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Renal Week 1 > Lecture 3: Anatomy, Embryology and Imaging of the Kidneys > Flashcards

Lecture 3: Anatomy, Embryology and Imaging of the Kidneys Flashcards

1
Q

What is the functional unit of the kidney?

A

Nephron

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2
Q

How are kidneys positioned in the body?

A

Right kidney is LOWER than the left kidney because of liver

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3
Q

Which kidney is higher than the other?

A

Left kidney is higher than the right

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4
Q

What is BUN?

A

Blood Urea Nitrogen

Normal values = 8-20 mmol/L

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5
Q

What is the difference between acute and chronic kidney disease?

A

Acute = reversible
Chronic = irreversible
Symptoms are similar
Symptoms of kidney failure are subtle up until patients lose more than 90% of kidney function

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6
Q

How do you tell the difference between chronic and acute injury of kidneys?

A

Look at kidney size
Small size = chronic irreversible disease
Bigger = better

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7
Q

What are the general gross features of the kidney?

A

Retroperitoneal
Surrounded by fascia and adipose tissue
Superior border = T12
Inferior border = L3

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8
Q

Is there a safe place to do an anterior needle biopsy?

A

No because there are too many structures in the way

You want to biopsy posteriorly

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9
Q

What is the kidney’s anatomical relationship to the diaphragm?

A

Kidney is close to diaphragm and moves when you breath

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10
Q

What are the pertinent points regarding the anterior and posterior relationships of the kidneys?

A
  1. Most of the posterior and lateral aspects of the kidney are protected by muscle and adipose
  2. Difficult to access kidneys from anterior approach
  3. Percutaneous approach from back
  4. Kidneys are susceptible to blunt and penetrating injuries
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11
Q

What are the pyramids of the kidney?

A

Sections of the medulla

Triangular structure ends in minor calices

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12
Q

What are the renal columns of Bertin?

A

They are the areas in between the

Medullary pyramids

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13
Q

What are the minor and major calices?

A

Urine first starts collecting into minor calices

Drains into 3 major major calices

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14
Q

What is the renal pelvis?

A

The area where the three main renal major calices drain into

Pelvis will then drain into the ureter

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15
Q

What are the renal sinuses?

A

Space between minor/major calices

Contains fat and vessels

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16
Q

What is the base of the renal pyramid?

A

The thicker portion of the pyramid of the medulla

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17
Q

After the urine goes through the collecting tubule, where does it go?

A

Goes into the ducts of Bellini

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18
Q

Goes into the ducts of Bellini

A

The ducts that collecting ducts drain into

Will then turn into the summit of the papilla

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19
Q

What is the papilla?

A

The location where the medullary pyramids empty urine into the minor calyx of the kidney
Marked histologically by medullary collecting ducts converging to form a duct of Bellini
Transitional epithelium begins to be seen here
Latin for nipple (area of the converging point of the pyramids)

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20
Q

What is the route of urine transport?

A 
Pyramid (collecting ducts)
Ducts of Bellini (at papilla)
Minor calices
Major calices
Renal Pelvis 
Ureter
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21
Q

What is hydronephrosis?

A

The build up of fluid in the kidney due to obstruction

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22
Q

What supplies the kidney?

A

Renal artery

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23
Q

What are the characteristics of renal artery?

A 
Gives off first the inferior suprarenal artery
Then
Gives off five SEGMENTAL arteries (segmental because each supplies a particular segment):
	i. superior segmental artery
	ii. anterior superior segmental artery
	iii. anterior inferior segmental artery
	iv. Inferior segmental artery
	v. Posterior segmental artery
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24
Q

What happens if segmental artery is occluded?

A

That segment of the kidney will become infarcted
Approximately 20% of tissue could be lost
Can occur by
i. embolus
ii. coil embolization of segmental artery

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25
Q

What is the order of renal arteries?

A
  1. Main renal artery
  2. Segmental renal arteries
    i. superior
    ii. anterior superior
    iii. anterior inferior
    iv. inferior
    v. posterior
  3. InterLOBar arteries
  4. Arcuate arteries
  5. InterLOBULar arteries
  6. INTRAlobular arteries/arterioles
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26
Q

What are voiding related problems?

