SONOGRAPHIC ASSESSMENT OF RENAL PARENCHYMAL AND MEDULLARY PYRAMID THICKNESSES AMONG HEALTHY CHILDREN IN SELECTED SCHOOLS IN ENUGU, NIGERIA

ABSTRACT: Renal parenchymal thickness (RPT) and renal medullary pyramid thickness (MPT) are important renal size parameters and there is no existing ultrasound normogram for RPT and MPT among children in our locality. Thus, this study was aimed at establishing normal values for RPT and MPT among children in Enugu metropolis; establishing the relationship between RPT and MPT with age, height, body weight, body mass index (BMI) and body surface area (BSA) among the subjects; establishing the relationship between RPT and MPT with Kidney length (KL) among the subjects, determining the normal values of renal medullary pyramid thickness to renal parenchymal thickness (MPT/RPT) ratio in children, and comparing the values of RPT and MPT obtained in this study with that from a previous study in Turkish population. The study was a prospective cross sectional study conducted in schools in Enugu metropolis in which 512 children who met the inclusion criteria were studied. Renal assessment was carried out using Chison digital ultrasound equipment, model 8100 with 3.5 and 5MHz transducer frequencies. The RPT and MPT were measured at the mid section of the kidney. The mean right and left RPT and MPT were (12.62 ± 1.67 and 7.10 ± 0.92)mm and (12.81 ± 1.7 and 7.23 ± 0.94) mm respectively. The right and left RPT correlated strongly with age, height, weight, and BSA but moderately with BMI. A moderate positive correlation was observed between MPT and age, height, weight and BSA. However, a weak correlation was observed between MPT and BMI. Thus, normograms of RPT and MPT in relation to age could be useful for the assessment of the kidneys in children.

 

TABLE OF CONTENT

CHAPTER ONE: INTRODUCTION

1.1 Background of the study-- - - - - - - 1

1.2 Statement of the problem. - - - - - - 4

1.3 Objectives of the study - - - - - - - 5

1.3.1 General objectives- - - - - - - 5

1.3.2 Specific objectives - - - - - - - 5

1.4 Significance of the study - - - - - - - 5

1.5 Scope of the study - - - - - - - 6

1.6 Research hypotheses- - - - - - - - 6

1.7 Operational definition of terms - - - - - - - 6

CHAPTER TWO: LITERATURE REVIEW

2.1.0 Theoretical background of the study - - - - - - 8

2.1.1 Embryonic development of the kidneys - - - - - 8

2.1.2 Gross anatomy of the kidneys - - - - - - - 9

2.1.3 Normal sonographic appearance of the kidney - - - - 11

2.2.0 Empirical literature review - - - - - - - 14

2.2.1 Renal size assessment by ultrasonography - - - - - 15

2.2.2 Relationship between parenchymal thickness and renal function - - 15

2.2.3 Relationship between parenchymal thickness and renal length- - 17

2.2.4 Relationship between renal size and age - - - - 17

2.2.5 Renal parameters variations -- - - - 17

2.2.6 Renal medullary pyramid thickness - -- - - - 19

2.3 Assessment of renal parenchymal and medullary thicknesses - - 19

CHAPTER THREE: RESEARCH METHODOLOGY

3.1 Research design - - - - - - - 21

3.2 Equipment - - - -- - - - 21

3.3 Study duration - - - - - - - - 21

3.4 Study population - - - -- - - - 21

3.5 Subjects recruitment- - - - - - - - 21

3.6 Sampling technique - -- - - - 21

3.7 Sample size - - - - - - - 22

3.8 Inclusion criteria - - - - -- - - 22

3.9 Exclusion criteria - - - - -- - - 22

3.10 Subject preparation - - - -- - - 22

3.11 Scanning technique - - - -- - - 22

3.12 Reliability of measurements (pilot study) - - - - 24

3.12 Informed consent/ethical clearance - - - - 25

3.13 Statistical analysis - - - - - - 25

CHAPTER FOUR: RESULTS

4.0 Results - - - - - - - - 26

CHAPTER FIVE: DISCUSSION AND CONCLUSION

5.1 Discussion - - - - - - - - - 52

5.2 Conclusion - - - - - - 57

5.3 Recommendations - - - - - - 58

5.4 Limitation of the study - - - - - - - 58

5.5 Areas for further studies - - - - - - - 59

References - - - - - - - - - 60

Appendices - - - - - - - 66