Session 1 - Introduction

Question 1

Where are the kidney located?

Answer 1

between T12 and L3

• Retroperitoneum on the posterior abdominal wall, either side of the vertebral column.

superior pole of right kidney = 11-12th rib
superior pole of left kidney = 12th rib

Question 2

At what level are the hila and ureters found?

Answer 2

Level of L1 vertebra

Question 3

Level of L1 vertebra

Answer 3

Descend anterior to the transverse processes of the lower lumbar vertebrae

Question 4

What muscle do the kidneys sit on?

Answer 4

psoas major

Question 5

What crosses the ureter in the pelvis in men and women?

Answer 5

In men Vas deferens crosses over the ureters. In women uterine artery crosses over it.

Question 6

What is the normal length, width and mass of a kidney?

Answer 6

Length 9-14cm, width 6-7 cm, 140g

Question 7

Which kidney is slightly higher and why?

Answer 7

left

• liver on right side pushing right kidney down

Question 8

A difference of more than what length/width between kidneys requires further investigation?

Answer 8

2cm

Question 9

A length of less than what may indicate CKD?

Answer 9

<8cm

Question 10

What is the renal angle and what happens here during kidney inflammation?

Answer 10

Angle between 12th rib and erector spinae muscle. Renal angle tenderness.

Question 11

What are the 2 main types of fat around the kidneys and where are they found?

Answer 11

Pararenal (external to posterior layer or renal fascia) and perirenal fat (within the renal fascial layers)

Question 12

why is the kidney not fixed and can move?

Answer 12

they are not tethered by any ligaments

- fascia and fat anchor it in space

Question 13

What is the posterior layer of renal fascia called?

Answer 13

Garota’s fascia

Question 14

What is the length and diameter of ureter?

Answer 14

25-30cm length, 1.5mm diameter

Question 15

What are the 3 different parts of the ureters?

Answer 15

Abdominal, pelvic and intramural

Question 16

Where is the most common area of ureteric injury? What are the 3 common sites of ureteric injury?

Answer 16

Near pelvic brim

1. Pelvic brim
2. Beneath uterine artery
3. At VUJ

Question 17

How/where do the ureters enter the bladder wall and what do they coalesce with?

Answer 17

Runs obliquely through the bladder wall and coalesces with the detrusor muscle. Enter into the bladder more inferiorly.

Question 18

What is the length of the intramural ureters?

Answer 18

1.2-2.5cm

Question 19

What is the vesicouretal junction (VUJ) and is there a sphincter present here?

Answer 19

Junciton between the ureters and the bladder, there in no sphincter present

Question 20

How is urine reflux into the ureters prevented without presence of sphincters?

Answer 20

Ureters pass diagonally through the bladder wall musculature, forming a one way flap valve, the internal pressure of filling bladder causing the intramural passage to collapse

Question 21

Which part of the urinary tract is lined with urothelium?

Answer 21

Pelvis of the kindeys, ureters and bladder

Question 22

What are some different positional changes of the ureters?

Answer 22

a) Both ureters entering one side of the bladder
b) Duplexed ureter both entering the bladder
c) Duplexed ureter, one not entering the bladder
d) Retrocaval position of the right ureter around the IVC

Question 23

What can a duplexed ureter where one does not enter the bladder cause?

Answer 23

Urinary infection

Question 24

What is the trigone?

Answer 24

Smooth triangular region of the internal urinary bladder formed by the two internal ureteric orifices and the internal urethral orifice

Question 25

What is the trigone sensitive to?

Answer 25

Area is very sensitive to expansion and once stretched to a certain degree, the urinary bladder signals the brain of its need to empty

Question 26

What is the urethral orifice in the bladder also called?

Answer 26

Internal urethral meatus - involuntary internal sphincter of bladder - due to detrusor muscle running circularly

Question 27

What are the 2 sphincters of the urethra and which has greater importance in men and women?

Answer 27

internal urethral sphincter (men), external urethral sphincter (women)

Question 28

Why is the internal urethral sphincter important in men?

