Kidneys Flashcards
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)
Kidneys
Any fat outside the PERIRENAL space
Pararenal fat
Structures in renal hilus (anterior to posterior)
Renal vein
Renal artery
Renal pelvis
Upper pole
L1 (lower because of the liver)
Related to 12th rib, liver, duodenum, hepatic flexure if the colon
Right kidney
Upper pole
T12
Related to 11th rib & 12th ribs, pancreas, spleen, splenic flexure of the colon
Left kidney
Internal structure of the kidneys
Outer cortex
Inner medulla
Collecting system
Directly below the renal capsule
Extends between the pyramids as rentals columns of Bertin
Outer cortex
5-11 renal pyramids (pyramids of Malpighi)
Tips terminate as 5-11 renal papillae
Inner medulla
5-11 minor calyces (cup-shaped, surround each renal papilla)
2-3 major calyces formed by fusion of minor calyces
Collecting system
Main urine collection chamber, continuous with ureter at ureteropelvic junction
Renal pelvis
Vascular supply
Renal artery ➡️ 5 segmental arteries (4 anterior & 1 posterior)
Interlobar arteries
Arcuate arteries
Branches of segmental artery that enters a renal column
Interlobar arteries
Branches of Interlobar artery, found between the cortex & medulla at corticomedullary junction
Arcuate arteries
Branches of Arcuate artery, found within cortex, terminate as afferent arterioles
Interlobar artery
During their ascent they rotate 90% medially, so the renal hilus is oriented medially
Rotation of the kidney
Fetal metanephros - location in the sacral region
Due to disproportionate growth of the embryo caudal to the metanephros
Ascent of the kidney
Inferior pole fuse & becomes trapped behind inferior mesenteric artery during ascent
Horseshoe kidney
Ureteric bud divides prematurely
Duplication of renal pelvis & ureter
Autosomal dominant
Multiple large cysts
SSX: bilateral flank masses, hypertension, renal failure, recurrent pyelonephritis, hepatic cysts, berry aneurysms of the circle of Willis
Adult polycystic kidney disease (APKD)
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)
Genitourinary tuberculosis
Associated with vesicoureteral reflux in children
Reflux of infected urine from bladder to kidneys
Chronic pyelonephritis (reflux nephropathy)
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
Renal cell CA
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
Kidney trauma
Surgical approach
Below & parallel to the 12th rib
Defines the PERIRENAL space that contains the ff:
-kidneys, adrenal gland, ureter, gonadal artery & vein, perirenal fat
GEROTA’s fascia
