Renal Anatomy Flashcards
What are the 4 primary functions of the kidney?
Filter blood,
produce urine;
hormone secretion (erythropoietin, renin);
calcitriol production.
What are the chief hormones the kidney secretes?
EPO
Renin
Describe the location of the kidneys
Located on each side of the vertebral column, between the parietal peritoneum and musculature of posterior abdominal wall and diaphragm (paravertebral gutter).
How is the kidney angled?
Kidney is angled such that the inferior pole is more lateral than the superior pole and the hilum faces anteromedially.
Which kidney is lower? What are the TV levels?
The right kidney is slightly lower (TV12-LV3) than the left kidney (TV11-LV2).
What is the clinical correlation related to the right kidney being lower than the left?
It is more easily palpated
What nerves are found posterior to the kidneys.
Subcostal N.
Iliohypogastric N.
Ilioinguinal n.
What is the Iliopsoas test?
Pain upon extension of the thigh (against resistance) can indicate abdominal infection. Because of the relationship of the psoas major to many viscera (kidneys, ureters, pancreas, appendix, cecum, sigmoid colon, etc) infection can spread from these organs to the psoas, producing pain upon stretch.
What structures are anterior to the right kidney?
Liver
Duodenum
Ascending colon
Hepatorenal recess
What structures are anterior to the left kidney?
Stomach
Spleen
Pancreas
Jejunum
Descending colon
What surrounds the kidneys? What functions does it serve?
Each kidney is surrounded with fat and fascia that serves a mainly protective function, but also helps to anchor the kidney in place.
What is renal fascia composed of?
anterior and posterior layers surrounding each kidney and suprarenal gland; layers blend medially with adventitia of renal vessels.
Are the kidney and suprarenal gland in the same compartment?
No, they are enclosed in the same layer of fat and fascia, but there is a septum that separates the two in their own compartments
Where is pararenal fat found?
External to the renal fascia
Where is perirenal (perinephric fat) found?
Between the kidney and the renal fascia
What causes nephrotosis? What is the result?
Caused by a deficiency in the fats and fasciae surround the kidney (often seen in late stages of starvation).
Kidney drops into pelvis
What symptoms are associated with nephrotosis?
Often asymptomatic
Sometimes presents with acute pain in the flank region which radiates to the groin.
What referred pain is typically associated with the kidney/ureter?
Acute pain in the flank region
The renal fasciae attach tightly to the renal vessels and hilum, which prevents the spread of what to the contralateral kidney?
perinephric abscess
Since the anterior and posterior layers of fasciae fuse delicately around the border of the kidney, a perinephric abscess may spread…
inferiorly into the pelvis
What are the external features of the kidney?
Renal capsule
Hilum
Entrance to renal sinus.
Allows for passage of renal pelvis, renal vessels, lymphatics, nerves.
Renal sinus – open space inside kidney containing renal calyces, renal pelvis, vessels, nerves, and lymphatics.
What are the components of the internal renal structure?
- Cortex
- Medulla
- Minor calyx
- Major calyx
What does the cortex contain?
Primarily contains the nephons
Also contains medullary rays (projections of medullary tissue)
What does the medulla contain?
Primarily contains collecting tubules organized into renal pyramids.
Also contains cortical columns (projections of cortical tissue)
Renal papillae – apex of renal pyramid; directed towards renal sinus.
What does the minor calyx do?
surround and drain renal papillae.
What is the major calyx?
confluence of 2-3 minor calyces.
What are the renal arteries branches of?
Which is longer?
What do they divide into?
Lateral, paired visceral branches of aorta (LV1/LV2).
Right renal artery is longer than left and passes posterior to IVC.
Renal arteries divide into 5 segmental arteries (end arteries) at renal hilum.
What is the course of the renal veins?
What do they drain to?
Which vein is longer?
Course anterior to the renal arteries.
Drain directly to the IVC.
The left renal vein is longer than the right
What does the left renal vein usually receive? (veins)
left gonadal, left inferior phrenic, and left suprarenal vein before joining the IVC.
What happens in renal vein entrapment? (Nutcracker syndrome)
The left renal vein passes between SMA and aorta; can be compressed between these two vessels. May cause: hematuria, abdominal pain, left testicular pain (pelvic pain in females).
Autonomic fibers distribute via the renal plexus. Describe the sympathetic innervation.
Preganglionic fibers (T10-L1) via lesser, least, and lumbar splanchnic nerves.
Postganglionic cell bodies located in the aorticorenal and renal ganglia; distribute via the renal plexus.
Efferent: vasomotor.
Afferent: acute pain to T10-L1.
Autonomic fibers distribute via the renal plexus. Describe the parasympathetic innervation.
Preganglionic fibers travel with vagus nerve.
