Renal Flashcards
Where are the kidneys located at in relation to the peritoneum and the vertebra
retroperitoneum - behind the peritoneum containing the abdominal organs
Lateral to the thoracic vertebrae
At which vertebral levels are the kidneys located at
Right - L1-L3
Left - T12 -L2
Why is the right kidney at a more inferior vertebral level than the left
Due to the size of the liver
At which quadrants are the kidneys located at
Flank (lumbar region) or Upper quadrant regions
Are there any ribs protecting the kidneys
Yes, ribs 11 and 12 are posterior to the kidneys (right behind, no other organs in between) and offer some protection
Why are ribs 11 and 12 called the floating ribs
Because they do not attach to the sternum
What may occur if ribs 11 and 12 fracture
the sharp displaced ends can lacerate the kidney
What structure is lateral to the kidneys
3 layers of anterolateral abdominal wall muscles
What are the 3 layers of anterolateral abdominal wall muscles
external oblique
internal oblique
transversus abdominis
What structure is medial to the kidneys
Renal hilum
What structures make up the renal hilum
Renal artery
Renal vein
Ureter
What structures are anterior to the kidneys- from deep to superficial
Renal capsule
Perinephric fat
Renal deep fascia
Paranephric fat
Visceral peritoneum
What structures lie posterior to the kidneys
Quadratus lumberus
Psoas major (posteromedially)
Ribs 11 and 12
Name A-G
A- visceral peritoneum
B- paranephric fat
C- renal fascia
D- perinephric fat
E- renal capsule
F- quadratus lumborus (left)
G- psoas major (left)
Right kidney lies posteriorly to which organs
Liver
Hepatorenal recess
2nd part of the duodenum
Ascending colon
Right colic flexure
What is the second part of duodenum
descending part
Left kidney lies posteriorly to which organs
Stomach
Tail of the pancreas
Hilum of the spleen
Splenic vessels
Name A and B
A- hepatorenal recess
B- subphrenic space
Name A-E
A- subphrenic space
B- hepatorenal recess
C- Inferior vena cava
D- abdominal aorta
E- duodenum (descending part)
What gland lies on top of the kidneys
adrenal gland
Name A-D
A- spleen
B- splenic artery
C- splenic vein
D- adrenal gland
Describe balloting of the kidneys
palpate posteriorly within just inferior to 12th rib (costovertebral angle) AND palpate anteriorly within the flank region
What is a renal papilla
The apex of renal pyramids
Describe the flow of urine to the bladder
- Urine formed by the renal pyramids
- Minor calyx collects urine from the pyramid
- Several minor calyx join together to form major calyx
- Urine pass through major calyx to reach the renal pelvis
- Urine drains into the ureter from the renal pelvis then to the bladder
Name A-I
A- renal cortex
B- renal papilla
C- minor calyx
D- major calyx
E- renal pelvis
F- ureter
G- renal column
H- renal pyramid
I- renal sinus
What is renal sinus
Compartment inside the kidney that uses fat to cushion the calyx / renal pelvis/ vessels etc
What are the variations of kidneys
Bifid renal pelvis (most common)
Bifid ureter
Unilateral duplicated ureter
Retrocaval ureter
Horseshoe kidney
Ectopic pelvis kidney
Name A-E
A- bifid renal pelvis
B- bifid ureter and unilateral duplicated ureter
C- retrocaval ureter
D- horseshoe kidney
E- ectopic pelvis kidney
What is retrocaval ureter
When the ureter is BEHIND the IVC instead of anterior
What are the 3 constriction sites of the ureter
Pelviureteric junction
Ureter crossing the common iliac artery
Vesicoureteric junction
What gives the renal pyramids a striped appearance
Regularly arranged nephrons running axially towards the apex of each pyramid
What does the renal corpuscle contain
glomerulus - consist of capillaries and Bowman’s capsule
Function of glomerulus
Filtration - 20% of the plasma entering the glomerulus is filtered
Blood enters the glomerulus via ______ and exits via _______
Enters via afferent arteriole
Exits via efferent arteriole
Name A-I
A- afferent arteriole
B- juxtaglomerular cells
C- foot processes of podocytes
D- podocytes
E- glomerular basement membrane
F- proximal tubule
G- mesangial cells
H- extraglomerular mesangial cells
