Age, kidney function, and risk factors associate differently with cortical and medullary volumes of the kidney

Xiangling Wang, Terri J Vrtiska, Ramesh T Avula, Leah R Walters, Harini A Chakkera, Walter K Kremers, Lilach O Lerman, Andrew D Rule, Xiangling Wang, Terri J Vrtiska, Ramesh T Avula, Leah R Walters, Harini A Chakkera, Walter K Kremers, Lilach O Lerman, Andrew D Rule

Abstract

The kidney atrophies in patients with advanced chronic kidney disease (CKD) but factors influencing kidney size in normal adults are less clear. To help define this, we measured kidney volumes on contrast-enhanced computed tomographic images from 1344 potential kidney donors (aged 18-75 years). Cortical volume per body surface area progressively declined in both genders with increased age. Statistically, this was primarily dependent on the age-related decline in glomerular filtration rate (GFR). Independent predictors of increased cortical volume per body surface area were male gender, increased GFR, increased 24-h urine albumin, current smoker, and decreased high-density lipid cholesterol. Medullary volume per body surface area increased with age in men, while it increased with age in women until the age of 50 years followed by a subsequent decline. Independent predictors of increased medullary volume per body surface area were older age, male gender, increased GFR, increased 24-h urine albumin, increased serum glucose, and decreased serum uric acid. Thus, while cortical volume declines with age along the same biological pathway as the age-related decline in GFR, albuminuria and some risk factors are actually associated with increased cortical or medullary volume among relatively healthy adults. Underlying hypertrophy or atrophy of different nephron regions may explain these findings.

Conflict of interest statement

DISCLOSURE

All the authors declared no financial disclosure or conflict of interests.

Figures

Figure 1
Figure 1
Age related changes in kidney volumes. (a) kidney cortical volume, (b) kidney cortical volume per BSA, (c) kidney medullary volume, (d) kidney medullary volume per BSA, (e) kidney parenchymal volume, and (f) kidney parenchymal volume per BSA by age (curves are smoother fit) in men (blue curve, cross) and women (red curve, closed circle).
Figure 2
Figure 2
Example of kidney cortex (yellow) and medulla (blue) segmentation using software ITK-SNAP in (a) and (b) a 3-dimensional view, (c) and (d) in a coronal view, (e) and (f) in a sagittal view, and (g) and (h) in a transversal view.

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