Morphometrical Assessment of Kidney in Fetuses of Different Gestational Age Groups

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International Journal of Scientific and Research Publications, Volume 4, Issue 10, October 2014
1
ISSN 2250-3153
Morphometrical Assessment of Kidney in Fetuses of
Different Gestational Age Groups
Khayati Sant Ram 1, Mahesh Sharma 2, Anshu Sharma 3, Kanchan kapoor 4, Kunal Chawla5, Richa gupta 6, Daisy
Sahni7
1 MBBS,MD. Dept. of Anatomy,Post Graduate institute of medical education and research, Chandigarh, INDIA
2. MBBS,MD Dept. of Anatomy, Government Medical College& Hospital Chandigarh, INDIA.
3. MBBS,MD Dept. of Anatomy, Government Medical College& Hospital, Chandigarh, INDIA
4. MSC,PHD Dept. of Anatomy, Government Medical College& Hospital, Chandigarh, INDIA
5. MBBS,MD Dept. of Anatomy,Post Graduate institute of medical education and research, Chandigarh, INDIA
6. MBBS Dept. of Anatomy,Post Graduate institute of medical education and research, Chandigarh, INDIA
7. Msc,PHD Dept. of Anatomy,Post Graduate institute of medical education and research, Chandigarh, INDIA
Abstract- The study was made on morphometric parameters of
indication of gestational age. Therefore an attempt was made to
human fetal kidney. The present study was carried out in the
determine the growth rate of fetal kidney with increasing
department of Anatomy, Government Medical College &
gestational age.
Hospital, Chandigarh. The material for the study consisted of 30
Present study was undertaken to determine the average size
spontaneously aborted human fetal specimens from 12th to 28th
(length/breadth/thickness), of kidney and ratio of suprarenal
weeks of gestational ages. The kidneys were taken from fetal
gland to kidney in aborted fetuses in an Indian population. A
specimens for morphological study. The measurements were
comparison was made between these dimensions. The study will
done compass, scale and vernier caliper. The present study
establish the macro development of kidney and its correlation
established a significant and positive correlation between the
with suprarenal in human fetuses in North-West Indian
length,breadth and thickness of kidney. All the parameters
population.
increased with increase in gestational age maximum increase was
observed from group B-C.Correlation of kidney with suprarenal
gland were positive. Length and thickness of kidney was more
II. MATERIAL AND METHOD
than suprarenal length and thickness, whereas breadth of kidney
The present study was carried out in the department of
was less than breadth of suprarenal gland in all the age groups.
Anatomy, Government Medical College & Hospital, Chandigarh.
All the parameters of kidney increased from that of suprarenal by
The material for the study consisted of 30 aborted human fetal
approximately two or more than two times from end of 1st
specimens from 12th to 28th weeks of gestational ages. The
trimester to 3rd trimester. A linear correlation of kidney
specimens were provided by the department of Obstetrics &
parameters with suprarenal parameters was observed.
Gynaecology
Government
Medical
College
&
Hospital,
Chandigarh for routine fetal autopsy. All fetuses were result of
Index Terms- breadth, kidney, length,
suprarenal
gland,
the intra uterine death or spontaneous abortion. Consent for
thickness.
autopsy and brief antenatal, medical, past history from the
mother was taken from the parents to perform the study.
The fetuses were divided into four groups according to the
I.
INTRODUCTION
gestational age:-
he kidney plays an important role in maintenance of internal
GROUPS
GESTATIONAL AGE
NUMBER
OF
Tmilieu. The slightestdifference initsfunction maylead to an
FETUSES
exponential alteration which can cost the life of a patient. The
A
11-15 weeks
5
knowledge of the gland is important in understanding, diagnosis
B
>15-20 weeks
9
and treatment of prenatal renal disorders like Wilms tumor,
C
>20-25 weeks
10
multicystic renal dysplasia, hydronephroses...etc1.
D
>25 weeks
6
Morphologic, functional and maturational aspects of the
human fetal kidney are unique.
For all fetuses, the Crown Rump Length (CRL) was
Over the past years, the evaluation of fetal morphometrical
measured.
growth parameters have been subject of increased awareness for
The right and left kidneys were measured in 30 fetuses from
the assessment of fetal growth and development. Some important
the gestational age of 12th to 28th weeks. Linear measurements
parameters were used as standards like crown- rump length,
were taken with the help of vernier caliper, divider and compass.
biparietal diameter, head, chest and abdominal circumferences.
All the measurements were taken thrice and then average of them
In some studies fetal organs were also measured to see their
was taken.
gross development at various gestational ages. In this study the
fetal kidney were measured. These measurements can give us
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International Journal of Scientific and Research Publications, Volume 4, Issue 10, October 2014
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ISSN 2250-3153
The following morphological measurements were taken on
growth of kidney was observed from group B to C, thereby
kidney: (Fig: 1)
implying that there is a sudden spurt in the growth in these age
1)
Length (l): The length was measured from the superior
groups.
pole to inferior pole.
The percentage increase in length of left kidney from 11th to
2)
Breadth (b): The breadth was measured as the widest
30th week of gestation was 57.8% (23.7-9.93/23.7) and was seen
distance at the hilum.
to be more than right kidney 59.53%.
