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Renal Week 1 > Lecture 3: Anatomy, Embryology and Imaging of the Kidneys > Flashcards

Lecture 3: Anatomy, Embryology and Imaging of the Kidneys Flashcards

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1
Q

What is the functional unit of the kidney?

A

Nephron

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2
Q

How are kidneys positioned in the body?

A

Right kidney is LOWER than the left kidney because of liver

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3
Q

Which kidney is higher than the other?

A

Left kidney is higher than the right

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4
Q

What is BUN?

A

Blood Urea Nitrogen

Normal values = 8-20 mmol/L

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5
Q

What is the difference between acute and chronic kidney disease?

A

Acute = reversible
Chronic = irreversible
Symptoms are similar
Symptoms of kidney failure are subtle up until patients lose more than 90% of kidney function

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6
Q

How do you tell the difference between chronic and acute injury of kidneys?

A

Look at kidney size
Small size = chronic irreversible disease
Bigger = better

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7
Q

What are the general gross features of the kidney?

A

Retroperitoneal
Surrounded by fascia and adipose tissue
Superior border = T12
Inferior border = L3

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8
Q

Is there a safe place to do an anterior needle biopsy?

A

No because there are too many structures in the way

You want to biopsy posteriorly

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9
Q

What is the kidney’s anatomical relationship to the diaphragm?

A

Kidney is close to diaphragm and moves when you breath

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10
Q

What are the pertinent points regarding the anterior and posterior relationships of the kidneys?

A
  1. Most of the posterior and lateral aspects of the kidney are protected by muscle and adipose
  2. Difficult to access kidneys from anterior approach
  3. Percutaneous approach from back
  4. Kidneys are susceptible to blunt and penetrating injuries
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11
Q

What are the pyramids of the kidney?

A

Sections of the medulla

Triangular structure ends in minor calices

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12
Q

What are the renal columns of Bertin?

A

They are the areas in between the

Medullary pyramids

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13
Q

What are the minor and major calices?

A

Urine first starts collecting into minor calices

Drains into 3 major major calices

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14
Q

What is the renal pelvis?

A

The area where the three main renal major calices drain into

Pelvis will then drain into the ureter

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15
Q

What are the renal sinuses?

A

Space between minor/major calices

Contains fat and vessels

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16
Q

What is the base of the renal pyramid?

A

The thicker portion of the pyramid of the medulla

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17
Q

After the urine goes through the collecting tubule, where does it go?

A

Goes into the ducts of Bellini

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18
Q

Goes into the ducts of Bellini

A

The ducts that collecting ducts drain into

Will then turn into the summit of the papilla

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19
Q

What is the papilla?

A

The location where the medullary pyramids empty urine into the minor calyx of the kidney
Marked histologically by medullary collecting ducts converging to form a duct of Bellini
Transitional epithelium begins to be seen here
Latin for nipple (area of the converging point of the pyramids)

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20
Q

What is the route of urine transport?

A 
Pyramid (collecting ducts)
Ducts of Bellini (at papilla)
Minor calices
Major calices
Renal Pelvis 
Ureter
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21
Q

What is hydronephrosis?

A

The build up of fluid in the kidney due to obstruction

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22
Q

What supplies the kidney?

A

Renal artery

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23
Q

What are the characteristics of renal artery?

A 
Gives off first the inferior suprarenal artery
Then
Gives off five SEGMENTAL arteries (segmental because each supplies a particular segment):
	i. superior segmental artery
	ii. anterior superior segmental artery
	iii. anterior inferior segmental artery
	iv. Inferior segmental artery
	v. Posterior segmental artery
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24
Q

What happens if segmental artery is occluded?

A

That segment of the kidney will become infarcted
Approximately 20% of tissue could be lost
Can occur by
i. embolus
ii. coil embolization of segmental artery

