Session 1: intro and imaging

Question 1

What level is the upper and lower border of the left and right kidney?

Answer 1

Left: T11 - L2
Right: T12- L3

The right kidney is lower because of the liver!

Question 2

What is the renal parenchyma?

What makes it up?

Answer 2

The functional tissue of the kidney

Mae up of nephrons (cortex and medulla)

Question 3

What is the endocrine function of the kidneys?

Answer 3

Secreting:

1. Renin
2. Erythropoietin
3. Prostaglandin

Question 4

How much is the water content of a 70kg adult male?

Hint: ICF and ECF

Answer 4

ICF = 28 L
ECF = 14 L

Total = 42 L

Question 5

What is the difference b/w osmolality and osmolarity?

Answer 5

Osmolality= measure of the osmoles of solute per Kg of solvent

Osmolarity= the number of osmoles of solute per liter (L) of solution

Question 6

What determines the OSMOLALITY of ICF and ECF?

Answer 6

ICF: K+

ECF: Na+ and Cl-

Question 7

What happens to a cell if put in a

HYPER-tonic and HYPO-tonic solution?

Answer 7

Hyper - shrink

Hypo - swell

Question 8

How much does the kidney receive from the CO?

Answer 8

20-25%

Question 9

How much does the kidney produce of ULTRAFILTRATE and URINE per day?

Answer 9

Ultrafiltrate = 180 L/day
Urine = 1.5 L/day

Question 10

Via what Na is transported across..

1. Apical/ luminal side
2. Basolateral side

Answer 10

Apical - co-transporter w/ AA and glucose

Basolateral - NaK ATPase

Question 11

1. What is mainly reabsorbed in the thin and thick limbs of the loop of henle?
2. How are they transported?

Answer 11

Water - osmosis
Na, Cl, K - NaK2Cl co-transporter, paracellular diffusion, NaH antiporter/ exchanger
Ca, Mg - paracellular diffusion

Question 12

Where does the following occur..

1. Counter current multiplication
2. Na regulation
3. H2O regulation?

Answer 12

1. Loop of henle
2. DCT
3. DCT and CD

Question 13

What system/hormone controls..
Na reabsorption
Water reabsorption

Answer 13

Na - RAAS via aldosterone

H2O - ADH

Question 14

Fluid in PCT is..

Isotonic, hypertonic, or hypotonic

Answer 14

Isotonic

Question 15

What are the functions of the loop of henle?

Answer 15

1. Counter current multiplication which creates a gradient to increase the osmolarity in medulla
2. Allows formation of concentrated urine

Question 16

What is the functional unit of the kidney?

How much does each kidney weigh?

Answer 16

1.5 million Nephrons

150g each

Question 17

What does the kidney synthesize? And catabolize?

Answer 17

Produce vitamin D

Catabolize insulin, PTH, and calcitonin

Question 18

What is meant by POLARIZATION of the kidney epithelium?

Answer 18

Availability of diff. Transporters on the apical and basolateral membrane

Question 19

Ready for kidney anatomy?

Answer 19

YAAAAAAS

Question 20

Is the kidney retro of intra-peritoneal organ?

Give examples of retroperitoneal organs

Answer 20

Retroperitoneal

SAD PUCKER:

Supra-renal gland 
Abdominal aorta 
Duodenum (2nd and 3rd part)
Pancreas 
Ureters 
Colon (ascending and descending)
Kidney 
Esophagus 
Rectum

Question 21

What is the clinical relevance of the LEFT renal vein?

Answer 21

In case of aneurysm in the abdominal aorta - the L renal vein will be occluded, as it lies behinds it

Question 22

Normally, how many renal arteries supply the kidney?

What happens if we get more?

Answer 22

One !

If more = they do not anastomose, therefore, occlusion of mone can lead to necrosis and ischemia

Question 23

Locate on a picture..
Renal column
Renal papilla

Answer 23

Use google pics!

Question 24

Describe the route of urine flow from the nephrons to the bladder…

Answer 24

Nephrons - collecting duct - renal pyramids - renal papilla - minor calyx - major calyx - renal pelvis - ureter - bladder

Question 25

What other arteries supply the kidney? Hint: 3

Answer 25

Extra renal art. Supra renal art. Testicular/ovarian art.

Question 26

Locate the 3 constrictions in a ureter..

