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Renal Week 1 > Renal System: Anatomy/Embryo Review > Flashcards

Renal System: Anatomy/Embryo Review Flashcards

1
Q

The ureters descend on the posterior abdominal wall on the surface of what muscle?

A

psoas major

and cross the pelvic brim at the bifurcation of the common iliac arteries into the internal and external iliacs.

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2
Q

What structures enters/exits the ‘hilum of the kidney’?

A

the renal vessels, lymphatics, nerves, and proximal ureter

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3
Q

What is the order from anterior to posterior of the structures entering the hilum?

A
  • renal vein
  • renal artery
  • renal pelvis/ureter
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4
Q

Projections of the renal cortex called the _____ extend in between the triangularly shaped medullary pyramids into the center of the kidney

A

renal columns

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5
Q

The apex of medullary pyramids converge onto what structures?

A

The apical projection (aka renal papilla) is surrounded by a minor calyx.

The minor calyx receives urine and these represent the most proximal part of the tube that will eventually form the ureter.

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6
Q

What do 2-3 minor calyx combine to form?

A

Several minor calyces unite in the renal sinus to form a major calyx and in turn, 2‐3 major calyces unite to form the renal pelvis.

The renal pelvis is the funnel‐shaped proximal end of the ureter. It occupies a posterior position in the renal hilum relative to the renal vein and artery.

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7
Q

What does a renal corpuscle consist of?

A

The renal corpuscle consists of the glomerular capsule (aka Bowman’s capsule) which covers a tuft of capillaries called the glomerulus

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8
Q

Describe the flow of filtrate in the renal nephron.

A

The proximal convoluted tubule extends from the capsule and then the tubule changes to a straight tubule called Henle’s loop (the straight tubule).

This is followed by the distal convoluted tubule which empties into a collecting duct.

The collecting ducts (usually 10‐20) empty the renal papilla into the minor calyx.

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9
Q

T or F. The kidneys are retroperitoneal

A

T. They are embedded in
fat and connective tissue.

The ureters are as well.

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10
Q

What spinal segments does the vertical positioning of the kidneys on the posterior abdominal wall correspond to?

A

T12-L3, though the right kidney is usually slightly lower than the left due to its relationship with the liver

The right kidney is usually related to the 12th rib posteriorly, while the left kidney is usually related to
ribs 11 and 12 posteriorly.

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11
Q

The hilum of BOTH kidneys lie in the same horizontal plane as which anatomical landmark?

A

the transpyloric plane

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12
Q

Describe the fascial layers surrounding the kidneys.

A

They are surrounded by a dense layer of renal fascia which consists of anterior and posterior laminae that splits from the transversals fascia.

Deep to the renal fascial is a layer of perirenal (or perinephric) fat which completely surrounds the kidney and serves to cushion and protect the kidney, which is quite fragile.

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13
Q

What lies directly outside the anterior and posterior laminae?

A

There is an additional layer of pararenal (or paranephric) fat external to the renal fascia which adds additional support and protection

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14
Q

What do the two layers of renal fascia do superiorly? Inferiorly?

A

The two layers of renal fascia are fused superiorly and continue across the hilum of each kidney where they fuse with the adventitia of the renal vessels

The facial layers are open inferiorly, to allow downward movement of the kidney with movements of the diaphragm

Note: The renal fascia must be incised in any surgical approach to the kidney.

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15
Q

What determines the potential spread of peritoneal abscess (pus around the kidneys)?

A

The fascia at the renal hilum usually attaches to the renal vessels and ureter, usually
preventing the spread of infection to the contralateral side.

However, pus from an abscess (or blood from an
injured kidney) may descend into the pelvic cavity between the loosely attached anterior and posterior layers of renal fascia.

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16
Q

What is nephroptosis?

A

dropped kidney. This occurs when abnormally mobile kidneys descend more than normal when the body is
erect.

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17
Q

How is nephroptosis distinguished from an ectopic kidney?

A

Distinguishable due to the presence of a ureter of normal length that has loose coiling or kinks due to the reduced distance between kidney and bladder.

Nephroptosis may be accompanied by intermittent pain in the renal region due
to stretch forces placed on the renal vessels. This pain is usually relieved by lying down.

This is one of the reasons transplant kidneys are placed in the iliac fossa of the greater pelvis.

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18
Q

Where do the renal arteries branch from the aorta?

A

slightly below the origin of the superior mesenteric branch (LV1/LV2)

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19
Q

T or F. The left renal artery is shorter than the right

A

T. Since the aorta lies to the left of the midline. The right
renal artery passes BEHIND the IVC to reach the right kidney.

20
Q

Describe the branches each renal artery

A

Each renal artery branches before entering the hilum of the kidney into an anterior and a posterior branch which supply the renal parenchyma.

The anterior branch further divides into four segmental arteries.

The renal arteries are also give off an inferior suprarenal artery to the lower pole of the gland, as well as a small ureteric artery.

There are often accessory renal vessels (~30%). These sometimes enter the poles of the kidneys.