I- efferent arteriole
J- Distal convoluted tubule
Function of juxtaglomerular cells
Secrete renin - for RAAS
What triggers the release of renin
Lower perfusion in the afferent arteriole = lower blood pressure
What substances are reabsorbed at the proximal convoluted tubule
100% of glucose and amino acids
67% salt and water
What substances are reabsorbed at the proximal convoluted tubule
100% of glucose and amino acids
67% salt and water
What substances are secreted into PCT
H+
Bile
Uric acids
Drugs
Toxins
PCT is smaller / larger than DCT
Larger
Why does PCT have less well defined margins on histology than DCT
Due to presence of brush borders
Function of loop of Henle
create a hyperosmotic environment in the medulla for urine concentration and conserving water
How does hyper osmotic environment of the medulla help with urine concentration
Allows water remaining in the fluid at collecting duct to be reabsorbed hence water is conserved and also there is less water in urine = more concentrated
What is the vasa recta
the capillary network surrounding the loop of henle
Describe the osmolality in vasa recta as it goes down the descending limb and go back up in the ascending limb of loop of Henle
Osmolality rises as it dips down into the medulla (hyper osmotic medulla)
Osmolality falls as it rises up into the cortex
The blood flow to vasa recta is high / low. Why is that
low, in order to allow sufficient time for passive diffusion of solutes and water to maintain the concentration gradient in medulla (prevent washout)
Function of distal convoluted tubule
Contols acid-base and water balance
What substances are reabsorbed in DCT
water
NaCl
HCO3-
Ca2+, Mg2+, K+
What substances are secreted into DCT
H+
K+
What hormone regulates K+ excretion in DCT
aldosterone - increase in aldosterone = hypokalaemia
What hormone regulates Na+ reabsorption in DCT
Aldosterone - increase in aldosterone = more reabsorbed = hypernatraemia
Function of collecting duct
Reabsorption of water, influenced by ADH
What is the effect of ADH on collecting duct
increases permeability of collecting duct -> increase water reabsorption
The right and left renal arteries arise from
abdominal aorta
At what level does the abdominal aorta branch into renal arteries
between L1 and L2
The right and left renal veins drain into
inferior vena cava
The renal veins are anterior/ posterior to the renal arteries
Anterior to the renal arteries
The lymph from the kidney drains into
lumbar nodes
Where are the lumbar nodes located at
around the abdominal aorta and inferior vena cava
At which point does the abdominal aorta bifurcate
L4, level of umbilicus
bifurcates into right and left common iliac arteries
The lymph from the ureters drain into
Lumbar nodes
Iliac nodes
Where are the iliac nodes located at
around the common, internal and external iliac vessels
Describe the blood supply to the ureters
Branches from
- renal artery
- abdominal aorta
- common iliac artery
- internal iliac artery
- vesical artery
Name A-M
A- right suprarenal vein
B- coeliac trunk
C- superior mesenteric artery
D- right renal artery
E- right renal vein
F- inferior mesenteric artery
G- left superior suprarenal artery
H- left middle suprarenal artery
I- left inferior suprarenal artery
J- left renal artery
K- renal vein
L- left common iliac artery
M- left common iliac vein
At what level does the abdominal aorta branch into suprarenal arteries
T12
Name A and B
A- lumbar nodes
B- external iliac nodes
Name A-E
A- T12
B- coeliac trunk
C- superior mesenteric artery
D- L1
E- L4
Describe the anatomical course of the ureters
- arise from the renal pelvis -> 1st constriction site = ureteropelvic junction
- pass anterior to the common iliac vessels to enter the pelvis -> second constriction site
- At the level of the ischial spine, they turn medially to enter the posterior aspect of the bladder
- 3rd constriction site = vesicoureteric junction
In what way does the ureter enter the bladder
inferomedially, to prevent the reflux of urine
In females, the ureter runs
posteriorly to the uterine tubes and the uterine artery
