Learn more about the anatomy of the kidneys and the urinary system with our urinary system quizzes and labeled diagrams. Right-sided pain was related to crossed renal ectopia. Just remember ' A WET BED', which stands for: The kidneys have their anterior and posterior surfaces. Anatomy Where is the renal cortex? Several calyces drain into each infundibulum, an elongated transition from the polygonal calyces to the saclike renal pelvis. The kidneys are highly vascular (contain a lot of blood vessels) and are divided into three main regions: the renal cortex (outer region which contains about 1.25 million renal tubules), renal medulla (middle region which acts as a collecting chamber), and renal pelvis (inner region which receives urine through the major calyces). For most people, obstruction of a single ureter does not induce renal failure. I would honestly say that Kenhub cut my study time in half. Figure 18-3 Illustration demonstrating basic intrarenal arterial anatomy. Some of them are congenital, such as a third kidney, which is usually atrophic. The kidneys help remove waste products from the . The posterior branch supplies the posterior part of the kidney, whereas the anterior branch arborizes into five segmental arteries, each supplying a different renal segment. Poorly functioning kidneys with little residual parenchymal volume may be removed because preservation offers opportunities for future complications (infection, hypertension) without contributing significantly to renal function. Ultrasound permits real-time optimization of imaging relative to the axis of each kidney. MR angiography can be useful for the diagnosis of renal vascular abnormalities. Summary: A variety of factors, including patient body habitus, local renal anatomy, cost and patient preference, must be taken into consideration when determining the optimal treatment modality for lower pole renal calculi. Estimated creatinine clearance may be calculated using serum creatinine with adjustments made for sex, age, and body weight. Learn how we can help 1.2k views Reviewed Dec 09, 2022 Thank Dr. Frank Kuitems and 4 doctors agree 3 thanks At one end of each nephron, in the cortex of the kidney, is a cup-shaped structure called the Bowman's capsule. A, Soft-tissue windows demonstrate no filling defect. Chronic glomerulonephritis usually causes bilateral increased renal echogenicity with smooth atrophy, whereas renal artery stenosis usually causes a similar but unilateral appearance (Fig. The kidneys are reddish-brown, bean-shaped organs situated retroperitoneal on the posterior abdominal wall. Eliminating toxic metabolites through urine, regulation of blood homeostasis and blood pressure, production of some hormones, Positioned retroperitoneally, consists of the cortex and medulla, empties urine into the ureter (which carries urine to the urinary bladder), Renal artery (branch of the abdominal aorta), Renal vein (drains to the inferior vena cava), Third kidney, horseshoe kidney, kidney agenesis, kidney stones, acute kidney failure, Regulates the amount of fluid in the body by increasing or decreasing the urine production, Maintain the pH of blood at 7.4 by decreasing or increasing the excretion of hydrogen ions, Medial part of the lower half of superior pole, Lateral part of the lower half of superior pole, Lateral part of inferior half of anterior surface, Medial part of inferior half of anterior surface, The perinephric fat (perirenal fat capsule). T2-weighted maximum intensity projection image from a magnetic resonance urogram performed to evaluate urinary obstruction identified in a patient with an obstructing soft tissue mass in the pelvis on unenhanced computed tomography (CT). The solid renal parenchyma consists of the peripheral renal cortex and more central renal medulla. But here is a neat little mnemonic to help. Axial image of the left kidney obtained in the excretory phase of a computed tomographic urogram demonstrates the effects of window settings on visualizing structures near excreted contrast. A, Axial image demonstrates the dilated renal pelvis and crossing vessel. Kidney stones are most often treated by ultrasound shock therapy, during which high-frequency radio waves break the stone into smaller pieces that can be passed naturally into the urine. The calcium or uric acid will precipitate and form stones. The renal corpuscle has two components: the glomerular (Bowmans) capsule in which sits the glomerulus. 18-18). When echogenicity of the renal cortex equals that of the liver, renal function is abnormal in approximately 38% of cases. Renal Cysts. The main unit of the medulla is the renal pyramid. They extend from lumbar vertebra T12-L3. IVC, Inferior vena cava. The ureters are the tubes that carry urine from the renal pelvis to the bladder. Table 18-7 Causes of Unilateral Small Smooth Kidney, Only gold members can continue reading. The upper poles are normally oriented more medially and posteriorly than the lower poles. impression is preserved. 