Answer 26

1. At the junction of pelvis 2. At the pelvis brim 3. Where is pierces the bladder

Question 27

What is the level of the ureter? At which level does it cross the pelvic brim? Close blood vessel? Close nerve?

Answer 27

- level of hilum L1/2 - at level of sacroiliac joint - anterior to bifurcation of the common iliac art. - obturator n.

Question 28

What's the diff. B/w a male and female ureter?

Answer 28

WATER UNDER THE BRIDGE Female: ureter under uterine artery Male: ureter under vas deferens

Question 29

Stones in ureter can cause pain in..? | Pain sensed via which nerves?

Answer 29

Loin, groin, and Flanks | T11-L2

Question 30

Describe the course of ureter? What muscle does the ureter lie on? What bony landmark defines the course of ureter? Draw the course on an x-ray!!! (Exam question)

Answer 30

Pelvis - in front of psoas major m. - pelvic brim - in front of common iliac art. - pierces posterior to the bladder Psoas major Transverse processes

Question 31

What is the main cause of difficulty maintaining urine stream and failure of bladder emptying and dripping in older male patients?

Answer 31

BPH

Question 32

Define renal angle tenderness? | What does is indicate?

Answer 32

Pain upon percussion of the Costco-vertebral angle (12th rib)/ (angle b/w vertebral column and costal margin) Kidney infection, pyelonephritis, or Kidney stone

Question 33

Patient presenting with ankle edema, what does this has to do with the kidney?

Answer 33

Proteinuria - serum proteins in urine (albumin) - low oncotic plasma proteins - peripheral edema

Question 34

Common 3 areas for stones?

Answer 34

Pelvi-ureteric junction Vesicles-ureteric junction Bifurcation of common iliac art.

Question 35

Describe the bladder and the anatomy of it ?

Answer 35

Hollow, destensible, muscular wall (detrusor muscle) Transitional epithelium in the mucosa 1. Apex (anterior angle that connects to the urachus/ median umbilical lig.) 2. Trigone (posterior wall, Triangle, contains ureter openings) 3. Neck (base)

Question 36

Describe the location of the bladder if full and empty?

Answer 36

Empty: in the lesser pelvis inferior to peritoneum Full: in the greater pelvis, above pubic bone, still inferior to the peritoneum

Question 37

What is the length of the urethra in males and females?

Answer 37

Males 20 cm | Females 4-5 cm

Question 38

- What are the parts of male urethra? - What type of epithelium makes each part? - What is the clinical relevance of the membraneous part?

Answer 38

Pre-prostatic (transitional) Prostatic (transitional) Membraneous (stratified columnar) Spongy/ penile (stratifies squamous) The membraneous part is the least distensible, therefore can get damages during catheterization

Question 39

What is the course of a female urethra?

Answer 39

Glans clitoris > vaginal opening >pass thro deep peritoneal pouch (ext. Ruhr also sphincter) > pass thro ext. urethral orifice

Question 40

Explain how Na is transported in PCT?

Answer 40

1. Via the 3Na 2K ATPase in the basolateral membrane: 3 Na are pumped out, while 2 K enter. 2. This creates a concentration gradient that drives Na entry on the apical membrane. 3. Glucose and amino acids are co-transported with Na. 4. Water enter by osmosis via aquaporins. 5. Lipid soluble molecules via transcellular route (passive diffusion). 6. Ions and urea via paracellular route.

Question 41

Explain the relation of renal arteries to the renal veins? | The location of L renal vein?

Answer 41

Renal arteries are behind renal veins L renal vein: in front of aorta, below SMA

Question 42

Describe the renal vasculture route?

Answer 42

Renal art. > segmental art.> interlobar art.> arcuate art.> interlobular art.> afferent arterioles> glomerulus> efferent arteioles> peritubular capillaries/ vasa recta> interlobular v.> arcuate v.> interlobar v.> renal vein> IVC

Question 43

What arteries supply the ureter?

Answer 43

Segmental Gonadal Vesicle Uterine

Question 44

What are the anterior and posterior relations of the L and R kidney? Draw!!!

Answer 44

Right: - anterior (adrenal gland, liver, duodenum, colon) - Posterior ( 11th rib, diaphragm, psoas major, quadratus lumborum, transverse abdominis) Left: - anterior (adrenal gland, spleen, stomach, pancreas, jejunum, colon) - posterior (12th rib, diaphragm, muscles)