Introduction Session 1 Flashcards
What vertebral levels are the kidneys?
Left higher mid 11/ T12- L2/3
Right end T12-L3/4
What vertebral level is the hilum of the kidneys normally?
L1
What length for the kidney is normal and when should a problem occur?
9-14 cm (men’s bigger)
<8cm length = chronic kidney disease
What is the renal angle?
Where the kidney can be palpated (tender if inflamed)
At back
Between 12th rib and erector spinae muscle
Layers surrounding the kidney
Paranephritic fascia
Posterior Renal fascia
Perinephritic fat
Renal capsule
Ureter route and segment
From kidney hilum pelviuretic junction (transitional zone) -> abdominal segment
L2 over gonadal vessels (bridge over water) (can be damaged at pelvic rim)
L4 pelvic segment - at sacroiliac joint over bifurcation of common iliac artery
Intramural segment (just below top of bladder) - Under uterine artery woman or vas deferens in men (water under the bridge)
Into bladder ureterovesicle junction
Positional variations of the ureter
Retrocaval position of the right ureter around the IVC (v rare)
Duplexed ureter - one not entering bladder (urinary incontinence)
Duplexed ureter - both entering bladder
Ectopic ureter - duplexed entering not bladder e.g. vagina/ urethra (urinary Incontinence)
What is the bladder trigone?
Smooth muscle triangle
Formed by 2 ureteric orifice and 1 internal urethral orifice/ meatus (external urethral meatus where urine/ semen leaves body)
V sensitive to expansion
Attaches the ureters to the bladder neck and urethra
What are the urinary sphincters and what’s their function?
Both internal (continuation of detrusor muscle) and external men and woman inhibit urination at the urethral meatuses
Men the internal also helps prevent backflow of semen/ retrograde ejaculation
What is the urogenital diaphragm?
Alongside the external urethral sphincter
Arteries and veins of the kidney and locations
Main going in - renal artery (from abdominal aorta) in hilum ->
in minor and major calyxs - anterior and posterior segmental arteries ->
Alongside renal pyramids/ in between lobes - interlobar arteries ->
( Afferent arterioles -> glomerulus-> efferent arterioles -> peritubular capillaries Supply O2 and nutrients to cortex or vasa Recta if juxtamedullary nephron supply medulla (-> interLOBULAR vein -> arcuate vein-> interlobar vein -> segmental vein -> renal vein -> IVC) )
Edge of renal pyramids - arcuate arteries ->
Branching off arcuate - interLOBULAR arteries ->
What’s the differences between cortical and juxtamedullary nephrons?
(90% nephrons) Cortical nephrons are short loops of henle (extends into outer region of the renal medulla), small glomerulus, forms renin for RAs, Forms peritubular capillary
Juxta nephrons have longer LOH (extends deeper into the inner medulla), big glomerulus, Doesn’t form renin, forms vasa Recta
What is vasa recta and what is it’s function
Capillary network from juxtamedullary nephrons that supplies blood to the medulla, maintains medullary interstitial gradient
Why are the kidneys so vulnerable to ischaemic damage?
They have the highest resting blood flow and cardiac output so if BP falls they are the first to fail
If kidneys are supplied by additional aberrant arteries where do they come from?
Superior mesenteric, suprarenal, testicular or ovarian arteries
