Vo l. XI[ , No. 1, 1977

,

-Abstract-

t

Radiologic Evaluation of the Size of Normal Kidney as Related

to Vertebral Height and its Movability in Korean Adults

C. K. Eun, M. D. , S. W. Lee, M. D. , K. S. Kim, M. D. and S. S. Park, M. D.

Department 01 Radiology, Sacret -H eart Hospital . School 01 Medicine , Chung- Ang University .

The kidney size and its movability on the change of position from supine to erect by radiogra-

phic measurement provide an important valu e in the di agnosis and t reatment of t he renal disease.

The lengh of the kidney, the rat io between the kidn ey leng th and t he total heigh t of the upper three lumbar vertebrae including intervertebral disc, the movable range of kidney in change of position from recumbent to erect and the distance from the left hilum fo th e right hilum were

measured on intravenous pyelograms of 87 males and 97 females of th e age of 20 to 59 years.

The following results were obtained :

l. The radiographic measurement of k.idney size and its movable ra nge :

right kidney left kidney sex 1 age 1-. .,---- - 1--- ---,- ----1 hilum (cm)

Ilength (cm) 1 M (cm) I K (ratio) 11ength (cm) 1 M (cm) 1 K (ra t i

mle / 20-59 /12. 4:tO. 761 2. 8:t l . 57 [ 1. 08:t0. 07 [ 12. 7:t0. 84 I 2. 7:t l. 46 | 1. 3:t l. 37 female [20-59 [ 12 98 [ 3. 5:t 1. 52 1 1. 13:t0. 10 1 12. 4:t0. 97 [ 3. O:t 1.45 11 0.10 1 1 l :t l .24

(M: The mean of th e movable range of kidney in change of posi tion from supine to erect) ( K: The ratio between the lengt h of kidney and the total height of the upper three lumbar

vertebrae including disc)

2. The size of kidney in male and the right kidney was smaller than in female and the left one, and mean difference was 0. 3-0.4 cm.

But the right kidney was larger in 25% of the cases than the left one.

3. The length of kidney was larger in 90% of the cases than th e total height of t he upper three

lumbar vertebrae including disc.

4. The motion range of kidney in the change of position from supine to erect was 0-8.2 cm and

the moving distance of the kidney in the right side and female was a little greater than that in

the left kidney and male.

5 ln 3% of the cases the kidnev moved more than 6 cm in chang~ Qf posit ion from supine to

- 70-

erect.

6. The right hilu~ was usually lower in position than the left one.

However, in 24 cases (13%) the right hilum was observed to be hgh er than the left one.

1.

X

Meschan ll , Simon2l , MolPl Hodson' l

Allen'l , Pa ul Juhl6l

.

T eplck Haskin7J Ockerblad8l

.

x -

183

~

1 3 Jl..

.3'-

n .

uman Dock"

20 59

87 96 183

.

m.

x - 40 inches

l

-

l Jl.. 3

- 71-

(D

@ l 3

.

l 3

.

@ (i lac crest)

.

@ Jacobson .

(D,@,@ @

(Fig. 1)

lY.

20~59 87 96

] -

Fig. 1. A schematic drawing of both kidneys and the lumber veatebrae demenstra-ting the met hod of measu rement of renal axis diameter, vertebral height, renal motion range and determination of hilum loc/!.tion

l 3

1)

Ta b le 1

12. 4::!:: 0. 76 cm,

12.0.:1::. O. 98 cm, 12. 7::!::0. 84 cm,

12. 4::!::0. 97 cm

0.3 cm , 0. 4 cm

0. 4 cm 03 cm

(Table 1) .

2)

60 (69%) , 69 (72%)

129 (70% )

5 (6%) , 3 (3%) 8 (4%)

22 (25%) , 24

(25%) 46 (25%) i (Tab le 3)

3) 1

3

l

3 Tab le 1

1. 08::!::0. 07, 1. 12::!::0. 08

1. 13::!::0. 10, 1 16::!::0. 1 0

(Tab l e 1)

- 1 3

11% , 4.6% , 5.2% ,

4. 2% , 9% , 4%

(Table 4)

4)

Table 2

2. 8::!:: 15. 7 cm , 2. 7::!:: 1. 46 cm

3. 5::!::1. 52 cm, 3. 0::!:: 1. 45 cm

(Tab le 2).

