Kidney Anatomy Flashcards
Are the kidneys intraperitoneal or retroperitoneal?
Retroperitoneal
What vertebral levels does each kidney lie between?
Left -> between T12-L2
Right -> L1-L3
What important muscles do the kidneys lie anterior to?
- Quadratus Lumborum
- Psoas Major
What vertebral level are the kidney hila at?
L1 (think of transpyloric plane)
What are the layers enveloping the kidneys?
Acronym = PR + PR
1. Kidney
2. Renal capsule
3. Perinephric fat
4. Renal fascia
5. Paranephric fat
What do the left and right gonadal veins drain into?
- Left gonadal vein drains into the Left Renal Vein at a 90 degree angle
- The right gonadal vein drains into the IVC
What is the relationship between the left renal vein and Nutcracker Syndrome?
- the left renal vein passes over the Aorta -> therefore can get compressed and lead to Nutcracker Syndrome
- also from the SMA which is anterior to the Left renal vein
What are symptoms of Nutcracker Syndrome?
- Varicocele
- Flank pain
- Haematuria (pissing blood)
What are causes of Nutcracker Syndrome?
- Aortic aneurysm
- Pregnancy
- Pancreatic tumour / Renal cell carcinoma
- Puberty growth
What does Varicocele present with?
- dull, aching pain -> worsened when standing or walking
- looks like bag of worms
- does NOT transilluminate
What structures pass through the Renal hilum?
Acronym = VAP
- Renal Vein
- Renal Artery
- Renal Pelvis
What are the muscles in the posterior abdominal wall?
- Quadratus Lumborum
- Psoas Major
- Iliacus
- Psoas Minor
if someone was stabbed in the back penetrating the kidney, it is likely that the Quadratus Lumborum was also pierced
What is the Psoas sign?
- positive sign indicates irritation of the peritoneal tissue surrounding psoas muscle -> indicates Appendicitis
What are the Ligaments fo the Diaphragm? and what structures pass through/underneath them?
- Median Arcuate ligament -> (Aortic hiatus stuff)
- Fibres arising from Crura of Diaphragm -> Splanchnic nerves
- Medial Arcuate ligament -> Sympathetic trunk
- Lateral Arcuate ligament -> Subcostal neurovascular bundle
What are the important nerves in the Lumbar plexus and what is their course with respect to the Psoas Major muscle?
- Genitofemoral nerve -> Anterior to Psoas m
- Lateral cutaneous nerve of thigh -> Superiorly and laterally to Psoas m
- Femoral nerve -> Inferiorly and laterally to Psoas m
- Obturator nerve -> Medially to Psoas m
Describe the course of the Renal Vasculature
Renal Artery (L1/L2) –> Segmental arteries –> Interlobar arteries –> Arcuate arteries –> Interlobular arteries –> Afferent arteriole –> Capillary network –> Efferent arteriole –> Interlobular veins –> Arcuate veins –> Interlobar veins –> Renal vein
What is the Renal Corpuscle comprised of?
- Glomerulus
- Bowman’s Capsule
- Mesangium
- Urinary Pole
What are the 3 cell types in the Renal Corpuscle
- Endothelial Cells (capillary walls)
- Mesangial Cells (connective tissue)
- Podocytes (filtration barrier) -> foot processes (blood filtered through the slits)
What is the Juxtaglomerular Apparatus responsible for?
responsible for controlling renin release to regulate blood pressure
What cells are a part of the Juxtaglomerular Apparatus? and what do they do?
Macula densa cells -> detect Na
Juxtaglomerular cells / Granular cells -> store + release renin
Mesangial cells -> selective vasoconstriction/dilation of afferent/efferent arterioles
Summary of Nephron
What is the function of the PCT? What are the major transporters? What epithelium?
Function:
- resorbs essential or organic nutrients, water and electrolytes
Major Transporters:
- SGLT-2
- Na+/H+ exchanger
- Na+/K+ ATPase
- GLUT1/GLUT2
Epithelium:
- Simple cuboidal/columnar with microvilli
What is the function of the DCT? What are the major transporters? What epithelium?
Function:
- Resorbs Na+ and Cl-
- Controls acid+base secretion
- Controls K+
Major Transporters:
- Na+/Cl- cotransporter
- Ca+ channels
- K+ ATPase
- H+/K+ ATPase
- Aquaporins
Epithelium:
- Simple cuboidal with shorter microvilli
What is the function Loop of Henle? What are the major transporters? Epithelium?
Function:
- Thin descending limbs = H2O resorption
- Thick ascending limbs = electrolyte resorption
Major transporters:
- remember NK2CL cotransporter
Epithelium
- Thin limb = simple cuboidal
- Thick limb = simple squamous
What is the epithelium in the collecting ducts?
Simple cuboidal epithelium
What is the function of the ureters? what are the 3 muscle layers?
Function = propel urine to bladder
3 Muscle Layers:
- Inner spiral (longitudinal)
- Outer spiral (circular)
- Outermost longitudinal (in lower third)
What is the epithelium of the ureter?
Transitional Epithelium
What are the 3 constrictions that Renal Stones can lodge into?
- Origin = Pelviuteric junction
- Pelvic Brim = crossing iliac artery
- Vesico Ureteric Junction = just before bladder
What are the 2 sphincters of the bladder and what is their neuronal control?
- Internal urethral sphincter -> autonomic control
- External urethral sphincter -> voluntary control
What is the epithelium for the bladder?
Transitional epithelium
What week does the urinary system develop?
4th week
What are the derivatives of Pronephros, Mesonephros and Metanephros?
Pronephros -> isnt patent
Mesonephros -> Gonads and Bowman’s Capsule
Metanephros -> Kidneys
What are the steps of the development of the Nephron?
- Mesenchymal cell condensation
- Epithelial vesicle
- Comma shaped body
- S shaped body
- Capillary Loop stage glomerulus
- Maturing glomerulus
CAKUT
Ones to Remember
- Polycystic Kidneys
- MCKD -> most fucked
- Cystic Kidneys
- Aplastic kidneys
