.701, p < 0.001). Cortical volume was significantly larger in patients with than in those without diabetes at each CKD stage, except stages 4 and 5. In the validation group (31 patients), the predicted estimated glomerular filtration rate (eGFR) strongly correlated with the actual eGFR (r = 0.803, p < 0.001).
A strong correlation between cortical size and kidney function was observed. Cortical size alterations depended on the cause of CKD. A regression equation incorporating kidney size can help assess the eGFR. These findings could help formulate strategies for improving CKD management.
慢性肾脏病（CKD）是一个公共卫生问题；肾脏大小与肾功能相关，但糖尿病肾病（DKD）除外，在DKD中肾脏会增大，这限制了形态学测量在CKD管理中的应用。然而，DKD中皮质大小随CKD进展的变化仍未得到充分研究。我们调查了糖尿病患者和非糖尿病患者的肾脏形态改变，并建立了一个纳入形态学改变的肾功能回归方程。
我们纳入了2018年至2024年在鸟取大学医院接受肾脏形态测量的312例患者。排除34例受试者后，将278例患者分为推导组和验证组。采用超声检查评估肾脏形态，包括实质、皮质和髓质厚度、长度以及肾脏和皮质体积。在每个CKD阶段对非糖尿病组和糖尿病组进行比较。多变量线性回归生成肾功能方程。
在推导组（247例患者）中，身高校正后的皮质体积与非糖尿病患者（r = 0.513，p < 0.001）和糖尿病患者（r = 0.701，p < 0.001）的肾功能密切相关。在每个CKD阶段，除4期和5期外，糖尿病患者的皮质体积显著大于非糖尿病患者。在验证组（31例患者）中，预测的估计肾小球滤过率（eGFR）与实际eGFR密切相关（r = 0.803，p < 0.001）。
观察到皮质大小与肾功能之间存在密切相关性。皮质大小改变取决于CKD的病因。纳入肾脏大小的回归方程有助于评估eGFR。这些发现有助于制定改善CKD管理的策略。