A

Inability to excrete urine

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27
Q

What are the characteristics of ureters?

A

Tubing that connects renal pelvis to urinary bladder
Runs downward and medial toward the FRONT of the psoas muscle
Abdominal part lies behind the peritoneum on medial part of psoas major
Opens into the fundus of the bladder
Can run anterior to common iliac artery

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28
Q

What are the characteristics of the ureter tubes?

A 
Thick walled narrow cylindrical tube
Composed of 3 coats
	i. fibrous
	ii. muscular
	iii. mucous coat
29
Q

How do ureters run into the bladder?

A

They run OBLIQUELY
Significance = if bladder contracts or overflows, the ureter opening into the bladder is very easily compressed and closed
If this lasts too long, it can obstruct the ureter

30
Q

What is a viscus?

A

Singular for viscera
Any large interior organ in any of the three great body cavities
Usually abdomen

31
Q

What are factors that can obstruct the ureters from within?

A
  1. kidney stones
    5mm needs an intervention
  2. tumors
  3. blood clot
32
Q

What are possibilities of extrinsic obstruction of the ureters?

A
  1. iliac artery aneurysm
  2. malignancies in adjacent structures such as lymph nodes/cervical cancer
  3. retroperitoneal fibrosis
  4. damage during surgery
  5. bladder disease
  6. congenital anomalies along course of ureters
33
Q

What are the key characteristics of the bladder?

A

A musculomembranous sac that acts as reservoir for urine

34
Q

What is the trigone?

A

The tips at which the ureters enter and the opening through which urine leaves (these 3 points = trigone)

35
Q

What is the muscle responsible for squeezing the urine?

A

The detrusor muscle

36
Q

What is the detrusor muscle?

A

The muscle that is responsible contracting bladder

37
Q

What are the layers of the bladder?

A
  1. mucosa
    i. transitional epithelium
    ii. Lamina propria
  2. submucosa
  3. detrusor muscle
  4. adventitia
38
Q

What are the key characteristics of the male urethra?

A 
Extends from internal urethral orifice in urinary bladder to external urethral orifice at end of penis
Up to 20 cm long
Divided into three portions
	i. prostatic
	ii. membranous
	iii. cavernous
39
Q

What are the three portions of the male urethra?

A
  1. prostatic
  2. membranous
  3. cavernous
40
Q

What are the key characteristics of the female urethra?

A
  1. narrow membranous canal
  2. 4cm long
  3. situated BEHIND the symphysis pubis
  4. imbedded in anterior wall of the vagina
    Easier to get UTI than males because it is about 16 cm shorter
41
Q

Where do the kidneys arise from?

A

The intermediate mesoderm

Differentiates to nephrogenic cord

42
Q

What is the relationship between the embryological formation of the urinary and reproductive systems?

A

They are viewed together because they both arise from common embryological origin
Both come from intermediate (lateral) mesoderm

43
Q

What are the three excretory organs that develop from the nephrogenic cord?

A
  1. Pronephroi
  2. Mesonephroi
  3. Metanephroi (permanent kidney)
44
Q

What are the characteristics of the pronephros?

A

Develops during 3rd week but regresses but 5th week

45
Q

What are the characteristics of the mesonephros?

A

Present at 3rd/4th week until the 12th week where it appears caudal to pronephros
Can make urine at 5th week
Consists of excretory tubules that contact a blood vessel medially and enter the mesonephric (Wolffian) duct laterally
In women, the mesonephros completely regress

46
Q

What does the mesonephros form in males?

A
  1. testes
  2. epididymal ducts
  3. vas deferens
47
Q

What are the key characteristics of the metanephros?

A

Develops at fifth week
Arises from mesenchymal nephrogenic blastema by ureteric bud
Ureteric bud induces nephron formation
After week 36, no nephrons being formed…architecture is complete

48
Q

What happens to premature babies?

