Evaluation of the accuracy of renal depth estimation formulas in horseshoe kidney

Abstract

Estimation formulas are usually used to calculate renal depth when glomerular filtration rate (GFR) is measured by the Gates method. Horseshoe kidney (HSK) anatomical structure is different from the normal form of the kidney. The existing formulas are based on the normal form. It is unknown whether the existing formulas are valid in HSK patients. This study was performed to estimate the accuracy of the existing 6 renal depth estimation formulas in HSK.Renal depth and total thickness (T, cm) of the body at the level of the kidneys were measured by CT in 94 HSK patients. Their sex, age, height (H, cm), and weight (W, kg) were recorded. The existing 6 estimation formulas were used to obtain estimated renal depth. Correlation coefficients, Bland-Altman analysis, and paired t test were performed between estimated and the CT measured renal depth.Estimated renal depths were all lower than the CT measured renal depths and there was significant difference between estimated and CT measured renal depth. The CT measured renal depth and estimated renal depth derived from Ma GY formula correlated best (right: r = 0.80, P < .01; left: r = 0.77, P < .01). The renal depth derived from Tonnesen formula was significantly lower than the CT measured renal depth. The agreement between the estimated renal depth derived from Tonnesen formula and the CT measured renal depth was the worst, with the mean difference of (right: −3.11 ± 1.13 cm; left: −2.79 ± 1.07 cm). The agreement between the estimated renal depth derived from Li Q formula and Ma GY formula and the CT measured renal depth was the best, with the mean difference of right: −1.68 ± 1.09 cm; left: −1.32 ± 1.06 cm and right: −1.59 ± 1.01 cm; left: −1.59 ± 0.99 cm, respectively. But the greatest error of the difference between Li Q formula and Ma GY formula estimated depth and the CT measured depth was up to −4.83 cm, and the estimated deviation is unacceptable.All the existing formulas do not fully apply to HSK. To provide reliable and accurate estimates of renal depth, we should develop a new formula to estimate the renal depth in HSK patients.

Establish new formulas for the calculation of renal and isthmus depth in horseshoe kidney

“…From Table 2 we can find that formulas 1 to 6 tended to underestimate renal depth for both kidneys, this result is consistent with a previous study. [4] Formula 2 results are significantly lower than CT measured renal depth, underestimated about −2.67 cm. Although there was a strong and significant correlation between the estimated renal depth from formulas 1 and 3 to 6 and CT measured renal depth, the mean difference deviation is more than −1.22 cm which was unacceptable.…”

“…1A). [4] The total thickness ( T , cm) of the body at the level of the kidneys was also measured by CT (Fig. 1A).…”

“…1A). [4] The posterior part of the isthmus is composed of soft tissue and vertebral body. Because the attenuation coefficients of soft tissue and vertebral body to gamma rays are different, we need to obtain the depth of isthmus soft tissue and vertebral body thickness, respectively.…”

“…Most horseshoe kidney (HSK) patients have abnormal kidney rotation and fusion of the kidneys at the lower poles to form an isthmus, and its anatomical structure is different from the normal form. [4] The existing 6 formulas [1,5–9] are based on the normal form of the kidney. All the existing renal depth estimation formulas do not apply to HSK.…”

“…All the existing renal depth estimation formulas do not apply to HSK. [4] At present, there is no formula for estimating renal depth in patients with HSK. In addition, there is no estimation formula for isthmus depth.…”