T a ble 5

6cm 2% ,

3% , 3% , 3%

3% 6cm

(Table

5)

5)

1. 3::!::1. 37 cm, 1. 1::!:: 1.24cm

(Tabl e 2)

.t'..

79% , 75% , 77% 7%

12.5% 10%

14% , 12. 5% ,

13% (Table 6)

y.

1 9)

.

Sim on ') l 100

9.4~13 7 cm ::L

1l .7 cm 10%

40%

Billi ng"l 100 99 1l ~13 cm

l 14 cm

Anderson lll 13

56cm 13 63cm - Paul

Juhl6l 12~ 1 2. 7 cm

3~5 mm 1.5 cm

12 ) 100

12. 49 cm, 12.77 cm ,

- 7 2 -

Table 1. The length of kidney and the rato of kidney length and theupper three lumbar vertebral including disc spaces

Rt Lt Age Sex 1 U . Ul I

Kidney length *Ratio Kidney length *Ratio (cm) (cm)

20-29 M 16 11. 9::!::0. 65 1. 04::!::0. 21 12. 3::!::0. 82 1 08::!::0.06 F 20 12. 1::!::0. 87 1. 14::!::0. 08 12. 5::!::0. 88 1. 16::!::0. 10

30-39 M 33 12. 4::!::0. 76 1. 09::!::0. 09 12. 6::!::0. 56 1. 11 ::!::O. 08 F 36 12. 4::!::0. 81 1. 15::!::0. 10 12. 7::!::0. 99 1. 18::!::0. 10

40-49 M 29 12. 5::!::0. 74 1. 09::!::0. 06 13. 1::!::1. 01 1. 14::!::0. 07 F 25 11. 9::!:: 1. 05 1. 12::!::0. 10 12. 3::!:: 1. 07 1. 14::!::0. 08

50-59 M 9 12. 4::!::0. 79 1. 08::!::0 . 08 llf22. 90 59 1. 13::!::0. 07 F 15 11. 8::!:: 1. 11 1. 1l ::!::0. 09 . 4::!::0. 84 1. 17 ::!::O. 09

Average M 87 12. 4::!::0. 76 1. 08::!::0. 07 12. 7::!::0. 84 1. 12::!::0. 08 F 96 12. O::!::O. 98 1. 13::!::0. 10 12. 4::!::0. 97 1. 16::!::0. 10

*Ratio: The rat io of the length of kidney and the total height of the upper three lumba vertebral in-c1uding disc spaces.

Table 2. The distance of movement of the kidney on the change of position from

recumbent to erect and the difference of height of both hi li

20-29 M 16 3. 5::!::1. 43 3. 3::!:: 1. 63 1. 6::!:: 1. 16 F 20 3. 8::!::1. 56 3. 3::!:: 1. 83 1. 5::!::0. 98

30-39 M 33 2.6::!:: 1. 62 2.8::!:: 1. 51 1. 2::!:: 1. 35 F 36 3. 4::!:: 1. 43 2. 8::!:: 1. 37 1. 31. 47

40-49 M 29 2. 8::!:: 1. 63 2. 7::!:: 1. 26 1. 1::!:: 1. 58 F 25 3 . 4::!:: 1. 72 3. 2::!:: 1. 41 o. 7::!::0. 93 50-59 M 9 2. 2::!::1. 94 2. 6::!:: 1. 44 1. 2::!:: 1. 37 F 15 3.7::!:: 1. 35 3. 0.:t1.l7 0.9.:t1. 36

Average 87 2.8::tl .57 2.7 .:t1. 46 1. 3::t1. 37 96 3. 5::t1. 52 3. O::!:: l. 45 1. 1::!:: 1. 21

Table 3. Comparision of the lengths of both kidneys

sTe I I;= No. of cases 1-- --1-_-

INo.ofl INo. ofl 0/ INo. ofl 0 Comparision I cases 1 ;/0 1 cases 1 70 1 cases I 70

Left > Right

Left=Right

Left < Right

60 69 69 72 129 71

5 6 3 3 8 4

22 25 24 25 46 25

12. 33 cm , 12.63 cm

1:':) 315

11.93 cm , 0] 12.63 cm

1 ) 250 - 1

7 3

.J!...