A

Not enough nephrons are formed, since week 36 is when nephron formation is complete

49
Q

What happens after termination of nephrogenesis?

A

Growth
Differentiation
Remodeling of kidney tissue

50
Q

What induces the formation of nephrons?

A

The ureteric bud

51
Q

What is the metanephric blastema?

A

The mesenchyme
Secretes growth factors that induce
Growth of ureteric bud from caudal
Portion of mesonephric duct

52
Q

What are the characteristics of the ureteric bud (metanephrogenic diverticulum)?

A

Proliferates and responds by secreting growth factors that stimulates differentiation of metanephric blastema into glomeruli and kidney tubules
Undergoes mesenchymal to epithelial transition

53
Q

What are the derivatives of the ureteric bud?

A
  1. ureters
  2. minor calyces
  3. major calyces
  4. collecting tubules
  5. Ducts of Bellini
    Each of these are the result of ureteric bud differentiation or arborization
54
Q

What is the relationship between the mesenchyme and the ureteric bud?

A

Mesenchyme and ureteric bud reciporocally induce each other to form 1 million nephrons in kidney

55
Q

What happens if there is a premature division of the ureteric bud?

A

Duplication of urinary tract

Can even have two separate kidneys if premature division occurred early enough

56
Q

What are the derivatives of the metanephric blastema (mesenchyme)?

A
  1. podocytes covering glomerular capillaries
  2. epithelial cells lining Bowman’s capsule
  3. Proximal convoluted tubules
  4. Descending thick limb of LoH
  5. Thin limbs of LoH
  6. Ascending thick limbs of LoH
  7. DCT
    Basically all the portions of the glomerulus and nephrons
57
Q

Where do nephrons/glomeruli come from?

A

The metanephric mesenchyme or the metanephric blastema

58
Q

Where do the collecting ducts/major/minor calices/renal pelvis come from?

A

Ureteric bud which stems off the mesonephric duct

59
Q

What is aplasia?

A

Aplasia implies that one or both kidneys have failed to develop
If aplasia is bilateral, no urine production in fetus = severe oligohydramnios
Leads to Potter sequence

60
Q

What is the function of the kidney as an embryo?

A

Amniotic fluid is swallowed and reabsorbed by GI tract
Kidney excretes amniotic fluid to replenish the external amniotic fluid volume
Thus excretion = 1/3 of embryo’s amniotic fluid volume
If kidney’s don’t work or have undergone agenesis, then you get oligohydramnios (not enough amniotic fluid)

61
Q

What is oligohydramnios characterized by?

A

Less amniotic fluid than normal in amniotic cavity

Caused by baby’s inability to excrete amniotic fluid

62
Q

What is Potter’s sequence?

A 
The result of oligohydramnios as a consequence
Of in utero kidney dysfunction
Fetus has following features:
	i. sloped forehead
	ii. parrot beak nose
	iii. low slung ears
	iv. shortened fingers
	v. internal organ abnormalities
63
Q

How does the kidney migrate to its ultimate position?

A

Metanephric kidneys start at tail of embryo
Vascular buds from kidney grow toward and invade the common iliac arteries
Growth of embryo in length causes kidney to ascend to final position
Don’t drag blood supply with ascent
Sends out new, more cranial branches
Induces regression of more caudal blood vessels

64
Q

What are ectopic kidneys?

A

Kidneys in an incorrect position

All ectopic kidneys are malrotated

65
Q

What are malformations related to the ascent of the kidney?

A
  1. pelvic kidney
  2. horshoe kidney
  3. supernumerary arteries
66
Q

What are the characteristics of pelvic kidney?

A

Kidney stays in the pelvis rather than ascending

67
Q

What are the characteristics of horseshoe kidney?

A

Two developing kidneys fuse ventrally into a single horseshoe shape trapped in the abdomen by inferior mesenteric artery

68
Q

What are the characteristics of supernumerary arteries?

A

More than one renal artery per kidney
Often asymptomatic but can sometimes compress the ureter
Causes hydronephrosis
Can complicate kidney transplant donation (not good to donate)

Renal Week 1 (15 decks)

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