Anatomy/Histology

Question 1

The kidneys are retroperitoneal organs that are positioned along the posterior abdominal wall at spinal levels _

Answer 1

The kidneys are retroperitoneal organs that are positioned along the posterior abdominal wall at spinal levels T12-L3

Question 2

The kidneys are surrounded by two dense layers of fat; _ and _

Answer 2

The kidneys are surrounded by two dense layers of fat; pararenal fat and perirenal fat

Question 3

Pararenal and perirenal fat layers are separated by _ fascia

Answer 3

Pararenal and perirenal fat layers are separated by Gerota’s fascia aka “renal fascia”

Question 4

Each kidney is completely enveloped by a thin fibrous _

Answer 4

Each kidney is completely enveloped by a thin fibrous renal capsule

Question 5

The top and bottom regions of the kidney are called the _ and _

Answer 5

The top and bottom regions of the kidney are called the superior and inferior pole

Question 6

The medial boarder of the kidney, where the renal vein, arery, and renal pelvis pierce through is called the _

Answer 6

The medial boarder of the kidney, where the renal vein, arery, and renal pelvis pierce through is called the hilum

Question 7

The renal veins drain into the _

Answer 7

The renal veins drain into the inferior vena cava

Question 8

The renal arteries arise from the _

Answer 8

The renal arteries arise from the aorta (L1) to vascularize the kidneys

Question 9

The suprarenal glands (sitting atop the kidneys) are called the _

Answer 9

The suprarenal glands (sitting atop the kidney) are called the adrenal glands

Question 10

The _ continues as the ureter and carries urine to the bladder

Answer 10

The renal pelvis continues as the ureter and carries urine to the bladder

Question 11

Internally, the kidneys contain both cortical and medullary regions which contain around 2 million functional units called _

Answer 11

Internally, the kidneys contain both cortical and medullary regions which contain around 2 million functional units called nephrons

Question 12

The renal cortex extends into the medullary region as _

Answer 12

The renal cortex extends into the medullary region as renal columns

Question 13

The renal medulla is arranged into _ with the broad base facing outward and the apex directed towards the center

Answer 13

The renal medulla is arranged into renal pyramids with the broad base facing outward and the apex directed towards the center

Question 14

The apex of the renal pyramids point towards the collecting system of the kidneys, called the _

Answer 14

The apex of the renal pyramids point towards the collecting system of the kidneys, called the calyces

Question 15

The tips of each of the pyramids are called the _

Answer 15

The tips of each of the pyramids are called the papilla
* The collecting ducts of hundreds of nephrons can be found in one pyramid and papilla

Question 16

The papilla project into the _ calyx

Answer 16

The papilla project into the minor calyx

Question 17

Explain the movement of urine through the kidneys

Answer 17

Blood is filtered in the nephron and urine is formed (metabolites, salts, urea, water) and flows down the collecting ducts –> exits at the papilla into the calyces –> down to the ureter

Question 18

About 12 minor calyces will merge to form 2-3 _

Answer 18

About 12 minor calyces will merge to form 2-3 major calyces

Question 19

The major calyces combine to form the _ which is the superior portion of the ureter

Answer 19

The major calyces combine to form the renal pelvis which is the superior portion of the ureter

Question 20

The kidney are divided into 5 functional segments:

Answer 20

The kidney are divided into 5 functional segments:
1. Superior (apical)
2. Anterior superior segment
3. Anterior inferior segment
4. Inferior segment
5. Posterior segment

Question 21

Each renal artery divides into _ segmental arteries which are distributed to the

Answer 21

Each renal artery divides into 5 segmental arteries which are distributed to the 5 segments

Question 22

After the renal artery branches into the segmental arteries to supply each segment of the kidney, they then branch into _ arteries

Answer 22

After the renal artery branches into the segmental arteries to supply each segment of the kidney, they then branch into interlobar arteries (between pyramids)

Question 23

Interlobar arteries feed into _ arteries which feed into the more superficial interlobar arteries

Answer 23

Interlobar arteries feed into arcuate arteries which feed into the more superficial interlobar arteries

Question 24

The _ arteries are the ones that feed into the afferent arterioles that supply the glomeruli

Answer 24

The interlobar areries are the ones that feed into the afferent arterioles that supply the glomeruli