3)
Thickness (t): The thickness was measured at the region
Similarly, the total increase in the breadth of left kidney was
of maximum anterior and posterior diameter
7.5 mm and right kidney was7.04 mm. The percentage increase
in left kidney was 63.23% (11.86-4.36/11.86)and was seen to be
Means of various measurements of fetal kidney, for each
more than right kidney 59.7% (11.78-4.74/11.78).
group were taken. A graph was plotted with gestational age on x
The increase in thickness of left kidney was 7.35 mm and
axis and measurements of length, breadth and thickness in
right kidney was 7.78mm. The percentage increase in left kidney
millimeters on y axis.
was 63.30% (11.61-4.26/11.61)and was seen to be less than right
Statistic evaluation- Statistical analysis was carried out
kidney 64.4% (12.08-4.3/12.08).
using Statistical Package for Social Sciences (SPSSInc; Chicago,
IL, version 15.0 for windows).All quantitative variables were
estimated using measures of central location (mean, median) and
IV.
DISCUSSION
measures of dispersion (standard error and standard deviation)
Some of previous studies have been done from ultrasound
and the data were presented in form of figures and tables.
measurements. Only few studies have been conducted by direct
Correlation of each parameter with crown rump length was
measurements of the fetal kidney for the accurate estimation of
calculated using Pearson's correlation coefficient. Mann-
the gestational age.
Whitney U test was used to note sexual dimorphism. P value of
Few studies2-5are available in the literature regarding
<0.05 was considered significant.
dimensions of fetal kidney for comparison with the data of the
present study.
Previous study on morphometry of fetal suprarenal gland
III. OBSERVATIONS AND RESULT
was done by the same author so its morphometeric comparison
The following measurements were taken respectively for
was done with the kidney. It was found out that length of right
kidney:-
kidney was increasing at a faster pace than the right suprarenal
LENGTH- There was a constant and linear increase in the
length whereas the thickness of right kidney was > 2 times than
length of right and left kidney from >15 week to >30 weeks of
that of right suprarenal gland. Length and thickness of left kidney
gestation. The total increase in right kidney length in group D
are < 2 times that of suprarenal gland. Breadth of right and left
was 2.47 times than that observed in group A. The total increase
kidney was less than that of right suprarenal gland in all the age
in left kidney length in group D was 2.38 times than that
groups. There was a significant linear correlation of length,
observed in group A. It was observed that rate of increase in
breadth, thickness of both the glands. Peak growth of both the
length of kidney was more on right side.
glands was seen from group B-C.
The line graph plotted between the mean length of kidney
Damen et al2 calculated the length of suprarenal gland in
showed a sharp increase in length seen in group B-C. The line
relation to length of the kidney. A strong linear correlation
graph plotted overlapped on each other in group C-D, due to
between suprarenal and kidney length was found. According to
there similar growth pattern (Fig 2).
them length of suprarenal gland was on an average 27% of that
BREADTH- The total increase in right kidney breadth in
of kidney and this relation remained constant with increased
group D was 2.63 times than that observed in group A whereas
gestational age or kidney size but no study on correlation of
left kidney breadth in group D was 2.72 times than that observed
breadth and thickness was found.
in group A. However, the breadth of kidney was more on left
Vlajkovic et al3 found out found out that the period from 14th
side.
to 16th week of intrauterine life was the fastest period of kidney
The line graph plotted between the mean breadth of kidney
growth during fetal development. In our study peak growth of
showed a sharp increase in breadth seen in group B-C. The line
both the glands was seen from group B-C.
graph overlapped on each other in group C-D and B-C (Fig 3).
Jovevska et al4 measured the length, breadth, thickness and
THICKNESS- There was a constant increase in the
volume of 60 extracted kidney en bloc. The kidneys were
thickness of right kidney. However the increase was not uniform
analysed both anatomically and echotomographicaly; the authors
in various gestational age groups. The total increase in right
opined that the parameters of both kidneys have almost the same
kidney thickness in group D was 2.80 times than that observed in
value and also there is no significant difference between male
group A whereas in left kidney thickness in group D was 2.72
and female fetuses. According to them the mean length of the left
times than that observed in group A. It was observed that rate of
kidney was 2.036 cm and right 2.055cm. The width was 1.038cm
increase in thickness of kidney was more on right side.
and 1.045cm in both left and right kidneys respectively. The
As plotted in the line graph there is parallel increase of
volume of both the kidneys were 0.693 and 0.790 respectively.
thickness in group A-B. There is growth spurt seen in group B-C.
However mean values calculated by the authors from the fetuses
(Fig 4).
of 18-31 weeks with no division in different age groups.
