REB 12. Kidney, Adrenal, Ureter Flashcards
Where are the hila of the kidneys located?
L1 - transpyloric plane
What muscles are the kidneys anterior to?
- psoas minor
- psoas major
- quadratus lumborum
What nerves run posterior to the kidneys, but anterior to the muscles of the back?
[1] Subcostal Nerve (T12)
- runs below the 12th rib
[2] Iliohypogastric Nerve (L1)
[3] Ilioinguinal Nerve (L1)
Where is the kidneys located taken into consideration the peritoneal cavity?
it is retroperitoneal
What vertebral level does the abdominal aorta enter the diaphragm at?
T12
Why is there a difference between the right and left kidneys in height? Where does each kidney reach up to?
- the right kidney is lower than the left kidney because of the liver
- right kidney goes up to 11th intercostal space
- left kidney goes up to 11th rib
What is the renal angle?
it is the angle between the 12th rib and the transverse processes (or erector spinae muscles)
What are some of the relations of the right kidney?
- peritoneum and liver (superiorly)
- duodenum (medially)
- adrenal glands (superior + anterior)
- colon (inferior + anterior)
- hepatic flexure (anterior)
What are some of the relations of the left kidney?
- peritoneum, lesser sac and stomach (anterior)
- spleen (anterior)
- splenic artery (anterior)
- pancreas (medial + anterior)
- transverse colon (lateral + anterior)
- peritoneum + small intestine (inferior + anterior)
- splenic flexure (lateral + anterior)
Since the kidneys are not fully covered by peritoneum, they have 3 supportive tissues which are: (from outside in)
[1] Renal (Gerota's) Fascia [2] Adipose Capsule - Perirenal Fat - Pararenal Fat [3] Renale Capsule
What is Renal (Gerota’s) Fascia?
it is a dense fibrous connective tissue that anchors the kidney
What is the Adipose Capsule?
it cushions the kidney and helps attach it to the body wall: perirenal and pararenal fat
What is the Renal Capsule?
it adheres to the kidney surface and prevents infections in surrounding regions from spreading to kidneys
What is in the hila of the kidneys?
the hilum contains the ureter, renal blood vessels, lymphatics and nerves
Renal Vein: superficial/anterior
Renal Artery: middle
Ureter: deepest/posterior
What is the blood supply of the hila of the kidneys?
[1] Renal Artery (L2)
[2] Segmental Arteries
- 4x segmental arteries anterior
- 1x segmental artery posterior
What are the parts of the kidney? (Name the internal parts and give a short description)
[1] Renal Cortex
- superficial, contact with capsule, granular tissue
[2] Renal Medulla
- exhibits cone-shaped medullary (renal) pyramids
[3] Renal Columns
- inward extensions of cortical tissue that separate the pyramids
[4] Minor Calyx
[5] Major Calyx
[6] Renal Pelvis
[7] Ureter
[8] Renal Papilla (apex of renal pyramid)
How does urine get drained out of the kidney? What structures does it pass through (in order)?
[1] Renal Medulla [2] Renal Papilla [3] Minor Calyx [4] Major Calyx [5] Renal Pelvis [6] Ureter
What constitutes a lobe in the kidney?
the medullary pyramid and its surrounding capsule
About how long are the ureters?
30 cm
What is the blood supply of the ureters?
[1] branches of Renal Artery
[2] Gonadal Arteries
[3] Superior Vesical Arteries
[4] Inferior Vesical Arteries
What cell type is the ureter made up of? Why?
Transitional Epithelium because it is
(a) waterproof
(b) distensible
What is the nerve supply of the ureter? Which area of the body is pain referred to?
Renal Plexus
- pain referred to small of back, lumbar region and genitals
What are the 3 constriction points of the ureter that kidney stones may arise in?
[1] Ureteropelvic Junction/Pelvi-ureteric Junction (PUJ)
[2] Pelvic Inlet (passes pelvic brim)
[3] Entrance to Bladder
What structures do the ureters pass down on their descent?
[1] tips of transverse processes of L1 to L5
[2] sacroiliac joint
[3] enters bladder at level of ischial spine
What level does the ureter enter the bladder?
level of ischial spine
What is another name for kidney stones?
urinary calculi
What are the majority of kidney stones made up of?
Main: Calcium Oxalate
- sometimes phosphate
(should appear on plain X-ray film)
What are the minority of kidney stones made up of?
- urate, cystine and struvite
- these may not appear on plain X-ray film
What are the 2 main layers that the adrenal gland has? Name the sublayers too!
[1] Cortex (outer) - Zona Glomerulosa (aldosterone) - Zona Fasciculata (cortisol) - Zone Reticularis (DHEA - androgen) [2] Medulla (inner) - has chromaffin cells which produce catecholamines
What does the medulla of the adrenal gland contain?
Chromaffin Cells to produce adrenaline and noradrenaline (catecholamines)
What are some clinical conditions related with the cortex of the adrenal glands?
[1] Cushing’s Syndrome
- overproduction of cortisol leading to increased BP
[2] Conn’s Disease
- rare; overproduction of aldosterone
[3] Addison’s Disease
- steroids are not produced to enough levels
What is Cushing’s Syndrome?
overproduction of cortisol leading to increased BP
What is Conn’s Disease?
rare; overproduction of aldosterone
What is Addison’s Disease?
steroids are not produced to enough levels
What is a clinical condition related with the medulla of the adrenal glands?
Phaeochromocytoma (Neuroendocrine) - medullary tumour (due to overproduction of catecholamines)
What is Phaeochromocytoma?
medullary tumour (due to overproduction of catecholamines)
What is the main venous drainage of the right suprarenal gland?
suprarenal vein drains directly into the IVC
What is the main venous drainage of the left suprarenal gland?
suprarenal vein drains into the left renal vein and then the IVC
What arteries are involved with the suprarenal gland?
[1] Superior Suprarenal Artery (branch of Inferior Phrenic Artery)
[2] Middle Suprarenal Artery (directly off of abdominal aorta)
[3] Inferior Suprarenal Artery (branch of the renal artery)
What vertebral level does the gonadal arteries come off of the abdominal aorta?
L2
What are 3 types of kidney defects?
[1] in utero, kidney develops in pelvis and ascends, but if this doesn’t occur, it stays in the pelvis
- asymptomatic
- usually at the level of the bifurcation of common iliac
[2] kidneys do not separate upon ascent and so, it is combined by the isthmus
- they still have ureters and renal arteries
[3] the ureters get duplicated (more common in females than males)
- incomplete and complete duplication
- incomplete duplication is more common (ureters join before entering bladder)
What is a bifid ureter?
It is when there is 2 ureters coming out of 1 kidney
What is Vesico-Ureteric Reflux?
- most commonly congenital
- it is due to the abnormal backwash of urine from the bladder to the upper kidney
- associated with recurrent UTIs
What is hydronephrosis?
the distension and swelling of kidney due to blockage or obstruction
- urine cannot exit the kidney
Where does the Superior Suprarenal Artery arise from?
Inferior Phrenic Artery
Where does the Middle Suprarenal Artery arise from?
Abdominal Aorta
Where does the the Inferior Suprarenal Artery arise from?
Renal Artery