Postganglionic cells within wall of organ.
Efferent: function debated, vasomotor (?).
Probably mostly sensory
What are calculi composed of?
Where do they accumulate/pass to?
What do they cause?
Kidney stones are typically concretions of salts and inorganic material.
These can accumulate in the kidney and pass into the ureter.
They can cause a significant amount of pain which will refer “from loin to groin”.
What good are anatomical vertebral levels for viscera?
Lets you know where they are
Why is the right kidney lower?
The liver pushes it down
What is a positive psoas sign?
What does this indicate?
When patient is laying on side, and you extend the thigh, they have pain.
Can be indicative of kidney infection (also other abdominal infections)
What is the renal sinus?
open space inside kidney containing renal calyces, renal pelvis, vessels, nerves, and lymphatics.
Where is the kidney in relation to the peritoneum?
posterior - retroperitoneal
What kind of patient will use up their kidney fat?
What does this cause?
Starvation, anorexia
Dropped kidney, nephroptosis
suprarenal gland = ?
adrenal gland
What do collecting tubules do?
Drain urine to the renal papilla
renal papillae end in?
Minor calyces
What does the left renal artery pass between?
The aorta and superior mesenteric artery (SMA)
How does renal vein entrapment present?
hematuria, abdominal pain, left testicular pain (pelvic pain in females), renal hypertension
Why does renal vein entrapment cause left testicular pain? (or female pelvic pain)
Varicoseal of the left gonadal vein
What is the parasympathetic innervation to the kidney?
The Vagus nerve
What is the function of the ureters?
muscular tube which transports urine from kidney to urinary bladder.
Where do kidney stones commonly lodge?
Constrictions (sites where kidney stones commonly lodge)
- At renal pelvis/ureteric junction.
- At passage over pelvic brim.
- At entry into urinary bladder.
What is hydronephrosis?
Back up of urine due to occlusion in ureter
What is the parasympathetic innervation to the lower ureters?
Pelvic splanchnic nerve
Kidney stones may pass from the kidney into the ureter. Pain from kidney and ureter is felt from “loin to groin” (lumbar region to inguinal region) due to due sensory afferents entering the spinal cord at?
TV10 - LV2
What is the smooth muscle between the urinary bladders adventitia and lamina propria?
Detrusor Muscle
Describe the trigone area of the urinary bladder.
Triangular area between the ureteral orifices and internal urethral orifice.
Superior border marked by interureteric crest; inferior border marked by uvula.
Inner trigonal muscle is an extension of ureteric muscle.
Outer trigonal muscle is typical detrusor muscle
What is on the superior surface of the bladder? The remainder?
superior surface is covered with a serosa; remainder has adventitia for outer layer.
What are the supporting ligaments of the bladder?
Lateral ligament of bladder (thickening of endopelvic fascia)
Puboprostatic or pubovesicle ligament
What is a cystocele?
A prolapsed urinary bladder
Cystocele (fallen bladder) can result from a weakening of the pelvic diaphragm and/or ligaments which support the bladder.
What are the causes?
The most common cause of a cystocele is childbirth; can also result from obesity, chronic constipation, or heavy lifting.
What does a cystocele cause?
Can cause urinary incontinence as well as incomplete emptying of the bladder.
What is the function of the urethra? How long is it?
Function: passage of urine and sperm; 18-22 cm long
What is the main muscle that provides urinary continence?
Sphincter urethrae muscle
What is the sphincter urethrae muscle composed of?
Skeletal and smooth muscle components
What glands are associated with the male urethra?
Bulbourethral Glands (Cowper's Glands) Urethral – mucous-secreting
What are the glands associated with the female urethra?
Paraurethral (Skene’s) glands; open near external urethral orifice; these glands are the homologue of the male prostate
As the bladder fills, an increasing number of stretch receptors begin to fire. These stretch neurons travel to the spinal cord with the pelvic splanchnic nerves. Ascending fibers travel through the spinal cord to the brainstem miturition center.
What are the cord levels of the pelvic splanchnic nerve?
S2, S3, S4
Describe the micturition process. 4 steps
As the bladder fills, an increasing number of stretch receptors begin to fire. These stretch neurons travel to the spinal cord with the pelvic splanchnic nerves (S2,S3,S4). Ascending fibers travel through the spinal cord to the brainstem miturition center.
Descending fibers from the brainstem then activate the motor (GVE-P) component of the pelvic splanchnic nerves.
The pelvic splanchnic nn cause contraction of detrusor mm and emptying of the bladder.
Descending fibers also cause relaxation of the sphincter urethrae muscles (inhibiting both the sympathetically-innervated internal portion….. and somatically innervated internal portion)
During potty training, what does a toddler learn/
Strenghtening the ascending pathways and developing control of the sphincter.
