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266
Renal tract
Renal lengths related to body height
Body height
(cm)
Right kidney
mean ± SD (cm)
100–130 7.4 ± 0.55 7.9 ± 0.59
110–131 8.0 ± 0.66 8.4 ± 0.66
124–149 8.0 ± 0.70 8.4 ± 0.74
137–153 8.9 ± 0.62 9.1 ± 0.84
143–168 9.4 ± 0.59 9.6 ± 0.89
152–175 9.2 ± 0.70 9.9 ± 0.75
Length of the right kidney versus body weight
Weight (kg)
Mean ± SD (mm)
20 81 ± 8
30 87 ± 7
40 89 ± 6
50 83 ± 8
60 98 ± 7
Left kidney
mean ± SD (cm)
Length of the left kidney versus body weight
Weight (kg)
Mean ± SD (mm)
20 83 ± 8
30 86 ± 8
40 90 ± 8
50 93 ± 9
60 98 ± 9
Adapted from Dinkel et al. 1985, Rosenbaum et al. 1984, Konus et al. 1998.
Renal size (pediatric)
FURTHER READING
Dinkel E, Erkel M, Dittrich M, Peters H, Berres M, Schulte-
Wissermann H. Kidney size in childhood. Sonographical growth
charts for kidney length and volume. Pediatr Radiol. 1985;
15:38–43.
Konus OL, Ozdemir A, Akkaya A, Erbas G, Celik H, Isik S. Normal
liver, spleen, and kidney dimensions in neonates, infants, and
children: Evaluation with sonography. AJR Am J Roentgenol.
1998; 171:1693–1698.
Rosenbaum DM, Korngold E, Teele RL. Sonographic assessment of
renal length in normal children. AJR Am J Roentgenol. 1984;
142:467–469.
Safak AA, Simsek E, Bahcebasi T. Sonographic assessment of the
normal limits and percentile curves of liver, spleen, and kidney
dimensions in healthy school-aged children. J Ultrasound Med.
2005; 24:1359–1364.
267
Renal tract
268
Renal size (neonates and infants)
PREPARATION
None.
POSITION
Supine.
TRANSDUCER
5.0–8.0 MHz curvilinear transducer and 9.0 MHz linear transducer.
METHOD
Image the right kidney using the liver as an acoustic window. The left
kidney is usually more difcult to visualize. The left anterior oblique
45° or right decubitus position may help. Both kidneys must be imaged
in both longitudinal and transverse planes.
APPEARANCE
Accentuated corticomedullary differentiation is a normal nding in
neonates and infants (age 1 day–6 months). The medullary pyramids
are seen as low-reective triangles arranged in the circular fashion
around the central echogenic renal sinus, while the renal cortex has
higher reectivity.
MEASUREMENTS
Renal lengths in term newborn infants
Renal length Male
mean ± SD (mm)
Right kidney longitudinal 42.6 ± 3.2 41.5 ± 3.5
Right kidney anteroposterior 20.2 ± 1.8 19.6 ± 1.6
Left kidney longitudinal 44.0 ± 3.3 42.2 ± 3.4
Left kidney anteroposterior 21.5 ± 1.8 20.8 ± 1.7
Female mm
mean ± SD (mm)
Renal size (neonates and infants)
On the longitudinal image two measurements are obtained (between cursors).
269
The width is measured from a transverse image obtained through the renal hilum (between
cursors).
