Kidneys

Question 1

Retroperitoneal

Lie on the ventral surface of quadrates lumborum

Lateral to PSOAS MUSCLE

covered directly by FIBROUS CAPSULE (true capsule)

Further surrounded by PERIRENAL FASCIA OF GEROTA (false capsule)

Answer 1

Kidneys

Question 2

Any fat outside the PERIRENAL space

Answer 2

Pararenal fat

Question 3

Structures in renal hilus (anterior to posterior)

Answer 3

Renal vein

Renal artery

Renal pelvis

Question 4

Upper pole

L1 (lower because of the liver)

Related to 12th rib, liver, duodenum, hepatic flexure if the colon

Answer 4

Right kidney

Question 5

Upper pole

T12

Related to 11th rib & 12th ribs, pancreas, spleen, splenic flexure of the colon

Answer 5

Left kidney

Question 6

Internal structure of the kidneys

Answer 6

Outer cortex

Inner medulla

Collecting system

Question 7

Directly below the renal capsule

Extends between the pyramids as rentals columns of Bertin

Answer 7

Outer cortex

Question 8

5-11 renal pyramids (pyramids of Malpighi)

Tips terminate as 5-11 renal papillae

Answer 8

Inner medulla

Question 9

5-11 minor calyces (cup-shaped, surround each renal papilla)

2-3 major calyces formed by fusion of minor calyces

Answer 9

Collecting system

Question 10

Main urine collection chamber, continuous with ureter at ureteropelvic junction

Answer 10

Renal pelvis

Question 11

Vascular supply

Answer 11

Renal artery ➡️ 5 segmental arteries (4 anterior & 1 posterior)

Interlobar arteries

Arcuate arteries

Question 12

Branches of segmental artery that enters a renal column

Answer 12

Interlobar arteries

Question 13

Branches of Interlobar artery, found between the cortex & medulla at corticomedullary junction

Answer 13

Arcuate arteries

Question 14

Branches of Arcuate artery, found within cortex, terminate as afferent arterioles

Answer 14

Interlobar artery

Question 15

During their ascent they rotate 90% medially, so the renal hilus is oriented medially

Answer 15

Rotation of the kidney

Question 16

Fetal metanephros - location in the sacral region

Due to disproportionate growth of the embryo caudal to the metanephros

Answer 16

Ascent of the kidney

Question 17

Inferior pole fuse & becomes trapped behind inferior mesenteric artery during ascent

Answer 17

Horseshoe kidney

Question 18

Ureteric bud divides prematurely

Answer 18

Duplication of renal pelvis & ureter

Question 19

Autosomal dominant

Multiple large cysts

SSX: bilateral flank masses, hypertension, renal failure, recurrent pyelonephritis, hepatic cysts, berry aneurysms of the circle of Willis

Answer 19

Adult polycystic kidney disease (APKD)

Question 20

Small granulomas in the cortex, near glumeruli ➡️ renal papillae, minor calyces

Usually proceeds from the kidney to the bladder

(vs schistosomiasis - from bladder to kidney)

Answer 20

Genitourinary tuberculosis

Question 21

Associated with vesicoureteral reflux in children

Reflux of infected urine from bladder to kidneys

Answer 21

Chronic pyelonephritis (reflux nephropathy)

Question 22

Arise from proximal convoluted tubule

Associated with Von Hippel-Lindau disease

Resistant to chemo due to P-glycoprotein or multi drug resistant gene

May thrombose the renal vein or IVC

SSX: hematuria , flank pain, left testicular varicocele, flank mass

Answer 22

Renal cell CA

Question 23

Fracture of lower ribs

Transverse process of lumbar vertebra

Gunshot or stab wound over lower rib cage

SSX: pulsatile/expanding retroperitoneal hematoma, hypotension, hematuria

• *** R kidney - ass. Liver trauma
• *** L kidney - ass. Spleen trauma

Answer 23

Kidney trauma

Question 24

Surgical approach

Answer 24

Below & parallel to the 12th rib

Question 25

Defines the PERIRENAL space that contains the ff:

-kidneys, adrenal gland, ureter, gonadal artery & vein, perirenal fat

Answer 25

GEROTA’s fascia