Soliter Böbrek ile Normal Böbreğin BT görüntüleri üzerinde morfolojik karşılaştırılması

Yıl 2014, Cilt: 2 Sayı: 2, 63 - 68, 16.11.2015

Veli Çağlar Ömer Kurt Ramazan Uygur Ümit Şener Ömer Özçağlayan Zeynettin Kasırga Berrin Tuğtağ

Öz

ÖZET
Amaç: Çalışmamız soliter böbrek ile sağlıklı iki böbreğe sahip bireylerde böbrek boyut ölçümleri ve stereolojik yöntemle böbrek hacim hesaplamasının yapılması ve iki grup arasındaki morfolojik farklılıkların belirlenmesi amaçlandı. Gereç ve Yöntem: Herhangi bir şikayet ile Namık Kemal Üniversitesi Araştırma ve Uygulama Merkezine başvurup, kontrast madde verilerek abdominal bilgisayarlı tomografisi (BT) çekilen hastalar çalışmaya dahil edildi. Hacim ölçümleri BT görüntüleri üzerinde Cavalieri prensibi ile yapıldı. Bulgular: Çalışmamıza katılan bireylerin 22’si soliter böbrek, 30’u sağlıklı iki böbreğe sahiptir. Normal grup için böbrek hacim ortalaması 159 cm3, böbrek uzunluğu 10.7 cm, genişliği 6.6 cm ve kalınlığı 5 cm olarak bulundu. Soliter böbrek grubunda ise, böbrek hacmi 274 cm3, uzunluğu 12 cm, genişliği 7 cm ve kalınlığı 6 cm bulundu. Sonuç: Soliter böbrek, normal böbreğe göre daha uzun, daha geniş, daha kalın ve hacimsel olarak da daha büyük olma eğilimindedir. Çalışmamızda soliter böbrek ile sağlıklı iki böbreğe sahip bireyler arasında, böbrek boyut ve hacim ölçümleri ile ilgili morfolojik farklılıklar ortaya konulmuştur. Elde edilen bu bulgular bazı böbrek hastalıklarının klinik tanı ve tedavisinde böbrek boyut ve hacminin doğru olarak değerlendirilmesi açısından literatüre katkıda bulunacağı düşüncesindeyiz.
Anahtar kelimeler: Böbrek hacmi, böbrek uzunluğu, BT, Cavalieri prensibi
 
ABSTRACT
Objective: This study was undertaken to compare the morphological differences between individuals with one functioning kidney and individuals with two functioning kidneys through the measurement of dimensions and stereological renal volume estimations.
Materials and Methods: The target sample consisted of patients who underwent an abdominal CT examination after attending Namık Kemal University’s Clinical Research and Application Center seeking medical attention. The volumetric estimations of CT images were based on the Cavalieri Principle.
Results: Of the overall study population, 22 had one healthy kidney and 30 had two healthy kidneys. Average renal dimensions were volume 159 cm3, length 10.7 cm, width 6.6 cm, and thickness 5 cm among anatomically normal individuals. The corresponding figures in the sole-functioning kidney group were volume 274 cm3, length 12 cm, width 7 cm, and thickness 6 cm.
Conclusions: Sole-functioning kidneys were longer, thicker, wider, and more voluminous compared with normal kidneys. We believe that the morphological differences between solitary and normal kidneys observed in this study in terms of dimensions and volume may represent a contribution to the existing literature that may assist in accurate volume and dimension estimations for clinical diagnosis and treatment of renal conditions.

