MSAP Renal Anatomy

Question 1

Functions of the Kidney

Answer 1

• Excretion (waste removal)
• BP regulation (by renin angiostensin - system)
• Vitamin D activation (hydroxylation)
• Blood volume regulation (water conserving or eliminating)
• Red cell production
• Plasma modification (NA, K, CL, P)

Question 2

Anatomy and location of the Kidneys

Answer 2

Paired retroperitoneal organs (behind the peritoneal)

between the peritoneum and posterior abdominal wall

• Between T12-L3 vertebral levels

Question 3

Why is the RT kidney lower than the LT?

Answer 3

The liver is on top of the RT kidney

Question 4

What brings blood to the kidneys?

Answer 4

The abdominal aorta

Question 5

Common Illiac veins

Answer 5

Common iliac veins (receives blood from RT and LT kidney) come together to form IVC

Question 6

What does the upper part of the LT kidney sit on?

Answer 6

llth rib on the LT side

Question 7

What does the upper part of the RT kidney sit on?

Answer 7

sits on the 12^th rib

Question 8

Hilus

Answer 8

Medially located

Port of entry for the renal artery

• Port of exit for the renal vein and ureter

Question 9

Renal lobe

Answer 9

renal pyramid and cortical structures overlying the pyramid

Question 10

Renal Lobule

Answer 10

each collecting duct and the nephrons it drains (A medullary ray and surrounding cortical tissue)

Question 11

Path of urine

Answer 11

Urine formed in nephron–> drains into collecting ducts–> Minor calyces join together to make the major calcyces–> renal pelvis–>out ureter

Question 12

Glomerulus

Answer 12

Tuft of capillaries

The sit of filtration of the plasma

Question 13

Glomerular/Bowman’s capsule

Answer 13

Double layered conduit into which the filtered plasma enters: Parietal layer and Visceral layer

Question 14

Renal tubules

Answer 14

• proximal convoluted tubule
• Loop of Henle; thick descending limb; think ascending limb (countercurrent mechanism that removes sodium and other ions as necessary)
• Distal convoluted tubule (blood is sensed in this area to determine if there is sufficient water coming out)

Question 15

Juxtamedulllary Nephron

Answer 15

few

Renal corpuscles (in the inner cortex near the medulla)

Loop of Henle (long and extension deep into the medulla)

Long loop means more water is forced to leave the LOH and back into the blood system

Question 16

Cortical Nephrons

Answer 16

The majority

Renal corpuscles (in the outer part of the cortex)

Loop of Henle (Short and located mainly in the cortex with superficial extension into the medulla)

Question 17

Cortical Collecting Ducts

Answer 17

Each DCT (distal convoluted tubules) empties into colleting tubules in the cortex

Question 18

Medulallary Collecting Ducts

Answer 18

In the medulla the smaller collecting tubules join the collecting ducts; at the apex of the renal pyramid they joint the larger ducts, Papillary ducts or ducts of Bellini

Question 19

Renal Cortex

Answer 19

Proximal and Distal convoluted tubules

Renal Glomeruli

Question 20

Afferent arteriole

Answer 20

blood towards glomerulus

Question 21

tuft of capillaries

Answer 21

responsible for producing filtrate that will become urine

Question 22

efferent arteriole

Answer 22

Blood leaving from the glomerulus

Question 23

Parietal layer of bowman’s capsule

Answer 23

covers inside of capsular space

Question 24

Visceral layer of bowman’s capsule

Answer 24

covers the capillaries

Question 25

proximal convoluted tubule

Answer 25

Filtrate released from the glomeruli leave via the proximal convoluted tubule; composed of cuboidal cells with microvilli at their apical surfaces

Question 26

Renal Medulla

Answer 26

Absence of renal corpuscles

Loops of Henle

Medullary collecting ducts

Question 27

Intrarenal arteries

Answer 27

Renal artery–>splits into lobar arteries near the hilus of the kidney–> splits again to give an interlobar artery–> turns at 90 degree angle and it becomes the arcuate artery–>gives rise to the interlobular artery which go into the lobules of the kidney

Question 28

Ureters

Answer 28

• From the kidneys to the bladder
• The muscular conduit for urine
• Paired retroperitoneal muscular tube
• Epithelium= transitional (found in the ureters and bladder); when the bladder needs to expand the cells can reform themselves (rearrange and stretch) ( goes from 6 layers deep down to 4 layers deep); intact apical layer to maintain structural integrity of bladder
• Urine is squeezed into the bladder by peristalsis by ureters

Question 29

Urethral sphincters innervations and function

Answer 29

Internal Urethral Spincter

located at the neck of the bladder

autonomic innervation

Detrusoor

smooth muscle contracts to squeeze urine out

autonomic innervation

Sphincter Urethrae (External urethral Sphincter)

skeletal muscle (voluntary)

innervated by the pudendal nerve

Question 30

Ureter Constriction Sites

Answer 30

3 constrictions:

At the UPJ (uretopelvic junction): between the ureter and renal pelvis

At the pelvic brim: as it enters the pelvic outlet

At the UVJ (uretovesical junction): the port of entry of the ureters into the bladder wall

Question 31

Clinical Correlation: Renal Calculi and the symptoms experienced by the patient

Answer 31

Calculi are also known as kidney stones

Calculi can become urter constriction sites

Smooth muscle in the walls of the ureters contract forcefully in an effort to move the stone and this results in excruciating pain

Ureters lie close to the gonadal vessels and may be ligated accidentally in surgeries such as hysterectomy (removal of the uretus)

Question 32

Bladder and its function

Answer 32

Location: Pelvic visceral structure; anchored at its neck by the pubovesical ligament (Female) and puboprostatic ligaments (Male)

Posterior to the pubic symphysis and separated from it by the retropubic space

Function: a temporary reservoir for the urine

Bladder interior: Fundus, body, ureteric orifice’s, trigone, neck, uvula

Bladder Trigone-smooth area of the bladder in the non-distended state

Ureters- open into the posterior, inferolateral aspect of the bladder

Urethra- commences at the neck of the bladder

Question 33

Female Urethra

Answer 33

Internal and external urethral sphincter; close together

• Shorter and wider
• Close to vagina and rectum
• Prone to infection (honeymoon cystitis)

Question 34

Male Urethra

Answer 34

Internal urethral sphincter above prostate gland just at neck of bladder

external urethral sphincter is inferior aspect of the prostate

Different portions of male urethra: prostatic uretha, membranous urethra, and penile urethra

Question 35

Urethral Injuries

Answer 35

Common in males

Frequently in the bulbous urethra

Usually due to trauma (ex. Bicycle injury)