Chapter 8 - Renal Flashcards by Christy Clavillas

The three kidney sytems:

1 pronephros
2 mesonephros
3 metanephros

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Paired organ that connects the primitive mesonephros to cloaca?

Wolffian duct

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Outgrowth from the caudal Wolffian duct where the renal collecting system is derived from?

Ureteric bud

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Nephron is derived from

Metanephric mesoderm

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Failure of obliteration of allantois (patent urachus)

Urachal fistula (baby draining urine from the umbilicus)

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Allantois > urachus >

Median umbilical ligament

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Urogenital sinus

1 urinary bladder

2 urethra

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Babies can’t go potty in utero

Potter sequence

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Malformation of ureteric bud results in bilateral agenesis

Potter sequence

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Potter sequence presentation

1 limb deformities
2 facial deformities
3 pulmonary hypoplasia (oligohydramnios)

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T/F Potter is incompatible with neonatal life

True

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Unascended kidneys (can’t pass umbilical arteries)

Renal ectopy

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Presentation renal ectopy

1 pyelonephritis

2 renal stones

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Horseshoe kidney is trapped under inferior mesenteric artery, rare in females, if found usually associated with

Turner syndrome (in 7%)

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Most common presentation horseshoe kidney

UTI

Followed by: obstruction, hematuria, or abdominal pain&raquo_space; nephrolithiasis

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Renal fusion can occur as clinical feature of VACTERL syndrome

Vertebral
Anal
Cardiac
Tracheal
Esophageal
Renal
Limb

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Urinary system is derived from?

Intermediate mesoderm

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Retroperitoneal structures - SAD PUCKER

Suprarenal glands (adrenal glands)
Aorta/IVC
Duodenum (2,3,4 segments)

Pancrease (except tail)
Ureters
Colon (ascending and descending)
Kidneys
Esophagus
Rectum

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Muscles of posterior abdominal wall

Psoas major
Psoas minor
Iliacus
Quadratus lumborum

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Kidneys are located at the level of

i. Left kidney: T12-L3

ii. Right kidney: lower due to liver

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Kidneys are embedded in loose connective tissue called

Gerotas fascia

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Kidneys lymphatic drainage

Lumbar nodes

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Kidneys nerve supply

Thoracic splanchnic nerves

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Right gonadal vein drains into

IVC

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Left gonadal vein drains into

Left renal vein

Water under the bridge - ureters pass under

1. Gonadal artery 2. Uterine artery or 3. Vas deferens

Ureteral stones most commonly impact:

1. Ureter-renal pelvis junction (UPJ) 2. External iliac artery 3. Ureter-bladder junction (UBJ)

Ureters join the bladder at posterior-inferior portion forming the

Urinary trigone

Bladder is lined by

Transitional epithelium

Prostate stores and secretes ___________ making 25% of the semen volume

Alkaline fluid

Vas deferens joins the duct of the seminal vesicle to become the

Ejaculatory duct

Male urethra is lined by

1. Transitional epithelium (as it exits the bladder) 2. Pseudostratified columnar epithelium 3. Stratified squamous epithelium (near meatus)

Male urethra's four anatomic divisions:

1. Preprostatic 2. Prostatic 3. Membranous 4. Penile

Passes through prostate gland, receives semen from ejaculatory ducts and lined by transitional epithelium

Prostatic urethra

Membranous urethra is surrounded by striated muscle forming voluntary external urethral sphincter and produce viscous secretions from

Bulbourethral glands

The longest segment consisting of bulbous and pendulous sections and travels through the corpus spongiosum

Penile urethra

Penile urethra is surrounded by Littre glands that secretes mucus added to the semen and is lined by

1. Proximally: pseudostratified columnar epithelium | 2. Distally: stratified squamous epithelium

Female urethra is lined by

1. Stratified squamous | 2. Pseudostratified columnar epithelium

T/F Female urethra is also lined by Littre glands

True

The transitional zone of prostate expands forming

Benign prostatic hypertrophy

Most cancers of the prostate arise from ____________ and do not cause urinary retention until late.

Outer peripheral zone

Primary functional unit of the kidney

Nephron

Nephron is composed of

1. Renal corpuscle | 2. Tubular system

Filtration barrier of the renal corpuscle is composed of

1. Fenestrated capillary endothelium 2. Basement membrane 3. Slit diaphragms between foot processes of podocytes

Damage to the filtration barrier allows larger molecules like proteins to cross the urinary space resulting in

Proteinuria

Glomerulus

Fenestrated endothelium

Bowman capsule

1. Visceral layer (inner) | 2. Parietal layer (outer)

Proximal convoluted tubule (PCT)

Simple cuboidal epithelium with brush border

Thick descending loop of Henle and thick ascending loop of Henle

Simple cuboidal epithelium

Thin descending loop of Henle and thin ascending loop of Henle

Simple squamous epithelium

Distal convoluted tubule (DCT)

Simple cuboidal epithelium without brush border

Collecting tubules

Simple cuboidal epithelium

Collecting ducts

Columnar epithelium

Renal calyces

Transitional epithelium

Renal pelvis

Transitional epithelium

Ureters

Transitional epithelium

Visceral layer is an outer lining on glomerular capillaries and lined by

1. Podocytes | 2. Foot processes

Parietal layer forms the outer covering continuous with PCT and does not play a role in filtration and is lined by

Simple squamous epithelium

Found between parietal and visceral layers; filtrate collects here

Urinary space

Cardinal feature of nephrotic syndrome

Heavy proteinuria

"Workhorse of the nephron"; reabsorbs all glucose and amino acids and most of the Na, H2O, HCO3, Cl, PO3

Proximal convoluted tubule

Thick descending limb and thin descending limb

Impermeable to Na but allows passive resorption of H2O

Thin ascending limb and thick ascending limb

Impermeable to H2O but reabsorbs Na

"Diluting segment"; impermeable to H2O but reabsorbs Na

Distal convoluted tubules

Transport urine from nephron to hilum; Na is reabsorbed in exchange of K and H (influence aldosterone) and H2O is reabsorbed (influence ADH)

Collecting tubules

Receive urine from numerous nephrons

Collecting ducts

Establish the hypertonic gradient and regulates the production of concentrated urine

Loop of henle