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Renal > Anat., embryology, imaging of kidneys > Flashcards

Anat., embryology, imaging of kidneys Flashcards

1
Q

What is the functional unit of the kidney and what does it do?

A

-nephron: accounts for major renal functions of solute excretion, fine tuning volume, electrolyte, and acid/base homeostasis, hormonal functions

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2
Q

How many nephrons in a kidney?

A

-1 million

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3
Q

Borders of the kidney

A

-superior pole -inferior pole -lateral border -medial border -help with localization

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4
Q

T/F: the kidney has a capsule

A

-true: fibrous capsule is present

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5
Q

3 main vessels entering/exiting renal hilum

A

-renal vein -renal artery -ureter

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6
Q

Kidney size and location

A

-avg 11 cm in length -right kidney is usually inferior to the left and little shorter, but fatter -prob due to liver squashing it -men >women

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7
Q

Chronic vs acute kidney disease

A

-chronic dz is irreversibe, while acute may be reversible -sxs may be similar, but imperative to distinguish the 2

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8
Q

Symptoms of kidney failure and function

A

-sxs of kidney failure often subtle until patients lose more than 90% of kidney function -not uncommon for pts to present with advanced kidney dysfunction

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9
Q

Name 1 trait that may help in distinguishing chronic from acute kidney disease

A

-kidney size! -chronically damaged kidneys are fibrosed (scarred) and often shrink

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10
Q

What do small kidneys indicate? what must one keep in mind?

A

-small kidneys almost always indicate chronic, irreversible kidney disease -normal size=acute -need to factor the person’s overall size in though–bigger people should have larger kidneys

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11
Q

General features of kidneys

A

2 reddish brown organs situated in posterior part of abdomen–retroperitoneal -surrounded by fascia and adipose tissue -cranial end is level with superior border of 12th thoracic vertebrae, caudal border with 3rd lumbar -long axis is directed laterally and posteriorly

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12
Q

Is there a unique connection in the L vs R kidney?

A

-Left renal vein also drains the testicular/ovarian vein

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13
Q

If one needs to bx the kidney, should they do so from the front or back?

A

-back! the front will perforate the large or small bowel or liver -the back only needs to go through the skin, fat, and 3 muscles (psoas, transversus abdominus, and quadratus lumborum) for middle/lower kidney

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14
Q

Diagram the 4 regions/overlaps of the kidney from posterior view

A

-recall superior portion connection with diaphragm means movement with respiration

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15
Q

Much of the posterial and lateral aspects of the kidneys are protected soley by muscle and fat…what does this clinically make them susceptible to?

A
  • blunt and penetrating injuries
  • for the same reason percutaneous procedures are approached from the back
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16
Q

Which part of the kidney is most useful to get bx of?

A

-cortex: outer 1.5-2 cm

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17
Q

What comprises the medullary rays?

A

-collecting tubules commence in the medullary rays of cortex

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18
Q

Pathway of collecting tubules

A
  • CT commence in medullar rays of cortex
  • unite at short intervals with one another and finally open into wider tubules called ducts of Bellini
  • these in turn open on the summit of the papilla
  • numerous fuct openings give the tip of the papilla a perforated (cribiform) appearance
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19
Q

Number of pyramids in a kidney and what separates them

A
  • 7-12
  • columns of Berton which act to anchor cortex and medulla
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20
Q

Describe the renal medulla

A
  • consists of pale, striated pyramids
  • based are directed towards the circumference of the kidney and apices towards the renal sinus
  • apex forms a papilla (nipple) which projects into the minor calices
  • minor calices drain into major calices which join to form the renal pelvis
  • pelvic ultimately trains via ureter to bladder
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21
Q

Pyramids and fuct of Bellini per pyramid

A
  • 6-14 pyramids per kidney
  • 20-60 ducts of Bellini per pyramid
22
Q

Staghorn Calculi

A

-radiological event seen when the collecting system are filled with (usually) struvite (infection stones) which form a cast of the collecting system which has a staghorn appearance

23
Q

Potential outcome of severe hydronephrosis

A
  • major and minor calyces have become grossly distended (with urine) due to obstruction at or below utero-pelvic function
  • this can compress the parenchyma (cortex) if chronic and severe
24
Q

Segmental arteries

A
  • first division of the renal artery: 1 posterior (posterior segmental arteries) and 4 anterior: (superior segmental, anterior superior segmental, anterior inferior, and inferior)
  • then can form interlobar arteries –> arcuate arteries –> interlobular arterioles
25
Q

Consequence and cause of segmental artery occlusion

A
  • if SA is occludes, that segment of the kidney will become infarcted and lose function
  • approx 20% of kidney tissue is lost
  • this can occur due to embolus (A. fib) or coil embolization of segmental artery (to stop a bleed)
26
Q

What 3 things serve as conduit for urine to travel from kidneys to environment

A
  • ureters, bladder, urethra
  • obstruction of outflow may impair renal function
27
Q

Ureter pathways

A
  • 25-30 cm
  • directly continuous near the lower end of the kidney with the tapering extremity of the renal pelvis
  • runs doward, medial, and infront of psoas major
  • abdominal portion lies behind peritoneum on medial part of psoas major
  • after entering pelvic cavity, it oens into fundus of bladder
28
Q

Structer of ureters

A
  • thick-walled narrow cylindrical tube
  • 3-4 mm diameter
  • composed of 3 coats: fibrous, muscular (circ and longitudinal), mucous
29
Q

Ureters in the bladder

A
  • run obliquely for ~2 cm through wall of bladder
  • open by slit-like apertures into cavity of the viscus at the lateral angles of the trigone
30
Q