Hodson') 1000

7]. 1 cm

0.5 cm

- Meschan ll -Hodson4l

4-15

0.35 cm 5cm

Wald") 35

32 2-3

.

Dorph lG ) 76% Urografin

8%

5% Urea

14% Hypaque

Mannitol

Moll Hodson3 ') X

X

l 20%

Table 4. Comparision of the lengths of both kidneys with the height of the upper three lumbar vertebrae

Se | ale Fema le T otal Side

----- - -sl - Rt l Lt l_J_ ~:. __ l_L_L~ No. of /-Comparision cases Renal length> No. of cases 72 82 88 92 160 174

L 1. 2&3 % 83 94 92 96 87 95.5

Renaal =Ll 2&3 No. of cases 5 l 3 0 8 l length % 6 3 0 4 0. 5

Renal Ll. 2&3 No. of cases 10 4 5 4 15 8 length % 11 5 5 4 9 4

--------_.

Table 5. The motion range of b :J th kidneys on the change of position from recumbent to erect

-x No ses _t I ~l-~e-=-jL!:~t ____ 1 L Male 87 7 4 13 7 65 73 9 7 2 3 o. 2~6.4cm (8%) (5%) (1 5%) (8%) (75%) (64%) (10%) (8%) (2% ) (3 %) 0~6. 9cm

Female 96 2 10 3 68 82 18 11 3 3 o. 3~6 . 4cm o~ 8. 2cm (2% ) (1%) (10%) (3%) (71%) (85%) (19%) (1 2%) (3%) (3%)

Table 6. Comparision of the height of both hili

Sexl _'- I Male / Female / Total No. of ~ \....lU Q. H ... I

@mParision csllL Left> Right

Left=Right

Left < Right

69 79 72 75 141 77

6 7 12 12.5 18 10

12 14 12 12.5 24 13

Batson17)

10%. 30%

10) l) 15

% 18. 6% 25%

4

% .

l 3

]i.

Simon2 ) 100

2 3. 7

::tO.37 95% 3. 0~4. 4

2 3. 1. ::t0. 77 2. 6~3. 6 . Currarino18)

1~ 4 ];!..

. Batson l 7) 200

' l 3

1.06. 1.08.

1.09. 1. 11 97.3%

l 3 l

4 ( )

.

1

3

9%. 4%

l

3

.

(peicle )

(Adipose sheath )

:; 1 9).

1 u1

l

- 74-

(emaciation) ,

(cystocele) 5 7 8 19)

Dietle

7.8)

Waldner 20 ) . Ji!.

7) x-

Meschanll

l 5cm l 3cm . Paul Juhl6 )

2~3cm

1

Smith'll 2.5 cm

111 BlackZZl

1 . Allen5)

0.1~6. 5 cm

SmithZ3l 4~5cm

l . 0 8.2 cm

2. 7~3. 5 cm

6cm 3%

.

6cm .

.J:!. 1

Paul Juhl 6 )

2cm BlackZ2l 1. 25~2. 5cm

1. 1~1. 3 cm

. ]:1-

Meschanll 15% HelmZl) 25%

McClellanZOl 7%

. Edsman2G )

2 0.2 umniit (llunmIn

+ l O. 5

unit 13%

.

Vl.

1 3

l

87 , 96 183

.

1. 12. 4:::tO. 76 cm, 12. 7:::tO. 84 cm 12. O:::tO. 98 cm, 12. 4:::tO. 97 cm

2.

O. 3~O. 4cm

. 25%

Ji!. .

3. 90% l

3 111

1. 08~1. 16 .

4

2. 8:::t l. 57 cm , 2. 7:::t1. 46 cm 3. 5:::t l. 52 cm, 3. O:::t l. 45 cm ~

5

O~8. 2cm 2. 7~3. 5

cm 6cm 3%

6cm

.