In males, the ureter runs
posteriorly to vas deferans
What are the 2 pouches in females
Uterovesical pouch
Rectouterine pouch
What is the pouch in males
Rectovesical pouch
Name A-E
A- uterine tube
B- external iliac vessels
C- Uterovesical pouch
D- ureter
E- Rectouterine pouch
What type of epithelium lines the ureter
transitional cell epithelium
Describe the innervation of the kidneys and ureter
sympathetic fibres from T10-L2
parasympathetic fibres from CN X
Describe the visceral afferent innervation of the kidneys
Run alongside with the sympathetic nerve fibres to enter T11-L1
If something is wrong with the kidneys, why do patients feel it at the loin area
Because the visceral afferent of the kidneys enter the spinal cord at T11-L1 and the dermatome covering the loin area is by T11-L1 as well
Describe the visceral afferent innervation of the ureters
Runs alongside with the sympathetic fibres to enter T11-L2
Pain in the ureter is often felt at
anywhere along the path of visceral afferent fibres
What is the pelvic floor muscle
levator ani - makes up the pelvic diaphragm
The pelvic floor muscle separates between
pelvis and perineum
What is trigone in bladder
smooth triangular area formed by the 2 ureteric orifices and internal urethral orifice
What is the muscle that lines most of the bladder
detrusor muscle
Function of detrusor muscle
Contracts to push urine out
Encircles the ureteric orifices and contracts when the bladder contracts in order to prevent reflux of urine
Forms the internal urethral sphincter muscle in males to prevent the reflux of semen during ejaculation
Name A-F
A- detrusor muscle
B- trigone area (smooth area)
C- prostate gland
D- urethra
E- internal urethral orifice
F- ureteric orifices
Where are the ureteric orifices located at
base of the bladder
Describe the location of the bladder
Most anterior organ in the pelvis
Posterior to pubic bone when empty
Describe the changes that occur when the bladder starts to fill
- When the bladder is empty, it is located in the true pelvis and it’s superior part is covered by the peritoneum
- When it begins to fill, it can enter the false pelvis, superior above the pubic bone but it’s superior part is still in contact with the peritoneum
Which part of the bladder is always in contact with the peritoneum
superior part
Describe the location of the bladder in females
Uterus is superior to the bladder in an anteflexed (bent forward) way
Separated by uterovesical pouch
Describe the location of the bladder in males
Prostate gland lies inferior to the bladder
Rectum is posterior to the bladder, separated by rectovesical pouch
What are the 2 routes of catheterisation
Urethral route
Suprapubic route
Under what condition can the suprapubic route be performed
Bladder needs to be full so that it becomes superior to the pubic bone, preventing damaging other organs of the peritoneum
Name A-F
A- bladder
B- Internal urethral orifice
C- urethra
D- levator ani muscle position
E- external urethral sphincter (voluntary)
F- external urethral orifice
Do females have internal urethral sphincter
No
The external urethral sphincter is a involuntary/voluntary muscle
Voluntary
Which structure is at around the same level as the external urethral sphincter
Levator ani muscle - so anything below the external urethral sphincter = perineum
Name A-G
A- internal urethral orifice
B- internal urethral sphincter
C- prostate gland
D- prostatic urethra
E- External urethral sphincter
F- spongy urethra
G- external urethral orifice
Describe the innervation of the bladder
Sympathetic - from T10-L2
Parasympathetic - from S2-S4 carried by pelvic splanchnic nerves
Describe the visceral afferent (sensory) innervation of the bladder
The part that touches the peritoneum:
- Runs along with the sympathetic fibres and enter T11-L2
The part that does not touch the peritnoneum
- Runs along with the parasympathetic fibres and enter S2-S4
If something is wrong with the bladder, where will the pain be felt at
suprapubic area
Name A-G
A- liver
B- appendix
C- bladder
D- stomach
E- duodenum and pancreas
