Clinical and radiological renal characteristics of patients with terminal uraemia.

Objective: To investigate, by means of ultrasonography and plain film radiography, the radiological appearance of the kidneys in patients with uraemia, and to study renal development during the time course preceding dialysis. Aetiology, clinical characteristics and long-term clinical outcome were also studied.

Material And Methods: Ultrasonography and plain film radiography of the kidneys, physical examination, laboratory tests, review of hospital files and interviews regarding risk factors were performed in 67 patients (median age 65.0 years) entering a dialysis programme. They were followed prospectively for 54-77 months. In a retrospective part of the study, old radiographs of the kidneys were compared with radiographs obtained at the start of dialysis.

Results: Chronic glomerulonephritis (CGN) and diabetic nephropathy (DN) were the leading causes of uraemia. Forty-two patients (63%) died during follow-up, mostly due to cardiovascular disease. Normal kidney size and echogenicity were common among DN patients, while the kidneys of CGN patients were generally small and hyperechoic. Mean renal length reduction was 23.6 mm in CGN patients and 18.9 mm in DN patients, during median times of 7.7 years and 5.0 years preceding dialysis, respectively. The most rapid renal length reduction was 27 mm in 1.5 years.

Conclusions: The study illustrates the changing aetiological spectrum and high mortality rate in patients with dialysis-treated uraemia. The ultrasonographic appearance of the kidneys in uraemia varies considerably, depending on the underlying disorder, but analysis of size and echogenicity are helpful in the evaluation of these patients. A rapid reduction in kidney size in renal failure patients is important to consider during radiological evaluation.