Kidney

Question 1

Anterior relationships of kidneys

Answer 1

Right:

1) Right suprarenal gland
2) Duodenum
3) Right colic flexure
4) Liver

Left:

1) Left suprarenal gland
2) Stomach
3) Left colic flexure
4) Spleen
5) Pancreas
6) Jejunum

Question 2

Posterior relationships of kidney

Answer 2

1) Diaphragm
2) 11th and 12th ribs
3) Quadratum lumborum, Psoas major muscle, Transversus abdominis
4) Subcostal, Iliohypogastric and Ilioinguinal nerves

Question 3

Coverings of kidney

Answer 3

Function:

1) Support kidney
2) Holds kidney in place (posterior abdominal wall)

Covering layers:

1) Renal capsule – tough fibrous capsule
2) Perinephric fat – collection of extraperitoneal fat
3) Renal fascia – encloses the kidneys and suprarenal glands
4) Pararenal fat – mainly located on posterolateral aspect of kidney
5) Transversalis fascia

Question 4

Renal hilum contents

Answer 4

1) Renal vein
2) Renal artery
3) Ureter
4) Lymphatic vessels
5) Sympathetic nerves

Question 5

Nut cracker syndrome

Answer 5

Left renal vein is found between the Superior Mesenteric artery (SMA) and aorta

SMA may compress the left renal vein, which can also affect other vessels emptying into the left renal vein (e.g. ovarian/testicular veins; leading to swelling of left testicle)

Question 6

Arterial supply

Answer 6

1) Right/Left Renal artery (L2)
2) 5 Segmental arteries
3) Lobar arteries
4) Interlobar arteries
5) Arcuate arteries – arches above base of pyramids
6) Interlobular arteries – ascends into cortex and give rise to afferent arterioles (glomerulus)

Segmental arteries:

1) 4 anterior (apical, anterior superior, anterior inferior, caudal)
2) 1 posterior

Question 7

Venous supply

Answer 7

1) Right/Left renal vein
2) Renal veins
3) Interlobar veins
4) Arcuate veins
5) Interlobular veins

Left renal vein:

• Enters IVC superior to right renal vein
• 3x longer than right renal vein
• Receives tributaries from:
  1) Inferior phrenic vein
  2) Suprarenal vein
  3) Left Gonadal vein

Right renal vein:
- Posterior to descending duodenum (2nd part) and head of pancreas

Question 8

Lymphatic drainage

Answer 8

Drain into the right and left lumbar lymph nodes (caval and aortic)

Question 9

Innervation

Answer 9

Sympathetic innervation (post-ganglionic fibres T10-T12):

1) Renin release from juxtaglomerular cells (Beta-1 adrenoceptor)
2) Vasoconstriction of arterioles