F- kidneys and ureters
G- liver and gallbladder
Inside the scrotum, the testis sits within
tunica vaginalis
During development, where was the testis located at and how does it end up in the scrotum
It was located at the posterior abdomen
It then descends down through the inguinal canal to the scrotum
Where is sperm produced
Seminiferous tubule
What is the spermatic cord
A collection of
- testicular artery
- pampniferous plexus
- vas deferens
- lymphs
- nerves
for the functioning of the testes
What nerves are contained in the spermatic cord
Autonomic nerves for smooth muscles
Somatic nerves (voluntary) for cremaster muscle
What is the vas deferens
Transports sperm from the seminiferous tubule
It begins at the inferior pole of testis
What happens when the spermatic cord twists
Testicular torsion = ischaemia of testes
Name A-D
A- parietal layer of tunica vaginalis
B- testis covered by visceral layer
C- epididymis covered by visceral layer
D- spermatic cord covered by visceral layer
Name A-E
A- potential space of tunica vaginalis (between the visceral and parietal layers)
B- seminiferous tubules
C- vas deferen
D- epididymis
E- spermatic cord
What blood vessels supply the testis
Left and right testicular arteries
What veins drain the testis and where does it drain into
(pampniform plexus drains into the testicular veins)
Right testicular vein drains into the IVC
Left testicular vein drains into the left renal vein then into IVC
How do the vessels pass in and out of the pelvis and abdominal cavity
Through deep inguinal ring
Which artery sits above the left renal vein
Superior mesenteric artery
Name A-F
A- right testicular artery
B- right testicular vein
C- deep inguinal ring
D- left renal vein
E- left testicular artery
F- left testicular vein
Name A-G
A- abdominal aorta
B- IVC
C- right testicular vein
D- right testicular artery
E- inferior mesenteric artery
F- left testicular artery
G- left testicular vein
Describe the route of ejaculation
- Sperm carried by vas deferens exit the scrotum via deep inguinal ring
- it then turns medially and into the pelvis
- then goes posterior to the bladder
- Receives contributions from the seminal vesicle at the ejaculatory duct
- Semen and sperm pass into prostatic urethra
Name A-D
A- prostate gland
B- vas deferans
C- seminal gland
D- ejaculatory duct
Name A-C
A- prostatic ducts
B- openings of ejaculatory ducts
C- prostate
What is inferior to the prostate gland
levator ani muscle (pelvic floor muscle)
hence the external urethral sphincter will be somewhere there too
What are the zones of the prostate gland
Central
Peripheral
Transitional
Which condition commonly arise from the peripheral zone of prostate
Prostate cancer
Which condition commonly arise from the transitional zone of prostate
BPH
Which zone of prostate is felt in PR exam
Peripheral zone
Lymph from the testis drain into
lumbar nodes around the abdominal aorta (paraaortic lymph nodes)
Lymph from the scrotum and penis drain into
superficial inguinal lymph nodes in the superficial fascia in the groin
Name A-D
A- corpus cavernosum
B- corpus spongiosum
C- glans
D- external urethral orifice
What does the corpus spongiosum transport
spongy urethra
What does the corps cavernosum transport
deep arteries of the penis
Deep arteries of the penis are branches of
internal pudendal artery which is a branch of internal iliac artery
What is the blood supply to the scrotum
internal pudendal artery and branches from the external iliac artery
Name A-E
A- internal iliac artery
B- external iliac artery
C- middle rectal artery
D- internal pudendal artery
E- inferior gluteal artery
Describe the visceral afferent innervation of testis
Visceral afferents run with sympathetic fibres to T10-T11 = pain in lower abdomen
Testis is very close to scrotal wall (body wall) so pain can be felt at groin area as well
Describe the visceral afferents of urethra
visceral afferent of proximal urethra (above levator ani) runs along with parasympathetic fibres to S2-S4
Somatic sensory of distal urethra are carried by pudendal nerve to S2-S4 = localised pain within the perineum