Key words: Kidney volume, kidney length, CT, Cavalieri Principle

Anahtar Kelimeler

Böbrek hacmi, böbrek uzunluğu, BT, Cavalieri prensibi

Kaynakça

• Barker DJ, Bull A R, Osmond C, Simmonds SJ. Fetal and placental size and risk of hypertension in adult life. BMJ 1990; 301(6746): 259–62.
• Kiprov DD, Calvin RB, McLuskey RT. Focal and segmental associated with unilateral renal agenesis. Lab Invest 1982;46(3):275–81. and proteinuria
• Roodhooft AM, Birnholz JC, Holmes LB. Familial nature of congenital absence and severe dysgenesis of both kidneys. N Engl J Med 1984;310(21):1341–45.
• Tiuzikov IA, Grekov EA, Martov AG. Diseases of solitary kidney: the history and evolution of scientific issues. Urologiia. 2013;6(6):103-10.
• Luyckx VA, Brenner BM. The clinical importance of nephron mass. J Am Soc Nephrol. 2010;21(6):898- 910.
• Hwang HS, Yoon HE, Park JH, et al. Noninvasive and direct measures of kidney size in kidney donors. Am J Kidney Dis. 2011;58(2):266-71. 7. 7
• Giral M, Nguyen JM, Karam G, et al. Impact of
• graft mass on the clinical outcome of kidney
• transplants. J Am Soc Nephrol. 2005;16(1):261-8.
• Canan S, Sahin B, Odacı E ve ark. Toplam hacim, hacim yoğunluğu ve hesaplanmasında kullanılan bir stereolojik yöntem: cavalieri prensibi. Turkiye Klinikleri Tıp Bilimleri 2002;22(1):7–14. hacim oranlarının
• Caglar V, Songur A, Yagmurca M, et al. Age-related volumetric changes in pancreas: a stereological study on tomography. Surg
• 2012;34(10):935-41. Radiol Anat
• Muto NS, Kamishima T, Harris AA, et al. Renal cortical volume measured using automatic contouring software for computed tomography and its relationship with BMI, age and renal function. Eur J Radiol. 2011;78(1):151-6.
• Seyer-Hansen K, Gunderson HJG, Ostterby R. Stereology of the rat kidney during compensatory renal hypertrophy. Acta Path Microbiol Immunol Scand Sect A. 1985;93(1):9-12.
• Woolf AS. The single kidney. In Stringer MD, Oldham KT, Mouriquand PD eds, Pediatric Surgery and Urology: Long-Term Outcomes, Chapt. 54. Cambridge, UK: Cambridge University Press, 2006;675-82.
• Velosa JA, Offord KP, Schroeder DR. Effect of age, sex, and glomerular filtration rate on renal function outcome of living kidney donors. Transplantation 1995;60(12):1618–21.
• Zeier M, Dohler B, Opelz G, Ritz E. The effect of donor gender on graft survival. J Am Soc Nephrol 2002;13(10):2570–6.
• Mei-Zahav M, Korzets Z, Cohen I, et al. Ambulatory blood pressure monitoring in children with a solitary kidney – a comparison between unilateral renal agenesis and uninephrectomy. Blood Press Monit 2001;6(5):263–7.
• Wasilewska A, Zoch–Zwierz W, Jadeszko I, et al. Assessment of serum cystatin C in children with congenital 2006;21(5):688–93. Pediatr Nephrol 17. Heinonen PK. Gestational hypertension and preeclampsia associated with unilateral renal agenesis in women with uterine malformations. Eur J Obstet Gynecol Reprod Biol 2004;114(1):39–43.
• Duke V, Quinton R, Gordon I, Bouloux PM, Woolf AS. Proteinuria, hypertension and chronic renal failure in X–linked Kallmann’s syndrome, a defined genetic cause of solitary functioning kidney. Nephrol Dial Transplant 1998;13(8):1998–2003.
• Nyengaard JR, Bendtsen TF. Glomerular number and size in relation to age, kidney weight, and body surface in normal man. Anat Rec 1992;232(2):194-201.
• Tauchi H. Tsuboi K. Okutomi J. Age changes in the human kidney of the different races. Gerontologia 1971;17(2):87-97.
• Coresh J, Selvin E, Stevens LA, et al. Prevalence of chronic kidney disease in the United States. Jama 2007;298(17):2038–47.
• Rule AD, Amer H, Cornell LD, et al. The association between age and nephrosclerosis on renal biopsy among 2010;152(9):561-7. Ann Intern Med.
• Brenner BM, Garcia DL, Anderson S. Glomeruli and blood pressure. Less of one, more the other? Am J Hypertens. 1988;1(4):335-47.
• Keller G, Zimmer G, Mall G, Ritz E, Amann K. Nephron number in patients with primary hypertension. N Engl J Med. 2003;348(2):101-8.
• Erten S, Gungor O, Sen S, et al. Nephrosclerosis and carotid atherosclerosis: lessons from kidney donor histology. Nephrology (Carlton). 2011;16(8):720-4.