18-19). Renal artery The large left proximal ureteral stone seen in this image is only partially obstructing, causing mild dilation in the left kidney collecting system. It protects your kidneys from injury, increases their stability and connects your kidneys to surrounding tissues. Arterial stenosis was confirmed by magnetic resonance angiography. Bone scan and chest x-ray to find out if the cancer has spread. In this way, the consistency of blood is preserved and no important substances are lost. The kidneys play a central role in homeostasis. There are 8-18 renal pyramids in each kidney, that on the coronal section look like triangles lined next to each other with their bases directed toward the cortex and apex to the hilum. In this case, the right kidney had more favorable anatomy for laparoscopic donor nephrectomy. more lateral and anterior than the superior poles. The most common indication for cortical scintigraphy is to evaluate kidneys that have been injured by vesicoureteral reflux, chronic obstruction, or severe or repeated urinary infections. BOX 18-1 Cockroft and Gault Equation for Calculating Estimated Creatinine Clearance. The presence of significant renal parenchyma may justify surgical repair to maximize the functional contribution of that kidney. Ultrasound performed for acute renal failure demonstrates bilateral hydronephrosis caused by a bladder tumor. Table 18-7 lists causes of unilateral smooth renal atrophy. Their shape resembles a bean, where we can describe the superior and inferior poles, as well as the major convexity pointed laterally, and the minor concavity pointed medially. The vessel which brings blood into the glomerulus is the afferent arteriole, whereas the vessel that carries the rest of the blood out that hasnt been filtered out of the glomerulus is called the efferent arteriole. Sagittal ultrasound image of the right kidney demonstrates increased size and echogenicity of the kidney, findings typical of human immunodeficiency virus nephropathy. 18-26). During the 6th to 9th weeks of life, the kidneys begin to ascend from their position in the pelvis to the level of T12-L1, inferior to the adrenal glands. Overview. Note that there is no contrast in the aorta. The portion of the kidney between the poles is called the interpolar region and contains the renal hilum (Fig. Because the fascia of the retroperitoneum prevents significant extravasation, the incision usually heals to form a larger lumen. Because they rarely cause symptoms, renal cysts are most often found during . Some tumors can be slow to grow while some can be aggressive. Causes. Many clinical laboratories now provide computer-generated calculations of estimated creatinine clearance or eGFR using patient data in the medical information system. On ultrasound, the renal cortex is usually echogenic in this setting. The patient had acute renal failure; therefore, contrast-enhanced CT was not performed. In other cases, both kidneys can be fused, usually at the inferior poles, which is a congenital state called the horseshoe kidney. Each end of the kidney is commonly called a. Annotated three-dimensional volume rendering of the left kidney acquired using a combined nephrographic phase and excretory phase during computed tomographic urography demonstrates regional anatomy of the kidney. This plexus provides input from: The sensory nerves from the kidney travel to the spinal cord at the levels T10-T11, which is why the pain in the flank region always rises suspicions that something is wrong with the corresponding kidney. Recent advances in MDCT and MRI permit cross-sectional vascular studies to replace conventional angiography before UPJ repair (Fig. Frontal image of the left kidney from an intravenous urogram demonstrating an aberrant renal papilla in the lower pole infundibulum. Figure 18-8 Junctional cortical line seen on a long-axis ultrasound image of the right kidney. It can be caused by a variety of factors, but most often arises because of the ischemia of the kidney and the toxic effect of some medications, resulting in the failure of all kidney functions. It is also permeable for the products of the metabolism, such are creatinine and drug metabolites. This is just a peek into the kidney physiology. The right kidney has a normal appearance (not shown). The center of the minor concavity is marked as the hilum of the kidney where the renal artery enters the kidney, and the renal vein and ureter leave the kidney. B, Axial CT image from a different patient demonstrates the more common location of the right renal artery posterior to the IVC. Even when there is another plausible explanation for decreased renal function (e.g., known prerenal causes), ultrasound offers the opportunity to rapidly and noninvasively identify a potentially correctible cause of renal failure. Each time a professor says 'nephron', a student gets a headache. A, Steady-state free precession, (B) T2-weighted with fat saturation, (C) T1-weighted, (D) T1-weighted with fat saturation, (E) postcontrast corticomedullary phase, and (F) postcontrast nephrographic phase. Read More Created for people with ongoing healthcare needs but benefits everyone. Differential diagnosis General imaging considerations include: renal cortical defect duplex kidney Kenhub. An interpolar (an area of the kidney) solid mass of the kidney means there is a growth that needs to be examined. In other cases, each renal unit has its own ureter. Note that retroaortic components are usually near the inferior poles (Fig. urinary system quizzes and labeled diagrams. Chronic glomerulonephritis usually causes bilateral increased renal echogenicity with smooth atrophy, whereas renal artery stenosis usually causes a similar but unilateral appearance (Fig. 18-4). Kim Bengochea, Regis University, Denver. 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