21
Q

T or F. The left renal vein is shorter than the right

A

F. The right is shorter

22
Q

What important vein does the left renal vein receive?

A

The left gonadal (testicular or ovarian) vein, whereas the right gonadal vein empties directly into the IVC

23
Q

Describe the ‘nutcracker’ relationship of the SMA.

A

the superior mesenteric artery descends over the left renal vein more superiorly and the 3rd part of the duodenum more inferiorly

24
Q

What is SMA syndrome?

A

The SMA syndrome is compression of the duodenum between the SMA and aorta.

It has a roughly 1 in 3
mortality rate. Fortunately, it is quite rare.

25
Q

What is Nutcracker syndrome?

A

compression of the left renal vein between the SMA and aorta.

Symptoms may include hematuria or proteinuria, abdominal (left flank pain), left testicular pain (in men) or, uncommonly the development of a left‐side varicocele (bag of worms).

Why would you see varicocele?

26
Q

Nutcracker syndrome with N/V would suggest at?

A

Nausea and vomiting may be present if the duodenum is also compressed.

27
Q

What does stenosis of the renal artery produce?

A

renal HTN that under perfuses the kidneys and promotes the secretion of renin

28
Q

What is the sympathetic innervation to the kidneys? Function?

A

Sympathetic fibers destined for the kidneys function to constrict renal arteries and reduce urine formation (primarily via the least thoracic splanchnic nerves, T12).

29
Q

Where is the pre‐ganglionic/post‐ganglionic synapse located?

A

in the renal/aorticorenal ganglia.

30
Q

What is the parasympathetic innervation to the kidneys? Function?

A

Parasympathetic fibers cause vasodilation of the renal vascular bed (vagus nerve, CN X).

Sensory information from the kidneys is transmitted via GVA fibers traveling with either the sympathetic or para-sympathetic feed.

31
Q

The lymphatic drainage of each kidney is to what nodes?

A

the lateral aortic (lumbar) or lateral caval nodes around

the origin of the renal artery/vein.

32
Q

Describe the flow of lymph from the lateral aortic (lumbar) nodes.

A
  • right/left lumbar trunk
  • cisterna chyli
  • thoracic duct
33
Q

T or F. Simple kidney cysts are inherited and cause severe symptoms frequently.

A

F. The cause is not fully understood, but they don’t appear to be inherited.

They usually don’t cause symptoms. In most cases, they are found during ultrasound or radiographic imaging that is being done for another purpose.

It some cases, they can cause pain, bleed, or become infected. Rarely do they impair renal function.

34
Q

What is the treatment for simple kidney cysts?

A

Treatment usually involves needle aspiration.

35
Q

What is polycystic kidney disease (PKD)?

A

Polycystic kidney disease is an important cause of renal failure. It is an inherited, autosomal genetic disorder.

The kidneys become markedly enlarged and distorted by cysts as large as 5 cm.

36
Q

How does PKD cause renal failure?

A

Kidney failure is caused by disruption of the collecting tubules prior to their
termination in the minor calyx, causing dilations of the loops of Henle.

37
Q

What symptoms accompany PKD?

A
  • High blood pressure
  • Pain in the back and side
  • Headaches
  • Blood in the urine
38
Q

What is the treatment for PKD?

A
  • Hemodialysis
  • Peritoneal dialysis
  • Kidney transplantation
39
Q

What are calculi?

A

Stones composed of salts of inorganic or organic acids, or other materials. They may form and become located in the calyces of the kidneys, ureters, or urinary bladder.

A renal calculus (kidney stone) may pass from the kidney into the renal pelvis and subsequently into the ureter (ureteric calculus). If the stone is sharp or excessively large, it will cause extensive dilation
of the ureter.

40
Q

What is the treatment for a kidney calculus?

A
  • Removal with a nephroscope

- Lithotripsy (breakdown of the stone via shockwave)

41
Q

What risk factors are associated with kidney calculi?

A

More frequent in men than in women, most common in people between 20‐60 years of age, and usually associated with sedentary lifestyles

42
Q

Most tumors that arise in the kidney are _______.

A

renal cell carcinomas.

43
Q

What part of the kidney do renal cell carcinomas arise from?

A

These tumors develop from the proximal tubular epithelium.

44
Q

What is a unique feature of renal cell carcinomas?

A

Renal cell tumors are unusual because they grow outward from the kidney, invading the fat and fasica, and also spread into the renal vein.

Venous extension is rare for any tumor, so when it is seen, renal carcinoma should be considered.

45
Q

What is another type of renal cancer?

A

Approximately 5% of tumors within the kidney are transitional cell tumors which arise from the urothelium of the renal pelvis.

46
Q

Can a kidney be removed without damaging the adrenal glands?

A

Yes, because the two are separated by a weak septum of renal fascia.

47
Q

The site for transplanting a kidney is _______. Why?

A

in the iliac fossa of the greater pelvis.

This site supports the
transplanted kidney so that traction is not placed on the surgically anatomosed renal vessels.

Renal Week 1 (20 decks)

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