Clinical utility of ureter path through the bladder

A
  • owing to their oblique course, the upper and lower walls of terminal portions of the ureters become closely applied to each other when the viscus is distended
  • act as valves to prevent regurg of urine from the bladder
  • also close off during bladder contraction to prevent reflux up ureters
  • when impaired, reflux nephropathy may develop
31
Q

Intrinsic factors of ureter obstruction

A
  • kidney stones: < 5mm usually pass spontaneously
  • > 5 mm often need an intervention to relieve obstruction
  • tumors and blood clots can also do this
32
Q

Extrinsic obstruction of ureters

A
  • adjacent malignancies: LNs, cervical cancer
  • often in pts with retroperitoneal fibrosis
  • surgical damage on accident (stented in high risk operations)
  • iliac aneurysm
  • bladder disease
  • congenita anomalies along course of ureters
33
Q

Bladder

A
  • musculomembranous sac which acts as reservoid for urine (detrusor muscle)
  • size, position, and relations vary on amt of fluid it contains
34
Q

Adjacent structures to bladder in men vs women

A
  • men: anterior is pubic symphysis, under is prostate/seminal vesicles, behind is colon
  • women: uterus, cervix, vagina behind it and colon behind all of this
35
Q

Male vs female urethra

A
  • male: longer (17.5-20 cm) divided into 3 portions (prostatic, membranous, cavernous)
  • female: shorter (4 cm), behind pubic symphysis, imbedded in anterior wall of vagina
36
Q

Kidneys arise mainly from the ___________.

A

-intermediate mesoderm

37
Q

The intermediate mesoderm differentiates to form the _______.

A

-nephrogenic cord

38
Q

Nephrogenic cord and 3 pairs of excretory organs

A
  • temporal and craniocaudal sequence
  • pronephroi “primitive kidneys”
  • mesonephroi: Middle kidneys
  • Metanephroi: permanent kidneys
39
Q

Timing of the 3 stages of morphogenic develop ment

A
  • pronephros: 3rd weeks, regressed by week 5; non functional
  • mesonephic kidney: 3-4th week to 12 wk; caudal to pronephros; consists of excretory tubules that contact a blood vessel medially and enter mesonephric (wolffian) duct laterally; completely regresses in women; becomes part of male reproductive system
  • metanephros: begin week 5 and gives rise to permanent kidney; ceased by wk 36 but nephrogenesis continues for some weeks after premature birth. Metanephic development continues after nephogenesis and grows, differentiates, and remodels kidney tissue yet does not add any more nephrons
40
Q

Does nephrogensis in premature infants continue as normal?

A

-it should end by week 36, so in premies it may continue weeks after they are born, however a full complement of nephrons is NOT achieved

41
Q

What does the metanephros arise from?

A
  • induction of mesenchymal nephrogenic blastema by the ureteric bud
  • ureteric bud induces nephron formation
  • dichotamous brnaching determines the arborization of the collecting system
42
Q

Ureteric branching morphogenesis

A
  • metanephric mesenchyma (blastema) secretes GFs that induce growth of ureteric bud from caudal portion of mesonephric duct
  • ureteric bud proliferates and responds by secreting GFs that stimulate proliferation and then diff. of metanephric blastema into glomeruli and tubules (M-E transition)
  • subsequent dichotomous branching events give rise to ureteric tree, with mesenchymal cells induced to condense and form cap mesenchyme at ureteric tips
43
Q

5 derivatives of ureteric bud

A
  • ureters
  • minor calyces
  • major calyces
  • collecting tubules
  • collecting ducts
44
Q

Duplication of the urinary tract occurs when…

A
  • ureteric bud prematurely divides before penetrating the metanephric blastema
  • results in either: double kidney and/or duplicated ureter and renal pelvis
45
Q

7 derivates of metanephric blastema

A
  • podocytes covering G. caps
  • epithelial cells lining Bowman’s capsule
  • proximal convoluted tubules
  • descending thick limg LoH
  • thin limbs of LoH
  • ascending thick LoH
  • distal convoluted tubules
46
Q

Disorders of kidney development

A
  • normal: ureteric bud grows into metanephic mesenchyme and is followed by bud branching and nephron induction, and finally, normal kidney
  • hypoplastic kidney: fewer layers of nephrons but retain moderate amt of excretory function
  • cystic dysplastic: malformed tubules, few nephrons, and some small cysts but have some excretory function
  • multicystic dysplastic: no excretory function and its pelvis is gone or severely disorganized
  • aplastic: no primary growth or development
  • most profound: agenesis( kidney and ureter often absent)
47
Q

Potter’s Sequence

A
  • in utero, kidney dysfunction causes oligohydramnios
  • causes increased pressure on developing fetus resulting in sloped foreheard, parrot beak nose, low slung ears, shortened fingers, internal organ abnormalities including lung disease!
  • new rx: inject saline into uterus and babys lung may develop
48
Q

Describe the ascent of the kidneys to their lumbar site

A
  • wk 6-10
  • metanephic kidneys initially form near tail of embryo
  • vascular buds from kidneys grow toward and invade the common iliac arteries
  • growth in the embryo in length causes the kidneys to “ascend” to their final position
  • they dont drag their blood supply with ascent, instead send out new and more cranial branches and induce regression of caudal branches
49
Q

What is the cause of an accessory renal artery?

A
  • arise when interim arteries do not regress
  • fairly common anomaly
50
Q

3 malformations related to ascent of the kidneys

A
  1. pelvic kidney: stays in pelvis rather than ascending
  2. Horseshoe Kidney: 2 developing kidneys fuse ventrally into a single horseshoe shape trapped in abdomen by IMA
  3. Supernumerary arteries: more than 1 renal artery per kidney; often asxs; can sometimes compress ureter causing hydronephrosis; kidney transplant donor organ: need to know if they have 1!

Renal (4 decks)

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