Part 10: Kidneys, Ureters and Suprarenal Glands Flashcards
Where do the kidneys lie?
High up, retroperitoneal in paravertebral gutter. Hilum of R is just above transpyloric line and hilum L just below.
What is the approximate size of normal kidney?
12x6x3cm and weighs 130g
What is the significance of renal fascia?
Surrounds perinephric fat and separates kidney from suprarenal gland. Firmly attached to renal pelvis and ureters and thus prevents infection spread to midline.
What structures lie in front of R kidney beneath peritoneum?
Hilum: D2
Lat part lower pole: Hepatic flexure
Med part lower pole: Contact with peritoneum, crossed by ascending R
Posterior: Diaphragm, QL, Psoas and laterally TAM
Upper halves: Peritoneum of hepatorenal pouch
How does the subcostal neurovascular bundle pass in relation to kidneys?
Posterior
What structures lie in front of L kidney beneath peritoneum?
Hilum: Tail of pancreas
Lat part of lower pole: Splenic flexure
Med part lower pole: in contact with peritoneum, crossed by upper L colic artery
Posterior: Diaphragm, QL, laterally TAM
Upper halves: Peritoneum of lesser sac (part of stomach bed)
What is the renal blood supply?
Renal arteries (aprox 1L/min) divides to supply renal segments. Anterior and posterior branches at hilum.
Anterior division supplies apical, upper, middle and lower segments.
Posterior branch supplies posterior segment. Occasionally lower segment supplied by branch directly from aorta (developmental remanent). All end arteries.
What is the venous drainage of the kidneys?
Veins from renal segments communicate with each other profusely and eventually for 5-6 vessels with unit at hilum to single vein to IVC. R shorter than L.
What is the order of artery, vein and ureter at hilum?
vein, artery ureter (front to back)
What is the nervous supply of the kidney?
Sympathetic supply from T12-L1 segments with postganglionic cells from coeliac, renal and superior hypogastric plexus. Sympathetic supplies vasomotor function. Parasympathetic input also but significance is uncertain.
What is the macroscopic structure of the dissected kidney?
Peripherally has dark red cortex beneath capsule which extends towards pelvis as renal columns. Between columns are pyramids of medulla - open into a renal papilla which projects into minor calyces
Describe the nephron
Functional unit of kidney (about 1 million). Consists of glomerulus (tuft of capillaries) which surrounded by podocytes projecting into rounded capsule (of Bowman). Continues as tubule system - PCT, loop of Henle, DCT and collecting tubule to collecting ducts which unit to open into papilla
Where does development of the kidney occur?
From intermediate cell mass -> metanephros -> bud forms.
Initially in pelvis supplied by iliac vessels. Migrates up with successive artery supply from aorta to final position. Old arteries degenerate. Occasionally a remanent to lower pole of kidney from aorta will exist.
How long are the ureters and where are their narrowings?
25cm long
Narrowing at PUJ, pelvic brim and termination in bladder mucosa.
What is the course of ureters?
From renal pelvis run down major psoas, under peritoneum. Crosses genitofemoral nerve, crossed by gonadal vessels. Leaves psoas muscle at bifurcation of common iliac artery to enter pelvis