From the above observations it is obvious that the growth of
In our study the length of kidney showed an increase of 9.4
kidney was seen to be proportional to gestational age. Maximum
mm from group A to 23.65 mm in group D. The increase in
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International Journal of Scientific and Research Publications, Volume 4, Issue 10, October 2014
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ISSN 2250-3153
length from group B to C was less in our study compared to other
[4]
VLAJKOVIC S,VASOVIC L,BJELAKOVIC MD,CUKURANOVIC R
studies. All the observed lengths in our study were less compared
(2006). Age Related Changes of Human Fetal Kidney Size. Cells tissues
organs 2006;182:193-200.
to other studies. However, sudden increase in length was noticed
[5]
KANSARIA JJ, PARULEKAR SV (2009). Normogram for Foetal Kidney
in group C which is in accordance with other studies, peak
Length. Bombay Hospital J 51, 155-62.
growth was observed from group B-C. The breadth of kidney in
[6]
COHEN HL,COOPER J,EISENBERG P et al (1991). Normal length of
the present study increased from 4.5 mm in group A to 11.82 mm
fetal
kidneys:sonographic
study
n
397
obstetric
patients.
Am
J
in group D. Thus an increase of 7.32mm was observed from
Roentgend(AJR) 157,545-8.
group A-D. The increase in breadth from group C to D was less
[7]
KONJE JC, ABRAMS KR (2002). Determination of gestational age after
24th week of gestation from foetal kidney length measurement. Ultrasound
(0.66) in the present study when compared to study done by
Obstet Gynecol 19, 592-7.
Kansaria et al (2.2mm)5.
[8]
KONUS OL, OZDEMIR A, AKKAYA A et al (1998). Normal liver, spleen
In the present study increase in thickness of 1.79 mm was
and kidney dimensions in neonates, infants and children: evaluation with
observed from group C-D. The thickness was less in our study
sonography. Am J Roentgenol 171, 1693-8.
when compared to study done by Kansaria et al. Values in the
present study are comparatively lower than the other studies6,7,8.
The difference in values could be because of difference in race,
AUTHORS
technique& observer's bias cannot be ruled out.
First Author - Khayati Sant Ram, MBBS,MD. Dept. of
Anatomy,Post Graduate institute of medical education and
research, Chandigarh, INDIA
V.
CONCLUSION
Second Author - Mahesh Sharma , MBBS,MD Dept. of
The present study established a significant and positive
Anatomy, Government Medical College& Hospital Chandigarh,
correlation between the length,breadth and thickness of kidney.
INDIA.
All the parameters were correlated to one another.Based on the
Third Author - Anshu Sharma, MBBS,MD Dept. of Anatomy,
present study the normal standarad of renal development is set
Government Medical College& Hospital, Chandigarh, INDIA
and pathological changes are possible to define.Morphological
Fourth Author - Kanchan kapoor, MSC,PHD Dept. of
characteristics of fetal kidney would give a clue to elucidate
Anatomy, Government Medical College& Hospital, Chandigarh,
pathogenesis of abnormal kidney.
INDIA
Fifth Author - Kunal Chawla, MBBS,MD Dept. of
INSTITUTION
RESPONSIBLE
FOR
RESEARCH
Anatomy,Post Graduate institute of medical education and
SUPPORT AND/OR FINANCIAL SUPPORT
research, Chandigarh, INDIA
Government Medical College& Hospital, Chandigarh
Sixth Author - Richa gupta, MBBS Dept. of Anatomy,Post
Graduate institute of medical education and research,
REFERENCES
Chandigarh, INDIA
[1]
TANK KC, SAIYAD SS , PANDYA AM , AKBARI VJ , DANGAR KP
Seventh Author - Daisy Sahni, Msc,PHD Dept. of
(2012). A study of histogenesis of human fetal kidney. Int J Biol Med Res.
Anatomy,Post Graduate institute of medical education and
2012; 3(1): 1315-1321.
research, Chandigarh, INDIA
[2]
ELIAS HAMD, STIGTER RH, WESTERS P, VISSER GHA (2004).
Growth and size charts of the fetal adrenal gland.2nd ed. Netherlands:
Correspondence Author - Khayati Sant Ram, Institution:
Budde Elinkwijk Nieuwegain;40-7.
Dept.: Dept of Anatomy, post graduate institute of medical
[3]
JOVEVSKA S, TOFOSKI G (2008). Comparsion Between Ultrasound
(US) and Macrodisection Measurements of Human Foetal Kidney. Sec Biol
education and research, chandigarh, india, City: Chandigarh
Med Sci 29, 337-44.
Country :India, E-mail: [email protected]
LENGTH
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International Journal of Scientific and Research Publications, Volume 4, Issue 10, October 2014
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ISSN 2250-3153
BREADTH
THICKNESS
FIGURE 1:-ANATOMICAL PARAMETERS MEASURED ON KIDNEY ON EACH SPECIMEN:-LENGTH (L), BREADTH
(B), THICKNESS (T)
FIGURE 2: INCREASE IN RIGHT AND LEFT LENGTHS OF KIDNEY IN DIFFERENT AGE GROUPS
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International Journal of Scientific and Research Publications, Volume 4, Issue 10, October 2014
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ISSN 2250-3153
FIGURE 3: INCREASE IN RIGHT AND LEFT KIDNEY BREADTH IN DIFFERENT AGE GROUPS
FIGURE 4: INCREASE IN RIGHT AND LEFT KIDNEY THICKNESS IN DIFFERENT AGE GROUPS
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