REB 12. Kidney, Adrenal, Ureter

Question 1

Where are the hila of the kidneys located?

Answer 1

L1 - transpyloric plane

Question 2

What muscles are the kidneys anterior to?

Answer 2

• psoas minor
• psoas major
• quadratus lumborum

Question 3

What nerves run posterior to the kidneys, but anterior to the muscles of the back?

Answer 3

[1] Subcostal Nerve (T12)
- runs below the 12th rib
[2] Iliohypogastric Nerve (L1)
[3] Ilioinguinal Nerve (L1)

Question 4

Where is the kidneys located taken into consideration the peritoneal cavity?

Answer 4

it is retroperitoneal

Question 5

What vertebral level does the abdominal aorta enter the diaphragm at?

Answer 5

T12

Question 6

Why is there a difference between the right and left kidneys in height? Where does each kidney reach up to?

Answer 6

• 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

Question 7

What is the renal angle?

Answer 7

it is the angle between the 12th rib and the transverse processes (or erector spinae muscles)

Question 8

What are some of the relations of the right kidney?

Answer 8

• peritoneum and liver (superiorly)
• duodenum (medially)
• adrenal glands (superior + anterior)
• colon (inferior + anterior)
• hepatic flexure (anterior)

Question 9

What are some of the relations of the left kidney?

Answer 9

• 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)

Question 10

Since the kidneys are not fully covered by peritoneum, they have 3 supportive tissues which are: (from outside in)

Answer 10

[1] Renal (Gerota's) Fascia
[2] Adipose Capsule 
- Perirenal Fat
- Pararenal Fat 
[3] Renale Capsule

Question 11

What is Renal (Gerota’s) Fascia?

Answer 11

it is a dense fibrous connective tissue that anchors the kidney

Question 12

What is the Adipose Capsule?

Answer 12

it cushions the kidney and helps attach it to the body wall: perirenal and pararenal fat

Question 13

What is the Renal Capsule?

Answer 13

it adheres to the kidney surface and prevents infections in surrounding regions from spreading to kidneys

Question 14

What is in the hila of the kidneys?

Answer 14

the hilum contains the ureter, renal blood vessels, lymphatics and nerves

Renal Vein: superficial/anterior
Renal Artery: middle
Ureter: deepest/posterior

Question 15

What is the blood supply of the hila of the kidneys?

Answer 15

[1] Renal Artery (L2)
[2] Segmental Arteries
- 4x segmental arteries anterior
- 1x segmental artery posterior

Question 16

What are the parts of the kidney? (Name the internal parts and give a short description)

Answer 16

[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)

Question 17

How does urine get drained out of the kidney? What structures does it pass through (in order)?

Answer 17

[1] Renal Medulla
[2] Renal Papilla
[3] Minor Calyx
[4] Major Calyx
[5] Renal Pelvis
[6] Ureter

Question 18

What constitutes a lobe in the kidney?

Answer 18

the medullary pyramid and its surrounding capsule

Question 19

About how long are the ureters?

Answer 19

30 cm

Question 20

What is the blood supply of the ureters?

Answer 20

[1] branches of Renal Artery
[2] Gonadal Arteries
[3] Superior Vesical Arteries
[4] Inferior Vesical Arteries

Question 21

What cell type is the ureter made up of? Why?

Answer 21

Transitional Epithelium because it is

(a) waterproof
(b) distensible

Question 22

What is the nerve supply of the ureter? Which area of the body is pain referred to?

Answer 22

Renal Plexus

- pain referred to small of back, lumbar region and genitals

Question 23

What are the 3 constriction points of the ureter that kidney stones may arise in?

Answer 23

[1] Ureteropelvic Junction/Pelvi-ureteric Junction (PUJ)
[2] Pelvic Inlet (passes pelvic brim)
[3] Entrance to Bladder

Question 24

What structures do the ureters pass down on their descent?

Answer 24

[1] tips of transverse processes of L1 to L5
[2] sacroiliac joint
[3] enters bladder at level of ischial spine

Question 25

What level does the ureter enter the bladder?

Answer 25

level of ischial spine

Question 26

What is another name for kidney stones?

Answer 26

urinary calculi

Question 27

What are the majority of kidney stones made up of?

Answer 27

Main: Calcium Oxalate
- sometimes phosphate
(should appear on plain X-ray film)

Question 28

What are the minority of kidney stones made up of?

Answer 28

• urate, cystine and struvite

- these may not appear on plain X-ray film

Question 29

What are the 2 main layers that the adrenal gland has? Name the sublayers too!

Answer 29

[1] Cortex (outer)
- Zona Glomerulosa (aldosterone)
- Zona Fasciculata (cortisol)
- Zone Reticularis (DHEA - androgen)
[2] Medulla (inner)
- has chromaffin cells which produce catecholamines

Question 30

What does the medulla of the adrenal gland contain?

Answer 30

Chromaffin Cells to produce adrenaline and noradrenaline (catecholamines)

Question 31

What are some clinical conditions related with the cortex of the adrenal glands?

Answer 31

[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

Question 32

What is Cushing’s Syndrome?

Answer 32

overproduction of cortisol leading to increased BP

Question 33

What is Conn’s Disease?

Answer 33

rare; overproduction of aldosterone

Question 34

What is Addison’s Disease?

Answer 34

steroids are not produced to enough levels

Question 35

What is a clinical condition related with the medulla of the adrenal glands?

Answer 35

Phaeochromocytoma (Neuroendocrine) - medullary tumour (due to overproduction of catecholamines)

Question 36

What is Phaeochromocytoma?

Answer 36

medullary tumour (due to overproduction of catecholamines)

Question 37

What is the main venous drainage of the right suprarenal gland?

Answer 37

suprarenal vein drains directly into the IVC

Question 38

What is the main venous drainage of the left suprarenal gland?

Answer 38

suprarenal vein drains into the left renal vein and then the IVC

Question 39

What arteries are involved with the suprarenal gland?

Answer 39

[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)

Question 40

What vertebral level does the gonadal arteries come off of the abdominal aorta?

Answer 40

L2

Question 41

What are 3 types of kidney defects?

Answer 41

[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)

Question 42

What is a bifid ureter?

Answer 42

It is when there is 2 ureters coming out of 1 kidney

Question 43

What is Vesico-Ureteric Reflux?

Answer 43

• most commonly congenital
• it is due to the abnormal backwash of urine from the bladder to the upper kidney
• associated with recurrent UTIs

Question 44

What is hydronephrosis?

Answer 44

the distension and swelling of kidney due to blockage or obstruction
- urine cannot exit the kidney

Question 45

Where does the Superior Suprarenal Artery arise from?

Answer 45

Inferior Phrenic Artery

Question 46

Where does the Middle Suprarenal Artery arise from?

Answer 46

Abdominal Aorta

Question 47

Where does the the Inferior Suprarenal Artery arise from?

Answer 47

Renal Artery