Anatomy/Histo Review

Question 1

Describe the anterior to posterior arrangement of the 3 things in the hilum of the kidney.

Answer 1

Anterior to Posterior:

Renal Vein
RenalArtery
Renal Pelvis

Question 2

The hilum of the kidney is at what vertebral level?

Answer 2

L1 (Transpyloric plane)

Question 3

What ribs are associated with the right and left kidneys? Why are they different? Which one is palpable?

Answer 3

Right Kidney = 12 rib

Left Kidney - 11,12 ribs

The right kidney is located a little lower than the left, so it is palpable.

Question 4

At what vertebral levels are the superior and inferior kidney borders?

Answer 4

Superior border: 12 rib

Inf. Border: L3

Question 5

Which is closer to the kidney… parArenal fat or perIrenal fat?

Answer 5

Perirenal fat.

the “I” is inside the fascia

Question 6

What is Nephroptosis?

Answer 6

Dropped kidney –> Occurs with abnormally mobile kidneys, and one just drops into the pelvic cavity.

Anatomically associated with a loose, kinked ureter.

Clinically associated with intermittent pain in the renal area due to the force of stretch on the renal arteries. Pain usually relieved by lying down.

Question 7

Referred pain from the kidney goes to the supra-pubic area. Why?

What nerves run along the posterior abdominal wall behind the kidney?

Answer 7

Subcostal
Ilioinguinal
Iliohypogastric

Question 8

Which renal vein is longer? What artery does it run under?

Answer 8

The left renal vein is longer, and it runs beneath the SMA.

Question 9

Name some symptoms of Nutcracker syndrome.

Answer 9

“bag of worms” in the left testicle (because the left testicular vein runs directly to the Left renal artery.

Hematuria/Proteinuria

Left flank pain

Question 10

Sympathetic innervation of the kidney comes primarily from which nerve?

Answer 10

Least thoracic splanchnic (T12)

Question 11

Via which nerve does the kidney get parasympathetic innervation?

Answer 11

Vagus (X)

Question 12

Lymphatic drainage from the kidney goes where?

Answer 12

Lateral Lumbar or Lateral Caval nodes near the origin of the renal artery and vein

Question 13

Your patient has one large renal cyst. What do you do now?

Answer 13

Aspirate it and leave it alone. Single renal cysts are generally asymptomatic, and rarely cause renal dysfx.

Don’t confuse with POLYCYSTIC KIDNEY DISEASE –> inherited autosomal disorder with enlarged, cystic kidneys. Disruption of the collecting tubules causes kidney failure.

Question 14

Name some symptoms of renal calculi.

Answer 14

Kidney stones.

Severe intermittent pain
Hematuria
Inability to urinate if flow blocked
Pain in kidney or genitals
Digestive issues

Question 15

Most common tumor of the kidney

Answer 15

Renal Cell Carcinomas

Develop from the proximal tubular epithelium.

Weird because they grow out FROM the kidney into the fat, fascia, and vein.

Venous extension is rare for any tumor, and a distinctive trait of Renal Cell Carcinoma.

Question 16

Where is a transplant kidney attached in the recipient’s body?

Answer 16

The renal A and V are joined to the EXTERNAL ILIAC artery and vein, and the ureter is sutured to the bladder.

It nests in the iliac fossa.

Question 17

What are the 3 stages of embryonic kidney development?

Answer 17

Pronephros - never functions in humans and regresses quickly

Mesonephros - second kidney that functions till the final kidney can (late 1st trimester) - has a duct that empties into the cloaca.

Metanephros - final kidney. 2 parts: URETERIC BUD and the BLASTEMA (Metanephric Mass).

Both these parts are required for kidney development.

Question 18

What does the ureteric bud become in the final kidney?

Answer 18

Drainage system: ureter, renal pelvis, major and minor calyces, collecting tubules.

Question 19

WHat does the blastema form in the final kidney?

Answer 19

Filtration system: The renal cortex and medulla.

ALL THE NEPHRONS (functional unit of kidney)

Question 20

What does the mesonephros become in men? women?

Answer 20

The mesonephros becomes part of the male genital tract.

It regresses in the female and becomes nothing.

Question 21

The final kidney is functional at how many weeks into pregnancy

Answer 21

10

Question 22

What are these things:

1. Unilateral Renal Agenesis
2. Hypoplastic Kidney
3. Supranumerary Kidney

Answer 22

1. Unilateral Renal Agenesis occurs when the ureteric bud and the blastema fail to develop or integrate with one another on one side.
2. Hypoplastic kidney is a small kidney that is architecturally normal. Same density of nephrons, just tiny.
3. Supranumerary Kidney results from SPLITTING OF THE BLASTEMA –> too many kidneys form.

Question 23

Bilateral renal agenesis is called….

Answer 23

potter’s syndrome.

Fatal –> oligohydramnios (low volume of amniotic fluid)

Question 24

How do you distinguish a dropped kidney from an ectopic kidney?

Answer 24

The ureter will be floppy and stretched in a dropped kidney, but normal and taut in an ectopic kidney (shorter).

Question 25

Horseshoe kidney gets stuck on which artery as it tries to ascend to its normal anatomical position?

Answer 25

IMA

at the level of the lower lumbar vertebrae

Question 26

What is the mechanism behind….

1. Double ureter
2. Ectopic Ureter

Answer 26

1. Double Ureter - splitting of the ureteric bud

2. Ectopic Ureter - 2 ureteric buds, one normal, and one going somewhere wrong like the vagina or the urethra

Question 27

The ureter runs along which muscle?

Answer 27

Psoas major

Question 28

Describe the water under the bridge relationship.

Answer 28

In males, the ureter runs beneath the vas deferens

In women, the ureter runs beneath the uterine artery

Question 29

In males, the neck of the bladder is immediately superior to ______________, which is why older men may develop incontinence.

Answer 29

The prostate is immediately inferior to the neck of the bladder.

Question 30

What are the 3 sites a kidney stone can lodge?

Answer 30

1. Junction of ureter with the renal pelvis
2. Pelvic brim
3. bladder wall