Answer 28

Contracts and prevents movement of the semen into the bladder during ejaculation (retrograde ejaculation)

Question 29

What part of the nervous system is responsible for closing the internal urethral sphincter?

Answer 29

Sympathetic nervous system (Point and Shoot)

Question 30

What is the blood supply to the kidneys and where does it originate from?

Answer 30

Renal arteries, originates from abdominal aorta at the level of the kidneys

Question 31

What does the renal artery first divide into?

Answer 31

Anterior and posterior renal artery branches

Question 32

Describe the blood supply within the kidneys.

Answer 32

Renal artery → Segmental → Interlobar → Arcuate → Interlobular → Afferent glomerular arteriole

Question 33

Whata re the bony landmarks used to approximate course of ureter?

Answer 33

• L1~thehilum
• Ureter runs along close to the tip of lumber
transverse processes,
• Often crosses the sacrum at approximately the SI joint and descends into the pelvis.
• The ischial spine is a secondary bony land mark that shows the approximate point at which the ureter ‘kink’ towards the bladder
• The ureters then run around the pelvis and enter the bladder posteriorly.

Question 34

what is the anatomical position of bladder?

Answer 34

• When empty the bladder rests on the symphysis pubis
• Women – In front of vagina, uterus and rectum
• Men – in front of rectum

Question 35

define urothelium

Answer 35

transitional epithelium

Question 36

describe the bladder wall composition

Answer 36

detrusor muscle - mucosa form rug except within trigone which is smooth

Question 37

describe the path of the ureters

Answer 37

The ureters enter the pelvic cavity from the abdomen by passing through the pelvic inlet. On each side, the ureter crosses the pelvic inlet and enters the pelvic cavity in the area anterior to the bifurcation of the common iliac artery. From this point, it continues along the pelvic wall and floor to join the base of the bladder. Entry points form the superior two corners of the trigone

Question 38

What are 2 types of nephrons and which is more common?

Answer 38

Cortical and Juxtaglomerula

cortical - 85-90%
juxtaglomerular - 10-15%

Question 39

what are the roles of the 2 types of nephron

Answer 39

cortical - Excretory and regulatory functions

juxta - Urine Concentration

Question 40

what is the difference between the 2 types of nephrons?

Answer 40

juxta has a longer loop of henle

Question 41

what is the epithelium lining the glomerulus?

Answer 41

simple squamous

Question 42

what is the epithelium lining the PCT?

Answer 42

simple cuboidal cells and each cell is made up of millions of microvilli, forming a dense brush border that increases the surface area available for absorption of tubular filtrate. they also have lots of mitochondria to provide energy for transport of substances

Question 43

what is the epithelium lining the loop of henle?

Answer 43

thin descending and ascending - simple squamous

thick ascending - simple columnar

Question 44

what is the epithelium lining the DCT?

Answer 44

simple cuboidal

Question 45

what type of cells are found in DCT?

Answer 45

• Principal cells (P cells) : these contain few mitochondria and respond to antidiuretic hormone (ADH) – also known as vasopressin
• Intercalated cells (I cells) : these contain lots of mitochondria and secrete hydrogen ions

Question 46

what is the epithelium lining the collecting duct?

Answer 46

simple cuboidal without microvilli or many mitochondria

Question 47

describe the juxtaglomerular apparatus

Answer 47

The juxtaglomerular apparatus is located where the thick ascending loop of Henle passes back up into the cortex and lies adjacent to the renal corpuscle and arterioles of its own nephron. It is the area of distal tubule associated with arterioles. The tunica media in the wall of the afferent arteriole contains an area of specialized thickened cells (granular cells), which secrete renin. The epithelium of the distal tubule forms specialized macula densa cells that respond to changes in the composition of the tubular fluid, especially the concentration of sodium ions in the filtrate. Extraglomerular mesangial cells or lacis cells are found outside the glomerulus, in association with the glomerular apparatus. They are contractile cells identical to the mesangial cells.