Renal Anatomy Flashcards
What is the location of the urinary system?
Behind the parietal peritoneum of the abdominal cavity (i.e. retroperitoneal space).
Kidneys are a retroperitoneal organ.
The retroperitoneal space is filled with…
extraperitoneal fat
The retroperitoneal space is enclosed by…
parietal peritoneum
transversalis fascia
What are the vertebral levels of the renal arteries?
L1/L2
What is the vertebral level of gonadal arteries?
L2
Reminder: The inferior vena cava crosses the diaphragm at which vertebral level?
T8
The kidneys & adrenals sit between which vertebral levels?
T12-L3
Which kidney sits slightly lower than the other and why?
The right kidney is a little lower due to the liver above it.
What is the costovertebral angle?
Angle between the vertebral column and 12th rib.
It marks the position of the kidneys.
What does pain on percussion/pressure at the costovertebral angle mean?
May be indicative of kidney pathologies (abscess, calculi, pyelonephritis).
Pain or tenderness at the costovertebral angle is a…
a) negative sign of CVA tenderness
b) positive sign of CVA tenderness
b) positive sign of CVA tenderness
Define perinephric (perirenal) fat.
Fat located inside the renal fascia leaflets, immediately surrounding the kidneys
Define paranephric (pararenal) fat.
Fat located posterior & lateral to the renal fascia.
Which layers have been cut to expose the kidney (to make a posterior approach to the kidney)? (7)
Skin
Muscles of the posterio-abdominal wall
Transversalis fascia
Paranephric fat
Renal fascia
Perinephric fat
Complete the statement:
Kidneys are smooth, ovoid organs covered in a…
fibrous capsule
Where are the adrenal glands located?
At the superior pole of each kidney
What is comprised in the hilum of the kidney?
Renal artery
Renal vein
Ureter
If the ureter is most anterior when looking at the kidney, and the renal vein is most posterior, what view must we have of the kidney?
Posterior view
When inspecting a kidney, you notice that the renal vein at the hilum is most anterior to you. What view do you have of the kidney?
Anterior view
What are renal columns?
Extensions of the cortex that extend into the medulla (toward the hilum), found between the renal pyramids.
What is the renal papilla?
The apex of the renal pyramids
What is the functional unit of the kidney?
Nephron
Minor calyces (8-12) at the base of renal papilla converge into… which converge into…
Minor calyces (8-12) at the base of renal papilla converge into (2-3) major calyces, which converge into the renal pelvis.
What is the renal sinus?
It is the central cavity o the kidney containing adipose tissue, renal pelvis & calyces and neurovasculature.
Blood supply to the kidneys comes from…
renal arteries
Renal arteries branch off the aorta at what vertebral levels?
L1/L2
Which renal artery is longer?Why?
Right renal artery
Explanation: The aorta is on the left of the IVC, so it is closer to the left kidney than the right.
Which renal vein is longer?
Left renal vein
Explanation: The IVC is on the right of the aorta, so it is closer to the right kidney than the left.
left renal vein passes under…
superior mesenteric artery
Renal blood supply is a location of high variation between humans.
What are extra renal arteries? Name the 2 types.
Additional arteries that supply the kidneys in addition to the main renal artery:
* Accessory/supranumerary renal arteries
* Aberrant/polar renal arteries
Extra renal arteries: Accessory/supranumerary arteries supply…
the renal hilum
Extra renal arteries:
Aberrant/polar arteries supply…
the superior or inferior poles of the kidney
What is the “Nutcracker Syndrome”?
Compression of the left renal vein, typically as it passes between the abdominal aorta & superior mesenteric artery.
This can lead to blockage of the venous return from the left kidney AND left gonad (i.e. testis, ovary).
Adrenal glands are surrounded by… (2)
perinephric fat
renal fascia
Adrenal glands are attached by renal fascia to…
the crura of the diaphragm
How does the adrenal gland shape differ on right and left?
Right: pyramidal
Left: crescent/semi-lunar
What are the 3 layers of the adrenal glands?
Capsule
Cortex
Medulla
Name 3 types of hormones produced in the cortex of the adrenal gland
corticosteroids
androgens
aldosterone
Name a type of hormone produced in the medulla of the adrenal gland
catecholamines
What vessels supply the adrenal glands?
- Superior suprarenal arteries
- Middle suprarenal arteries
- Inferior suprarenal arteries
What gives rise to superior suprarenal arteries?
Inferior phrenic artery
What gives rise to middle suprarenal arteries?
Abdominal aorta
What gives rise to inferior suprarenal arteries?
Renal artery
Describe the venous return from the adrenal glands.
Venous return drains via the right and left suprarenal veins.
The right suprarenal vein drains into…
The left suprarenal vein drains into…
Right: inferior vena cava
Left: left renal vein
The kidneys are innervated by…
the renal nerve plexus
Which 2 splanchnic nerves synapse with the aorticorenal ganglion, contributing to the renal plexus?
Lesser splanchnic
Least splanchnic
(sympathetic)
The suprarenal gland (adrenal gland) is innervated by…
greater splanchnic nerve
Why is there no ganglion to the adrenal glands?
The adrenal medulla contains chromaffin cells, which are essentially modified postganglionic sympathetic neurons.
Describe the parasympathetic innervation of the kidneys.
The posterior vagal trunk and pelvic splanchnic nerves contribute to the renal plexus to innervate the kidneys.
What are ureters?
Muscular tubes that travel between the kidneys and urinary bladder (25-30cm in length).
They carry urine from the kidneys to the bladder.
The ureters enter the pelvis at the …
bifurcation of the common iliac arteries.
Gonadal arteries and veins cross … to the ureters
a) over/anterior
b) under/posterior
a) over/anterior
Mnemonic: Water under the bridge
Visceral afferent nerves from the ureters travel to spinal levels…
T11-L2
What nerve fibres are responsible for referred pain in the lower abdomen/groin region?
Visceral afferent nerves from T11-L2 spinal levels.
What are renal and ureteric calculi (stones)? What are their effects?
Calculi (kidney stones) are made of salts and minerals concentrated in the urine. When they pass into the ureter, large calculi can cause distention that leads to intermittent pain as the stone is “passed” down the ureter & may even obstruct the flow of urine.
What is the treatment for calculi? (2)
Nephroscopic removal and lithotripsy (shockwaves to break up the calculi).
Sites of ureter constriction (i.e. common sites where calculi can become lodged) (3)
- Ureteropelvic junction
- Crossing iliac vessels at pelvic brim
- Entering the wall of the bladder
Where is the median umbilical ligament (bladder)?
Apex of the bladder
Openings in the bladder where the ureters drain.
Ureteric orifice (1 for each ureter)
What is the trigone
Triangular region of smooth mucosa on the posterior wall of the bladder.
Raised band of tissue that stretches across the posterior wall of the bladder, between the ureteric orifices.
Interureteric ridge
The opening of the urethra is called…
internal urethral orifice
What is the name of the muscle of the urinary bladder?
detrusor muscle (smooth muscle)
The median umbilical ligament is an embryological. remnant of…
the urachus: a canal between the bladder and umbilicus