Question 25

The kidneys receive sympathetic innervation from the _ nerves and parasympathic innervation from the _

Answer 25

The kidneys receive sympathetic innervation from the **splanchnic nerves** and parasympathetic innervation from the **vagus nerve**

Question 26

The sympathetic splanchnic neves synapse in the _

Answer 26

The sympathetic splanchnic neves synapse in the **aorticorenal ganglia and renal plexus** at the base of the renal arteries

Question 27

Post ganglionic sympathetic nerves innervate the renal vasculature to trigger _ in the kidney and _ renal blood flow

Answer 27

Post ganglionic sympathetic nerves innervate the renal vasculature to trigger ***vasoconstriction*** in the kidney and **reduce** renal blood flow

Question 28

(True/False) The kidneys have visceral sensory nerves

Answer 28

True; the kidneys have visceral sensory nerves that carry pain from the kidneys

Question 29

The visceral sensory nerves from the kidneys travel to the _ level of the spinal cord

Answer 29

The visceral sensory nerves from the kidneys travel to **T10-T12** of the spinal cord *and corresponding dermatomes* * Kidney pain causes unilateral flank pain

Question 30

The abdominal portion of the ureter descends along the anterior aspect of the _ muscle

Answer 30

The abdominal portion of the ureter descends along the anterior aspect of the **psoas muscle**

Question 31

The ureter descends along the psoas muscle and is crossed by the _ vessels before the ureter then crosses the common iliac

Answer 31

The ureter descends along the psoas muscle and is crossed by the **gonadal vessels** before the ureter then crosses the common iliac

Question 32

The ureter passes the pelvic brim to enter the pelvis over the _ artery

Answer 32

The ureter passes the *pelvic brim* to enter the pelvis over the **common iliac artery** (where it bifurcates)

Question 33

The pelvic portion of the ureter travels along the lateral pelvic wall and ultimately enters the urinary bladder at the _ junction

Answer 33

The pelvic portion of the ureter travels along the lateral pelvic wall and ultimately enters the urinary bladder at the **uretero-vesical junction**

Question 34

The ureters receive their blood supply from the contribution of several nearby arteries, including:

Answer 34

The ureters receive their blood supply from the contribution of several nearby arteries, including: * Renal * Gonadal * Aorta * Common iliac * Internal iliac * Uterine * Vesical

Question 35

The _ and _ arteries vascularize the upper portion of the ureters

Answer 35

The **renal** and **gonadal arteries** vascularize the upper portion of the ureters

Question 36

The _ , _ , and _ arteries vascularize the middle portion of the ureters

Answer 36

The **gonadal, aorta, and common iliac arteries** vascularize the middle portion of the ureters

Question 37

The _ , _ , and _ arteries vascularize the lower portion of the ureters

Answer 37

The **internal iliac, uterine, and vesical arteries** vascularize the lower portion of the ureters

Question 38

There are several constrictions of the ureter that are caused by ureteral narrowing or compression by adjacent structures; these areas are common sites for _

Answer 38

There are several constrictions of the ureter that are caused by ureteral narrowing or compression by adjacent structures; these areas are common sites for **kidney stones**

Question 39

The first constriction site (most proximal to the kidney) is at the _ junction

Answer 39

The first constriction site (most proximal to the kidney) is at the **uretero-pelvic junction** *near the hilum of the kidney*

Question 40

The second constriction site is located where the ureter passes the _

Answer 40

The second constriction site is located where the ureter passes the **iliac vessels**

Question 41

The third constriction site (most distal) is at the _ junction

Answer 41

The third constriction site (most distal) is at the **uretero-vesical junction** *where the ureter traverses the bladder wall*

Question 42

Pain from the ureters (from obstruction or distension) gets conveyed to the spinal cord segments _

Answer 42

Pain from the ureters (from obstruction or distension) gets conveyed to the spinal cord segments **T10-L2** * This is why ureteric pain is ipsilateral pain in the lower quadrant of the body wall and groin

Question 43

The glomerulus is the tuft of _ capillaries that extends into the Bowman capsule

Answer 43

The glomerulus is the tuft of **fenestrated capillaries** that extends into the Bowman capsule * Endothelial cells contain openings or fenestrae * Fenestrations are important because they allow molecular exchange

Question 44

Most fenestrated capillaries in the body contain _ ; however, those in the glomerulus are unique because they lack these

Answer 44

Most fenestrated capillaries in the body contain **diaphragms** ; however, those in the glomerulus are unique because they lack these

Question 45

What type of capillaries are seen here?

