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Flashcards in Kidneys Deck (25):
0

Defines the PERIRENAL space that contains the ff:
-kidneys, adrenal gland, ureter, gonadal artery & vein, perirenal fat

GEROTA's fascia

1

Retroperitoneal

Lie on the ventral surface of quadrates lumborum

Lateral to PSOAS MUSCLE

covered directly by FIBROUS CAPSULE (true capsule)

Further surrounded by PERIRENAL FASCIA OF GEROTA (false capsule)

Kidneys

2

Any fat outside the PERIRENAL space

Pararenal fat

3

Structures in renal hilus (anterior to posterior)

Renal vein

Renal artery

Renal pelvis

4

Upper pole

L1 (lower because of the liver)

Related to 12th rib, liver, duodenum, hepatic flexure if the colon

Right kidney

5

Upper pole

T12

Related to 11th rib & 12th ribs, pancreas, spleen, splenic flexure of the colon

Left kidney

6

Internal structure of the kidneys

Outer cortex

Inner medulla

Collecting system

7

Directly below the renal capsule

Extends between the pyramids as rentals columns of Bertin

Outer cortex

8

5-11 renal pyramids (pyramids of Malpighi)

Tips terminate as 5-11 renal papillae

Inner medulla

9

5-11 minor calyces (cup-shaped, surround each renal papilla)

2-3 major calyces formed by fusion of minor calyces

Collecting system

10

Main urine collection chamber, continuous with ureter at ureteropelvic junction

Renal pelvis

11

Vascular supply

Renal artery ➡️ 5 segmental arteries (4 anterior & 1 posterior)

Interlobar arteries

Arcuate arteries

12

Branches of segmental artery that enters a renal column

Interlobar arteries

13

Branches of Interlobar artery, found between the cortex & medulla at corticomedullary junction

Arcuate arteries

14

Branches of Arcuate artery, found within cortex, terminate as afferent arterioles

Interlobar artery

15

During their ascent they rotate 90% medially, so the renal hilus is oriented medially

Rotation of the kidney

16

Fetal metanephros - location in the sacral region

Due to disproportionate growth of the embryo caudal to the metanephros

Ascent of the kidney

17

Inferior pole fuse & becomes trapped behind inferior mesenteric artery during ascent

Horseshoe kidney

18

Ureteric bud divides prematurely

Duplication of renal pelvis & ureter

19

Autosomal dominant

Multiple large cysts

SSX: bilateral flank masses, hypertension, renal failure, recurrent pyelonephritis, hepatic cysts, berry aneurysms of the circle of Willis

Adult polycystic kidney disease (APKD)

20

Small granulomas in the cortex, near glumeruli ➡️ renal papillae, minor calyces

Usually proceeds from the kidney to the bladder

(vs schistosomiasis - from bladder to kidney)

Genitourinary tuberculosis

21

Associated with vesicoureteral reflux in children

Reflux of infected urine from bladder to kidneys

Chronic pyelonephritis (reflux nephropathy)

22

Arise from proximal convoluted tubule

Associated with Von Hippel-Lindau disease

Resistant to chemo due to P-glycoprotein or multi drug resistant gene

May thrombose the renal vein or IVC

SSX: hematuria , flank pain, left testicular varicocele, flank mass

Renal cell CA

23

Fracture of lower ribs

Transverse process of lumbar vertebra

Gunshot or stab wound over lower rib cage

SSX: pulsatile/expanding retroperitoneal hematoma, hypotension, hematuria

**** R kidney - ass. Liver trauma
**** L kidney - ass. Spleen trauma

Kidney trauma

24

Surgical approach

Below & parallel to the 12th rib