Renal tract
270
Renal lengths in preterm newborn infants according to weight
Kidney Gender Weight (g)
Renal length
(range in mm)
Right kidney
longitudinal
Right kidney
anteroposterior
Female ≤ 750
751–1000
1001–1250
1251–1500
1501–1750
1751–2000
2001–2250
2251–2500
≥ 2501
Male ≤ 750
751–1000
1001–1250
1251–1500
1501–1750
1751–2000
2001–2250
2251–2500
≥ 2501
Female ≤ 750
751–1000
1001–1250
1251–1500
1501–1750
1751–2000
2001–2250
2251–2500
≥ 2501
Male ≤ 750
751–1000
1001–1250
1251–1500
1501–1750
1751–2000
2001–2250
2251–2500
≥ 2501
23.7–41.0
25.2–40.5
28.2–45.8
28.4–44.2
32.2–43.4
32.3–49.3
35.2–48.1
35.3–48.1
37.3–47.9
23.0–37.3
25.0–39.7
28.5–41.0
25.4–48.4
31.0–49.7
30.8–50.2
33.0–56.0
36.0–51.0
38.7–54.5
11.1–17.1
10.8–19.1
11.9–21.7
12.8–25.6
13.9–24.8
13.4–22.4
15.0–24.1
15.2–23.1
13.7–23.7
9.7–16.2
9.7–22.0
10.3–20.7
9.5–22.4
12.0–19.4
13.0–23.1
13.9–25.5
13.3–24.4
14.9–30.5
Renal size (neonates and infants)
Renal lengths in preterm newborn infants according to weight
Renal length
Kidney Gender Weight (g)
Left kidney
longitudinal
Female ≤ 750
751–1000
1001–1250
1251–1500
1501–1750
1751–2000
2001–2250
2251–2500
≥ 2501
Male ≤ 750
751–1000
1001–1250
1251–1500
1501–1750
1751–2000
2001–2250
2251–250
≥ 2501
Left kidney
anteroposterior
Female ≤ 750
751–1000
1001–1250
1251–1500
1501–1750
1751–2000
2001–2250
2251–2500
≥ 2501
Male ≤ 750
751–1000
1001–1250
1251–1500
1501–1750
1751–2000
2001–2250
2251–2500
≥ 2501
(range in mm)
21.4–37.6
25.5–37.8
27.4–42.9
29.3–44.3
31.8–46.8
32.6–47.5
35.9–46.8
35.2–50.0
38.7–50.3
26.7–33.6
24.1–39.9
28.3–45.1
23.8–46.1
30.5–54.0
30.9–49.7
33.6–52.2
36.2–48.4
39.9–52.4
10.1–16.4
10.3–18.2
10.2–22.2
13.4–21.1
12.0–20.5
13.0–21.6
12.5–21.9
13.6–26.1
14.0–22.5
11.1–16.0
9.6–21.5
10.3–20.3
11.3–21.9
11.6–27.6
12.0–27.1
12.6–22.0
12.8–24.5
14.1–27.5
271
Renal tract
272
FURTHER READING
Erdemir A, Kahramaner Z, Arik B, Bilgili G, Tekin M,
Genc Y. Reference ranges of kidney dimensions in term
newborns: Sonographic measurements. Pediatr Radiol. 2014;
44:1388–1392.
Erdemir A, Kahramaner Z, Cicek E, Turkoglu E, Cosar H,
Sutcuoglu S, Ozer EA. Reference ranges for sonographic
renal dimensions in preterm infants. Pediatr Radiol. 2013;
43:1475–1484.
Haller JO, Berdon WE, Friedman AP. Increased renal cortical
echogenicity: A normal nding in neonates and infants.
Radiology. 1982; 142:173–174.
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Renal tract
274
Renal pelvic diameter (fetus and neonate)
PREPARATION
None.
POSITION
Prone.
TRANSDUCER
5.0–8.0 MHz curvilinear transducer.
METHOD
The maximum pelvic diameter is measured from transverse and longitudinal images.
APPEARANCE
The central reectivity from the renal sinus fat is less prominent than in
the adult, and the cortex is iso-reective to the normal liver. The medullary pyramids are larger and of lower reectivity, resulting in better
corticomedullary differentiation than in the adult. Normally, only a
small amount of uid is present in the renal pelvis; any dilatation of
the calyces is abnormal.
MEASUREMENTS
This remains a controversial area, and each institution will have its
own protocol. The following measurements are a guide.
Width and length of the renal pelvis in the fetus from 12–35 weeks of
gestation
Renal pelvis Male
mean ± SD (mm)
Right kidney width 3.61 ± 1.1 3.51 ± 0.8
Right kidney length 4.28 ± 1.1 4.17 ± 0.95
Left kidney width 3.58 ± 1.3 3.43 ± 0.7
Left kidney length 4.31 ± 1.0 4.33 ± 0.8
Female
mean ± SD (mm)
The maximum
renal pelvic
diameter is
measured from
transverse images
at the point where
the pelvis is at
the brim of renal
tissue.
Renal pelvic diameter (fetus and neonate)
275
The pelvic diameter measurements during antenatal imaging thought
to represent groups at risk for signicant renal abnormality are:
5 mm At 15–20 weeks
8 mm At 20–30 weeks
10 mm > 30 weeks
Infants with antenatal renal dilatation should have an ultrasound 1
week postnatal to evaluate for severe obstruction. In infants not requiring immediate intervention or surgery for severe obstruction, repeat
ultrasound and a voiding cystourethrogram is suggested at 6 weeks.
If at 6 weeks the renal pelvis is < 6 mm and there is no vesico-ureteric
reux, then no further investigation is needed. If the renal pelvis is
≥ 11mm, with caliectasis, further investigation is necessary. If the renal
pelvis is between 6 and 10 mm, then serial ultrasound examinations
are suggested until the renal pelvis appears normal (< 6 mm) or warrants further studies for obstruction (> 10 mm with caliectasis).