6

1. 3:::t l. 37cm, l l :::t l. 24 cm . 24(13%)

REFERENCES

1. Meschan, 1.: Normal kidney size and posz"t i9n. Analysis of roentgen signs tn general radiology.

- 75-

W. B. Saunder. Philadelphia. Londo . Toronto.

3 rd editio 1342- 1313, 1973. 2. Simon, A.: Normal renal size: An absolute

criterion. Am. J. Roetgenol. 92:270, 1964.

3. MO Il, H. : Size of normal kideys. Acta Radiol.

46 :640, 1956. 4. Hodson, C.].: Physiological changes size of

th r. human kidney. Clin. Radiol. 12:91- 94, 1961.

5. "Allen, A. C. : Aatomy fixation of kidey and nephrotosis. The kidey. Grue & Stratto.

New York. 2d edition , 19-22, 1962. 6. Paul, L. W and ]uhl, ]. H. : Roentge anatomy

of kidney. The essentials of roentgen i. t erpreta

tion. Harper & Row, Publishers. Hagerstow

Maryland New York. Evaston . San Fransco.

Londo 3rd editio 650 & 660, 1972

7. Teplick , ]. G. and Haskin, M E.: Nephroptosis. Roetgenologic diagnosis. W. B. Saunders com -

pay . Philadelphia. Lodon. Toronto, 3rd edi-tion. 863, 1976.

8. Ockerblad, N. F . : Kidey ptosis. Urology in

9 l 5 1 ~53 1973

14 1 : E lj r!.i.

l tl:.: 10 2

265~269 1974

15. Wald, H. : The weight of normal adult kidneys and its variability. Arch. Path. 23:493, 1937.

16. Dorph. S. , and igaard, A.: Variation in size of the normal kidney following intravenous

admi:istratio of water soluble contrast medium

and urea. British Journal of RadiOlogY. 46:183-

186, 1973. 17. Batson , P. G. , and Keats, T. E.: Roentge0-

graPhic determinatio of normal adlllt kidey

size as related to vertebral hei"ght. Am.]. Ro-

etgenol. Radium. Ther. Mcl. Med. 116:737,

1972.

18. Currar ino, G. : Roetgenologic estimation of kid ey size i: normal individuals with emphasis in

ormal children. Am. J. Roentgenol. Radi:m

Ther. Nucl {ed. 93:464, 1965. 19. MOll, H.: The position 01 the kidneys . Acta.

Radiol. (diagnosis). 1:22- 28, 1963.

generai practice. The year book publishers. 1nc. 20. Wardner, H. E. : Movab le kidney. The kidney.

Chicago. 2 nd edition, 97- 103, 1947. 9. Hodson , C. ]. , Drew; ] . A. , Karn , M. N. , and

King, A Real size in ormal children. Arch. Dis. Child. 37:616-622, 1962.

10. Billing, L.: Roentge diagnosis of polycystic kidney. Acta. Radio!. 41 :306, 1954.

11. Anderson , M.]. F. , and Mogensen , C. 1.: Re-

lationshz between size and function in normal

subjects. Acta. Radiol. (diagosis). 14:209-213 ,

1973.

12. . A j x-!J f.Jc

Vol 9. 307, 1965.

13. A A 'J'J 't~~

n x -~~;~ 4t

Little & Brown company. Boston. 3 rd edition, 375, 1957.

21 . Smith , P. G. , McKim , G. F. , and Rush , T. W. :

Cited by Black 13l .

22. Black, D. A. K.: The anatomy of the Itume

kidneys. Renal disease. Blackwell Scientific

publicatios. Oxford. 3 rd editi1. 3, 1964. 23. Smit h, D. R.: Anatomy of kidneys. General

urology. LANGE Medical publications. Los

Altos. California , 8 th edition. 1, 1975. 24 . Helm, F.: Cited by Moll 19 l

25. McClellan, R. : A 10 Iying left kidney. j. Urol. 75:198, 1956

26. Edsman , G.: Cited b;; Moll lO l ,

- 76 -