1975, British Journal of Radiology, 48, 993-995

DECEMBER

1975

Renal compensatory hypertrophy in the adult By R. S. Dossetor, F.R.C.R.* . X-Ray Department, Radcliffe Infirmary, Oxford (Received January, 1975)

cases included in the series had bladder tumours, and the development of ureteric obstruction led to loss of function of one kidney. Care was taken that the details of the repeat examination, such as the quantity and nature of the contrast medium used, the time the films were taken, and patient preparation, all corresponded with those of the initial examination. The relative magnification of the image of the kidneys on the films was assessed by comparison with the size of a vertebral body, and suitable correction was made where necessary, by the method of Fletcher and Leckv (1969).

ABSTRACT

Compensatory renal enlargement was assessed in 19 adult patients who either had a nephrectomy (17 cases) or developed a functionless kidney following obstruction (two cases). Hypertrophy of the healthy kidney was assessed by comparing renal size on urography before and after removal or destruction of the diseased kidney. Compensatory renal enlargement was demonstrated in 40 per cent of the patients, including two patients in their sixties. The average increase in length was 3 per cent and the maximum increase in length was 9 per cent. Therefore compensatory enlargement does occur in adult life, but is much less than that occurring in childhood. The presence of a hypertrophied adult kidney over 17 cm in length usually indicates that the contralateral renal disease was present in childhood.

It is known that considerable compensatory renal enlargement can occur in childhood (Laufer and Griscom, 1971) but its occurrence in adult life has been disputed (Marshall, 1963; Heidemann and Rosenbaum, 1970). The purpose of this study was to determine if compensatory renal enlargement occurs in adult life, and to compare the degree of hypertrophy in adults with that known to occur in childhood.

RESULTS

The results are shown in Table I. 40 per cent of the kidneys showed hypertrophy. The average increase in length was 3 per cent, the maximum being 9 per cent. These results were statistically significant (p< 0-01, Students t test). DISCUSSION

Sources of error

Klatte et al. (1972) reviewed the sources of error occurring in a study of this kind. The experimental error in measurement of renal length is approximately 5 mm (Klatte et al., 1972; Heidemann and Rosenbaum, 1970), physiological changes in kidney size may occur (Hodson, 1961), and kidneys may increase in size at the beginning of intravenous urography (Wolpert, 1965; Dorph and 0iggard, 1973). However, measurement of renal length alone is the best parameter of renal size in vivo (Klatte et al, 1972). As most of the removed kidneys in this series were diseased they cannot all be regarded as having full or indeed equivalent function. Further, intravenous pyelography may not accurately reflect selective renal function. Ellis, Klahr and Bricker (1964) found severe errors of this type.

MATERIALS AND METHODS

Twenty-one patients who had had nephrectomy or complete destruction of one kidney were collected. All the patients had had an initial intravenous urogram showing good urinary concentration of contrast material, with at least half of the renal parenchyma appearing normal. All had follow-up intravenous urograms, and two of the patients were eliminated from the series because their second intravenous urogram did not adequately show the renal outlines. Of the remaining 19 patients, 14 had a nephrectomy for a neoplasm and three had a nephrectomy for a non-neoplastic disease. One of these latter patients had a hydronephrosis, and another a mass which on histology proved to be a small renal cyst. The third patient had a nephrectomy for a pyonephrosis. On review of this patient's initial urogram, which was reported as normal, a small non-obstructing calculus was seen in the pelvis of the kidney which was later resected. Two further *Present address: X-ray Department, The Royal Sussex County Hospital, Eastern Road, Brighton, Sussex.

Compensatory renal enlargement in adults The occurrence and degree of compensatory renal hypertrophy in adults has been disputed. Marshall (1963) stated that significant hypertrophy did not occur over the age of 30, and Heidemann and Rosenbaum (1970) came to a similar conclusion in their

993

VOL.

48, No. 576 R. S. Dossetor TABLE I 19 PATIENTS WITH GOOD FUNCTION IN THE DISEASED KIDNEY

Name

Sex

Age at nephrectomy

First renal length

G.H. A.L. S.B. M.T. E.M. D.D. R.C. C.B. R.M. P.B. D.C. K.S. W.B. S.B. *M.J. R.C.

F M M F M M M F M F F M M M M M

59 56 35 46 44 39 55 67 50 49 33 58 59 71 60 40

131

fM.M. tJ.H.

M M

§G.C.

F

Mean SEM P

13-8 130

13-8 13-2 13-8 140

13-5 15-2 12-6 13-3 141

14-3 11-7

Length increase mm

Time interval between nephrectomy Hypertrophy and second IVU (10/

0 8 7 -6 11 4 6 7 8 4 4-5 -4

V /o

6% 5% -4% 9% 3% 4%

CO/ J /o CO/ -> 0/ /o •3 J /O TO/ J-3

0/ /O

-0-5

-0-5

Diagnosis

7 months 8 years 5 years 6 years 8 years 3 months 2 years 5 years 3 years 11 months 2 years 4 months 3 years 3 years

Neoplasm kidney Neoplasm kidney Neoplasm kidney Neoplasm kidney Neoplasm kidney Neoplasm kidney Neoplasm kidney Neoplasm kidney Neoplasm kidney Neoplasm kidney Neoplasm kidney Neoplasm kidney Neoplasm kidney Neoplasm kidney

-1% 1%

14-3

-1 1 4

TO/ •^ /O

2 years

47 63

13-5 15-2

11 9

Hydronephrosis due to anomalous vessels

8% 6%

1 month

20

13-8

13

9%

15 months

Small cyst of kidney Stone and pyonephrosis

50 3-0

13-8

+ 4-5

+ 3-3% 0-9%

Renal compensatory hypertrophy in the adult.

Compensatory renal enlargement was assessed in 19 adult patients who either had a nephrectomy (17 cases) or developed a functionless kidney following ...
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