Lecture 1 - intro

Question 1

Location of kidneys

Answer 1

Retroperitoneal

Left kidney - T11 - L2 (12th rib)
Right kidney - T12 - L3

Right kidney is slightly lower due to the liver

Question 2

At what spinal level is the kidney hilum located at?

Answer 2

L1

Question 3

Functions of the kidney

Answer 3

Regulates:

• blood pressure
• blood pH - produces HCO3-

Produces:

• EPO
• renin - Activates RAAS
• prostaglandins

Excretes:

• hepcidin
• phosphate
• H+
• K+
• excess fluid
• urea

Reabsorbs:

• Na+
• glucose

Other:
Activates vitamin D
Metabolises drugs
Breaks down insulin and PTH calcitonin

Question 4

What does the kidneys rest on?

Answer 4

Psoas major
Posterior aspect of the diaphragm
Quadratus lumborum
Transversus abdominis

Question 5

Anterior relations of the right kidney

Answer 5

Hepatic flecture of colon
Ascending duodenum
Suprarenal gland

Question 6

Anterior relations of the left kidney

Answer 6

Splenic flecture 
Stomach 
Spleen
Pancreas
Adrenal glands

Question 7

Bony landmarks for ureters

Answer 7

Sacroiliac joints

Ischial spine

Question 8

Ureters

Answer 8

Smooth muscular tube that propels the urine to the bladder in peristaltic waves

25- 30 cm long

Beyond the pelviureteric junction divide into:

• proximal (abdominal)
• middle (pelvic)
• distal (intramural)

Question 9

Bladder

Answer 9

Stores urine

Question 10

Arterial blood supply of the kidneys

Answer 10

Left and right renal arteries via the hilum
(from the abdominal aorta)

Divides into:

• segmental arteries (5)
• interlobar arteries - between renal pyramids
• arcuate arteries - between cortex and medulla
• interlobular arteries
• afferent arterioles
• glomerulus
• efferent arterioles
• peritiubular capillaries / vasa recta

Then to renal veins ( in reverse order)

Question 11

Size and weight of kidney

Answer 11

6- 7 cm wide
9 - 14 cm high - if less CKD

A discrepancy of 2+ cm between the kidenys should be investigated

170 - 210g

Question 12

Retroperitoneal organs

Answer 12

Suprarenal glands
Abdominal aorta and IVC
Duodenum 
Pancreas
Ureters and bladder
Colon (ascending and descending)
Kidneys
Esophagus
Rectum

Question 13

Layers of the kidney

Answer 13

Paranephric fat
Renal fascia - Gerota's fascia
Perinephric fat - surrounds the kidney within the renal fascia 
Renal capsule
Cortex
Medulla
Pelvis

Question 14

Water under the bridge

Answer 14

Ureters lie underneath the gonadal arteries

Question 15

Intramural segment of the ureters

Answer 15

Ureters enter the bladder obliquely at the vesicoureteric junction (no sphincter)

Enters lower down in the bladder so that the detrusor muscles can contract and create a flap to prevent back flow

Question 16

3 common sites of renal stones

Answer 16

1. Vesicoureteric junction
2. Pelvic brim
3. Pelviureteric junction

Question 17

Bladder wall

Answer 17

Lumen covered in urothelium
Circular muscles
Longitudinal muscle
Adventitia (serosa)

Question 18

Pouches

Answer 18

Men: Rectovesical pouch only

Women: rectovesical pouch and vesicouterine pouch (pouch of Douglas)

Question 19

Urinary retention

Answer 19

Detrusor muscle becomes thinner and loses its elasticity

Question 20

Name of the remnant of the allantois

Answer 20

urachus

Question 21

How long is a urethra is men and women

Answer 21

Men - 15cm

Women - 4cm

Question 22

Divisions of the urethra in males

Answer 22

Pre-prostatic urethra
Prostatic urethra
Membranous urethra
Bulbous urethra
Spongy (penile) urethra 
Navicular fossa
External urethral meatus

Question 23

Parts of the kidney

Answer 23

Cortex - outer (where glomerulus is)
Medulla - inner
Renal pyramid - section of medulla
Renal lobe - section of medulla and cortex
Renal pelvis
Major calyx
Minor calyx
Renal papilla - where pyramids empty into minor calyx
Renal columns - cortex inbetween medullary pyramids

Question 24

Parts of a nephron tubule

Answer 24

Bowman's capsule 
Proximal convuluted tubule
Descending limb
Loop of Henle
Ascending limb 
Distal convuluted tubule 
Collecting duct

Question 25

What aspects of the nephron are in the renal cortex?

Answer 25

``` Bowman's capsule Glomerulus Proximal convuluted tubule Distal convuluted tubule Collecting duct ```

Question 26

What aspects of the nephron are in the renal medulla?

Answer 26

Loop of Henle = Descending limb + Ascending limb | Collecting duct

Question 27

Glomerulus

Answer 27

Tuft of capillaries between the afferent and efferent arteriole

Question 28

Efferent arterioles

Answer 28

Make up a dense peritubular network of capillaries that supplies the tubule with O2 and nutrients In juxtamedullary glomeruli - the efferent arteriole descends into the renal papillae to form the vasa recta and supply the tubules in the medulla (10%)

Question 29

Arcuate arteries

Answer 29

Small branches of the arcuate arteries supply the juxtomedullary glomeruli

Question 30

Cortical nephrons

Answer 30

``` 90% of nephrons Short loops of Henle In outer part of cortex Small glomerulus The afferent arteriole diameter is larger than the efferent Forms pertibular capillary Rich sympathetic innervation High concentration of renin - produced by granular cells ```

Question 31

Juxtamedullary nephrons

Answer 31

``` 10% of nephrons Long loops of Henle In inner part of cortex next to the medulla Large glomerulus Afferent arteriole diameter = efferent arteriole Forms vasa recta Poor sympathetic innervation Low concentration of renin ```

Question 32

Landmark for renal artery

Answer 32

Superior mesenteric artery

Question 33

Ischaemic damage

Answer 33

The kidney takes 22% of cardiac output therefore more vulnerable to ischaemic damage

Question 34

Left gonadal vein

Answer 34

Drains into the left renal vein before draining into the IVC

Question 35

Loop of Henle

Answer 35

Descending and ascending limb

Question 36

Juxtaglomerular complex

Answer 36

Between the distal convoluted tubule and afferent arteriole Contain: Macula densa cells Juxtaglomerular cells Extraglomerular mesangial cells