Answer 45

Fenestrated capillaries

Question 46

What is the function of these cells?

Answer 46

Filtration- these cells are podocytes

Question 47

The parietal layer is the _ epithelium that lines the outer wall of the Bowman capsule

Answer 47

The parietal layer is the **simple squamous** epithelium that lines the outer wall of the Bowman capsule

Question 48

Visceral layer is the modified simple squamous epithelium composed of _ that lines the inner wall of the Bowman capsule and envelopes the glomerular capillaries

Answer 48

Visceral layer is the modified simple squamous epithelium composed of **podocytes** that lines the inner wall of the Bowman capsule and envelopes the glomerular capillaries

Question 49

The _ is the narrow cavity between the visceral and parietal layers into which the ultrafiltrate passes.

Answer 49

The **Bowman space** (i.e., urinary space) is the narrow cavity between the visceral and parietal layers into which the ultrafiltrate passes

Question 50

The _ is the site on the BC where the afferent arteriole enters and efferent leaves the glomerulus; the _ pole is the site on the BC where the urinary space becomes continuous with the lumen of the PCT

Answer 50

The **vascular pole** is the site on the BC where the afferent arteriole enters and efferent leaves the glomerulus; the **urinary pole** is the site on the BC where the urinary space becomes continuous with the lumen of the PCT

Question 51

List the three components of the renal filtration barrier

Answer 51

1. Fenestrations of the endothelial cells 2. Basement membrane 3. Filtration slits between the podocytes

Question 52

_ assists in restricting negatively charged proteins from passing into the Bowman space

Answer 52

**Heparan sulfate** assists in restricting negatively charged proteins from passing into the Bowman space

Question 53

_ in the basement membrane serves as a macromolecule filter to prevent large proteins from passing through

Answer 53

**Type IV collagen** in the basement membrane serves as a macromolecule filter to prevent large proteins from passing through

Question 54

Identify the four types of cells shown here

Answer 54

1. Podocyte 2. Simple squamous cell in the parietal layer 3. Endothelial cell 4. Mesangial cell

Question 55

What is the function of the mesangial cells?

Answer 55

Mesangial cells do the following: * Contribute to formation of the glomerular basement membrane * Phagocytosis of filtered debris * Production of the ECM for structural support of capillaries * Secretion of cytokines for immune defenses * Contract, thereby decreasing the surface area available for filtration * Possess receptors for angiotensin II and atrial natriuretic peptide

Question 56

What region is marked by the question marks?

Answer 56

**Proximal convoluted tubule** This region can be recognized as the PCT because (1) this is the urinary pole where the glomerulus flows into a tubule (see dotted line in image at right), (2) the PCT cell has a brush border (formed by microvilli) at its apical surface for absorption, (3) the cytoplasm contains vesicles and vacuoles (small white dots above) which indicate endocytosis and absorption, and (4) the TEM shows an invaginated basal surface with lots of mitochondria (numerous gray oval structures) which are needed for energy in a cell with lots of Na+ pumps in the basolateral membrane. This image is too highly magnified to see the “convolutions” (twists and turns) of the PCT

Question 57

Oligohydramnios indicates _ kidney function

Answer 57

Oligohydramnios indicates **poor kidney function** since *amniotic fluid is fetal urine* * Lack of amniotic cushioning around the fetus can cause congenital defects

Question 58

_ is a complication of oligohydramnios that is incompatible with life; it involves limb deformities, facial abnormalities, and pulmonary hypoplasia

Answer 58

**Potter sequence** is a complication of oligohydramnios that is incompatible with life; it involves limb deformities, facial abnormalities, and pulmonary hypoplasia

Question 59

Horseshoe kidney involves _

Answer 59

Horseshoe kidney involves **fusion of the two kidneys**, usually at the lower poles

Question 60

Fused horseshoe kidneys become trapped just below _ structure; this leaves them lower in the abdomen and less protected than usual

Answer 60

Fused horseshoe kidneys become trapped just below the **inferior mesenteric artery**; this leaves them lower in the abdomen and less protected than usual