Renal Anatomy

Question 1

Kidney function

Answer 1

Excretes most of waste products of metabolism.
Controls water and electrolyte balance of body.
Maintains acid-base balance of body.
Secretes hormones and renin into the blood stream

Question 2

What is the pronephros and mesonephros?

Answer 2

Question 3

Metanephros forms what 2 structures?

Answer 3

Ureteric bud

Metanephrogenic blastoma

Question 4

Polycystic vs Horseshoe kidney

Answer 4

Polycystic Kidney:
Hereditary disease.
Failure of union between convoluted tubules and collecting tubules.
Retention of urine in proximal tubules results in cysts.

Horseshoe Kidney:
Caudal ends of both kidneys fuse.
Prone to infection and stones

Question 5

Kidneys develop where?

Answer 5

Pelvis

Question 6

Kidney arterial supply is ORIGINALLY from where?

Answer 6

Middle sacral artery

Question 7

Location of kidney

Answer 7

Primary retroperitoneal.
Left kidney higher than right (Liver).
Located between T12 – L3 vertebrae.
Hila of kidney: L1

Question 8

Which kidney is higher?

Answer 8

Left

Question 9

Costovertebral angle

Answer 9

Angle between 12th rib and vertebral column.
Occupied by the lower part of the pleural sac.
Kidney lies inferiorly.

Question 10

Renal angle

Answer 10

The angle between the 12th rib and the lateral border of erector spinae muscle.
Occupied by kidney.

Question 11

Answer 11

Question 12

Right kidney anterior relations

Answer 12

Question 13

Left kidney anterior relations

Answer 13

Question 14

Kidney posterior relations

Answer 14

Question 15

Coverings of kidney

Answer 15

Important bc spread of infections

Question 16

Answer 16

Question 17

What propels urine into bladder?

Answer 17

Smooth muscle in calyces propels urine through renal pelvis into ureters to the bladder.

Question 18

Renal hilum and renal sinus

Answer 18

Question 19

Kidney arterial supply

Answer 19

Question 20

5 segmental branches of kidney arteries

Answer 20

Apical
Caudal
Anterior Superior
Anterior Inferior
Posterior

Question 21

Kidney veins

Answer 21

Question 22

Lymphatics of kidney

Answer 22

Lymphatics follow renal veins.

Drain into right and left lumbar nodes (caval and aortic) near origin of renal artery

Question 23

Kidney innervation

Answer 23

Sympathetic Supply

Function: Vasomotor regulating blood flow and renin secretion.
From renal plexus, which follows renal arteries.
Post-ganglionic sympathetic from (T10 – L2).

Parasympathetic Supply

Contested: some texts state vagus nerve
More recent research suggests there is no evidence of parasympathetic supply.

**Renal function not dependant on innervation as shown with renal transplantation (complete transection of innervation).
Renal function regulated by hormones.

Question 24

Staghora calculi

Answer 24

Struvite

Recurrent urinary tract infection increase in ammonia production increase PH decrease phosphate solubility

Question 25

Ureter

Answer 25

25 – 30 cm long muscular tube Transports urine from kidney to urinary bladder. Begins as a continuation of renal pelvis. Peristaltic contractions 3mm in diameter

Question 26

Journey of the ureter in abdomen

Answer 26

Question 27

Journey of ureter in pelvis

Answer 27

Question 28

Kidney stones - renal and ureteric calculi

Answer 28

Common clinical problem. May cause distension of muscular tube. Complete or intermittent obstruction of urinary flow. Pain referred from ‘loin to groin’. Ureteric colic is severe intermittent pain due to contraction of ureteric muscles to overcome an obstruction, usually due to stone or clot formation.

Question 29

Ureteric constrictions

Answer 29

The ureter has constrictions at three points (sites of obstruction and stone impaction): 1. Ureteropelvic junction. 2. Crossing of common iliac artery. 3. Site of entrance to bladder.

Question 30

Arteries

Answer 30

1. Renal artery 2. Gonadal artery 3. Common iliac artery 4. Internal iliac artery

Question 31

Bladder male vs female

Answer 31

Question 32

Bladder external features

Answer 32

Pyramidal in shape Apex: Points towards pubic symphysis Attachment to median umbilical ligament - Running to umbilicus - Remnant of urachus: fibrous remnant of allantois Base: Faces posteroinferiorly Two inferolateral surfaces Neck: surrounds urethra: fixed in position

Question 33

Bladder ligaments

Answer 33

Help prevent prolapse

Question 34

Bladder internal features

Answer 34

Question 35

Bladder arterial supply

Answer 35

Superior vesical artery males only- inferior vesical artery vaginal artery in females

Question 36

Bladder veinous drainage

Answer 36

Vesical venous plexus ``` Bladder drained by: Vesical venous plexus - Drains into internal iliac vein - Communicates inferiorly with: 1. Inferior prostatic inferiorly (males) 2. Utero-vaginal plexus (females) ```

Question 37

Bladder innervation

Answer 37

Parasympathetic: Motor to detrusor / inhibitory to internal urethral sphincter. Sympathetic contraction of internal urethral sphincter: nervous to go to toilet. Or during  ejaculation to prevent semen entering bladder. Visceral afferents are stimulated by stretching: bladder contracts by reflex…  We learn to supress this reflex when we are get potty trained. 

Question 38

Urethra female

Answer 38

Question 39

Urethra male

Answer 39