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Case 2 > Anatomy of the Kidney > Flashcards

Anatomy of the Kidney Flashcards

1
Q

The Kidneys functions

A 
Filter the blood to maintain the intra and extracellular environments
Regulating ions concentration
Regulating body fluid 
Removal of cellular wastes
pH regulation
Erythrocyte formation
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2
Q

Position of Kidneys

A
  • retroperitoneal organs
  • Kidneys lie on the psoas muscle beside the vertebral bodies.
  • left kidney is higher
  • left renal vein is longer
  • The diaphragm and 11th and 12th ribs lie behind the upper half of each kidney.
  • renal vein is most anterior –> renal artery –> pelvis/ureter
  • LEFT RENAL VEIN receives the left gonadal vein
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3
Q

Retroperitoneal organs

A 
Pancreas 
Majority of duodenum
Ascending colon 
Descending colon 
Kidneys
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4
Q

Position & Size of the kidneys

A 
upper side between T11 and T12
Hilum at L1/2
Lower poles at L3
Width is about 5 - 6cm
Length is about 10 -11cm
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5
Q

Kidney is located in the

A

right/left lumbar (flank)

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6
Q

Anterior Relations of the RIGHT kidney

A

Right Kidney

Top to bottom:
suprarenal
hepatic 
duodenal
right colic flexure
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7
Q

The liver and jejunum is separated from the kidney by __________

A

peritoneum

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8
Q

Anterior Relations of the LEFT kidney

A

spleen

left suprarenal gland

The splenic artery runs across the kidney immediately above the pancreas

pancreas

jejunum

left colic flexure

stomach

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9
Q

Posterior Relations of the Kidneys

A

The kidney rests on the ff:
Diaphragm - Separates the upper part of the kidney from the pleura and the 12th rib (11th rib for left kidney)
Psoas major muscle
Quadratus lumborum
Origin of the transversus abdominis muscle
Medial and lateral lumbocostal arches (origin of the fibres of the diaphragm)

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10
Q

Ureter length and constrictions

A

Approximately 25 cm – 30cm long
The upper half of this length lies on the posterior abdominal wall and the lower half in the true pelvis.

Position:
Posteriorly, rests on the psoas major muscle
Anteriorly, covered by peritoneum
At the brim of the pelvis, it crosses the upper end of the external iliac artery and vein.
Comes to lie on the lateral wall of the pelvis.

Constrictions:
Hilum
Pelvic brim
Bladder entrance

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11
Q

Male Ureter

A
  • Superior vesical artery
  • Obturator nerve
  • Inferior vesical artery
  • ductus deferens.
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12
Q

Female Ureter

A
  • Superior vesical artery
  • Obturator nerve, artery and vein
  • Vaginal artery
  • Uterine artery
  • Ovary
  • Cervix
  • Vagina
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13
Q

Urinary Bladder

A 
Lies in the pelvis but when distended, part extends above the level of the pubic symphysis and comes in contact with the abdominal wall.
The urge to urinate comes at 300 ml.
The total capacity is about 500 ml.
Has 4 surfaces 
2 inferolaterals
Superior surface
Base of posterior surface
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14
Q

Wall of bladder layers

A
  • Adventitia
  • Detrusor muscle
  • Submucosa
  • Lamina propia
  • Transitional epithelium
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15
Q

Male Urethra

A

Around 20 cm
Average diameter in both sexes is 6 mm
Divided into 3 parts

  • Prostatic (3 cm)
  • Membranous (1.5 cm)
  • Penile/spongiosa (15 cm)
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16
Q

Female Urethra

A

Very short
About 4 cm long
Corresponds to both the prostatic and membranous parts of the male urethra
Closely related to the anterior wall of the vagina

17
Q

Clinical significance

A

Renal radiology = two types:

  1. descending pyelography = intravenous
  2. ascending pyelography = retrogate

Foley catheter insertion

18
Q

Kidney blood supply

A 
Aorta 
Renal artery
Segmental artery
Interlobar artery
Arcuate artery
Interlobular artery
Afferent arteriole
Glomerulus
Efferent arteriole
Peritubular capillary/Vasa recta
Interlobular vein
Arcuate vein
Interlobar vein
Renal vein
19
Q

Blood Flow to the kidneys

A

in 24 hours - 1750 L blood passes
170-175 L is absorbed/filtered
1-3 million nephrons per kidney

20
Q

Nephron

A 
AA
PCT
Thick LoH
Thin LoH
DCT
Collecting tubule
Collecting ducts
EA
21
Q

Nephron

A

Bowman’s capsule= Collects filtrate, ultrafiltration

Proximal convoluted/straight tubules= Reabsorption

Loop of Henle= Hypertonic gradient

Distal straight/convoluted tubules= Acid base balance; Water balance; Absorption; Secretion

Collecting tubule and ducts= Reabsorption of water

22
Q

Nephron’s Epithelium

A

Bowmans capsule: parietal layer - capsular squamous epithelium
visceral layer - podocyte, basement membrane, fenestrated endothelium

Glomerulus

PCT cells: with microvilli, infolded PM, mitochondria

DCT cells: fewer mitochondria, fewer microvilli

LoH: thin segment cells

Collecting duct cells: principal cell, intercalated cell

23
Q

Types of Nephrons

A

Cortical
Has short nephron loop and glomerulus further from the corticomedullary junction
Efferent arteriole supplies peritubular capillaries

Juxtamedullary
Has long nephron loop and glomerulus closer to the corticomedullary junction
Efferent arteriole supplies vasa recta

24
Q

Filtration Membrane

A

podocytes: cell body; pedicels; filtration slits

slit membrane between pedicels

basal lamina

fenestrations of glomerular endothelial cells

25
Q

Juxtaglomerular complex

A

consists of:

  • juxtaglomerular cells/granular cells
  • macula densa cells
  • extraglomerular mesangial cells

It is where the most distal portion of the ascending loop of Henle or part of the distal convoluted tubule (DCT) lies between the afferent arteriole (feeding the glomerulus) and efferent arteriole (draining the glomerulus).
These structures are modified at the point of contact

26
Q

State the functions of the different cells in the JGA

A
  1. Granular or JG cells
    Enlarged smmu cells with prominent secretory granules called RENIN.
    Act as mechanoreceptors that sense the blood pressure in the afferent arteriole.
  2. Macula Densa
    Closely packed specialized cells lining the wall of the cortical thick ascending limb
    Sensitive to the concentration of sodium chloride in the late thick ascending limb.

These are chemoreceptors that respond to changes in the NaCl content of the filtrate.
The JG cells and macula densa are important in the regulation of the rate of filtration and systemic pressure.

  1. Extraglomerular mesangial cells
    The function remains unclear
27
Q

Tubuloglomerular Feedback

A

MAP increase:
increase RBF, GFR, Na+ to Macula dense => (NOS inhibition = decrease NO and adenosine release) Constriction if AA

MAP decrease:
decrease RBF, GFR, Na+ to macula densa => (NOS promotion = increase NO) DILATION of AA

Case 2 (9 decks)

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