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25
What is the order of renal arteries?
1. Main renal artery 2. Segmental renal arteries i. superior ii. anterior superior iii. anterior inferior iv. inferior v. posterior 3. InterLOBar arteries 4. Arcuate arteries 5. InterLOBULar arteries 6. INTRAlobular arteries/arterioles
26
What are voiding related problems?
Inability to excrete urine
27
What are the characteristics of ureters?
Tubing that connects renal pelvis to urinary bladder Runs downward and medial toward the FRONT of the psoas muscle Abdominal part lies behind the peritoneum on medial part of psoas major Opens into the fundus of the bladder Can run anterior to common iliac artery
28
What are the characteristics of the ureter tubes?
``` Thick walled narrow cylindrical tube Composed of 3 coats i. fibrous ii. muscular iii. mucous coat ```
29
How do ureters run into the bladder?
They run OBLIQUELY Significance = if bladder contracts or overflows, the ureter opening into the bladder is very easily compressed and closed If this lasts too long, it can obstruct the ureter
30
What is a viscus?
Singular for viscera Any large interior organ in any of the three great body cavities Usually abdomen
31
What are factors that can obstruct the ureters from within?
1. kidney stones 5mm needs an intervention 2. tumors 3. blood clot
32
What are possibilities of extrinsic obstruction of the ureters?
1. iliac artery aneurysm 2. malignancies in adjacent structures such as lymph nodes/cervical cancer 3. retroperitoneal fibrosis 4. damage during surgery 5. bladder disease 6. congenital anomalies along course of ureters
33
What are the key characteristics of the bladder?
A musculomembranous sac that acts as reservoir for urine
34
What is the trigone?
The tips at which the ureters enter and the opening through which urine leaves (these 3 points = trigone)
35
What is the muscle responsible for squeezing the urine?
The detrusor muscle
36
What is the detrusor muscle?
The muscle that is responsible contracting bladder
37
What are the layers of the bladder?
1. mucosa i. transitional epithelium ii. Lamina propria 2. submucosa 3. detrusor muscle 4. adventitia
38
What are the key characteristics of the male urethra?
``` Extends from internal urethral orifice in urinary bladder to external urethral orifice at end of penis Up to 20 cm long Divided into three portions i. prostatic ii. membranous iii. cavernous ```
39
What are the three portions of the male urethra?
1. prostatic 2. membranous 3. cavernous
40
What are the key characteristics of the female urethra?
1. narrow membranous canal 2. 4cm long 3. situated BEHIND the symphysis pubis 4. imbedded in anterior wall of the vagina Easier to get UTI than males because it is about 16 cm shorter
41
Where do the kidneys arise from?
The intermediate mesoderm | Differentiates to nephrogenic cord
42
What is the relationship between the embryological formation of the urinary and reproductive systems?
They are viewed together because they both arise from common embryological origin Both come from intermediate (lateral) mesoderm
43
What are the three excretory organs that develop from the nephrogenic cord?
1. Pronephroi 2. Mesonephroi 3. Metanephroi (permanent kidney)
44
What are the characteristics of the pronephros?
Develops during 3rd week but regresses but 5th week
45
What are the characteristics of the mesonephros?
Present at 3rd/4th week until the 12th week where it appears caudal to pronephros Can make urine at 5th week Consists of excretory tubules that contact a blood vessel medially and enter the mesonephric (Wolffian) duct laterally In women, the mesonephros completely regress
46
What does the mesonephros form in males?
1. testes 2. epididymal ducts 3. vas deferens
47
What are the key characteristics of the metanephros?
Develops at fifth week Arises from mesenchymal nephrogenic blastema by ureteric bud Ureteric bud induces nephron formation After week 36, no nephrons being formed…architecture is complete
48
What happens to premature babies?
Not enough nephrons are formed, since week 36 is when nephron formation is complete
49
What happens after termination of nephrogenesis?
Growth Differentiation Remodeling of kidney tissue
50
What induces the formation of nephrons?
The ureteric bud
51
What is the metanephric blastema?
The mesenchyme Secretes growth factors that induce Growth of ureteric bud from caudal Portion of mesonephric duct
52
What are the characteristics of the ureteric bud (metanephrogenic diverticulum)?
Proliferates and responds by secreting growth factors that stimulates differentiation of metanephric blastema into glomeruli and kidney tubules Undergoes mesenchymal to epithelial transition
53
What are the derivatives of the ureteric bud?
1. ureters 2. minor calyces 3. major calyces 4. collecting tubules 5. Ducts of Bellini Each of these are the result of ureteric bud differentiation or arborization
54
What is the relationship between the mesenchyme and the ureteric bud?
Mesenchyme and ureteric bud reciporocally induce each other to form 1 million nephrons in kidney
55
What happens if there is a premature division of the ureteric bud?
Duplication of urinary tract | Can even have two separate kidneys if premature division occurred early enough
56
What are the derivatives of the metanephric blastema (mesenchyme)?
1. podocytes covering glomerular capillaries 2. epithelial cells lining Bowman’s capsule 3. Proximal convoluted tubules 4. Descending thick limb of LoH 5. Thin limbs of LoH 6. Ascending thick limbs of LoH 7. DCT Basically all the portions of the glomerulus and nephrons
57
Where do nephrons/glomeruli come from?
The metanephric mesenchyme or the metanephric blastema
58
Where do the collecting ducts/major/minor calices/renal pelvis come from?
Ureteric bud which stems off the mesonephric duct
59
What is aplasia?
Aplasia implies that one or both kidneys have failed to develop If aplasia is bilateral, no urine production in fetus = severe oligohydramnios Leads to Potter sequence
60
What is the function of the kidney as an embryo?
Amniotic fluid is swallowed and reabsorbed by GI tract Kidney excretes amniotic fluid to replenish the external amniotic fluid volume Thus excretion = 1/3 of embryo’s amniotic fluid volume If kidney’s don’t work or have undergone agenesis, then you get oligohydramnios (not enough amniotic fluid)
61
What is oligohydramnios characterized by?
Less amniotic fluid than normal in amniotic cavity | Caused by baby’s inability to excrete amniotic fluid
62
What is Potter’s sequence?
``` The result of oligohydramnios as a consequence Of in utero kidney dysfunction Fetus has following features: i. sloped forehead ii. parrot beak nose iii. low slung ears iv. shortened fingers v. internal organ abnormalities ```
63
How does the kidney migrate to its ultimate position?
Metanephric kidneys start at tail of embryo Vascular buds from kidney grow toward and invade the common iliac arteries Growth of embryo in length causes kidney to ascend to final position Don’t drag blood supply with ascent Sends out new, more cranial branches Induces regression of more caudal blood vessels
64
What are ectopic kidneys?
Kidneys in an incorrect position | All ectopic kidneys are malrotated
65
What are malformations related to the ascent of the kidney?
1. pelvic kidney 2. horshoe kidney 3. supernumerary arteries
66
What are the characteristics of pelvic kidney?
Kidney stays in the pelvis rather than ascending
67
What are the characteristics of horseshoe kidney?
Two developing kidneys fuse ventrally into a single horseshoe shape trapped in the abdomen by inferior mesenteric artery
68
What are the characteristics of supernumerary arteries?
More than one renal artery per kidney Often asymptomatic but can sometimes compress the ureter Causes hydronephrosis Can complicate kidney transplant donation (not good to donate)

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