Each time a professor says 'nephron', a student gets a headache. Internal Anatomy. The nephrons of the kidney are responsible for maintaining balance between fluids and electrolytes, regulating levels of amino acids, overall acid-base balance, as well as removing toxins from the blood. Further testing/diagnosis is required. This kidney measured 14 cm in length. Medullary cystic disease is encountered only rarely, and in addition to the echogenic atrophic cortex, the medullary pyramids are particularly hypoechoic. At one end of each nephron, in the cortex of the kidney, is a cup-shaped structure called the Bowman's capsule. The posterior branch supplies the posterior part of the kidney, whereas the anterior branch arborizes into five segmental arteries, each supplying a different renal segment. The visible contrast seen in the excretory phase has been concentrated many-fold. The kidney tissue is protected by three layers that entirely surround the kidney: Outside the fascia is the most superficial layer a layer of fat tissue called the paranephric fat. Each end of the kidney is commonly called a. Annotated three-dimensional volume rendering of the left kidney acquired using a combined nephrographic phase and excretory phase during computed tomographic urography demonstrates regional anatomy of the kidney. The kidneys are a pair of bean-shaped organs located below the rib cage, one on each side of the spine. On axial sections, the polar regions of the kidney typically form a closed circle or donut shape, with the hole formed by renal sinus fat. Dialysis. This can cause varicocele of the left testicle because gravity works against the column of the blood in the left testicular vein. The pyramids are separated by extensions of the cortex called the renal columns. Their shape resembles a bean, where we can describe the superior and inferior poles, as well as the major convexity pointed laterally, and the minor concavity pointed medially. The opposite situation is possible too, if the kidneys excrete too many hydrogen ions, the pH of blood becomes too alkaline, and leads to a state called alkalosis. This phenomenon is due to T2-shortening and susceptibility (T2*) effects caused by concentrated gadolinium, and can potentially obscure filling defects and urothelial lesions. Chronic obstruction, however, results in damage to the papilla, evident in the clubbed calyx of papillary necrosis (Fig. The bilateral small smooth kidney pattern describes most of what is often diagnosed on sonography as medical renal disease, although the authors prefer the term renal parenchymal disease. RENAL ANATOMY Renal Parenchyma The kidneys can be divided into three main regions from cranial to caudal. B, A curved planar reformation of the crossing vein demonstrates its course. The kidneys are located between your intestines and your diaphragm. A, Enhancement of the mass is conspicuous in the corticomedullary phase. If the renal pelvis extends out of the renal sinus, it is considered to be an extrarenal pelvis (Fig. This method is the standard in evaluation of UPJ obstruction and often is used for other types of chronic obstruction. Retrograde urogram shows a calculus in the left ureter. impression is preserved. Each kidney should always be evaluated in long axis (coronal, sagittal, or both, depending on sonographic window) and axial to the kidney. However, T1-weighted images provide good corticomedullary differentiation. Solid masses are more likely to be cancerous but they are not all cancerous. The solid renal parenchyma consists of the peripheral renal cortex and more central renal medulla. So the pyramids represent the functional tissue that creates urine, whereas the calyces are the beginning of the ureter and transport the urine to it. Grounded on academic literature and research, validated by experts, and trusted by more than 2 million users. A frontal section through the kidney reveals an outer region called the renal cortex and an inner region called the renal medulla (Figure 25.1.2). Localized means that the tumor has not spread out from where it first started. Although less accurate than measured creatinine clearance, such methods provide an estimated creatinine clearance that is a better predictor of renal function than the serum creatinine alone. A, Axial image from contrast-enhanced computed tomography (CT) demonstrates an accessory right renal artery coursing anterior to the IVC. 18-7). Surgery was successful and the surgeon confirmed the anatomic survey was correct. This article will discuss the anatomy and major functions of the kidney. Small renal shadows may be seen on radiographs, and reniform shape is preserved on cross-sectional imaging. Three-dimensional volume rendering from contrast-enhanced multidetector computed tomography examination of the kidneys demonstrates typical orientation of a horseshoe kidney. Because an extrarenal pelvis is not confined by the renal parenchyma, there is a tendency for it to expand. When abnormal echogenicity is detected, it is important to note whether it is unilateral or bilateral. 18-27). Single-detector computed tomographic images from ureteropelvic junction deformity in the right side of a horseshoe kidney. The presence of significant renal parenchyma may justify surgical repair to maximize the functional contribution of that kidney. The medial border of the kidney contains a very important landmark called the hilum of the kidney, which is the entry and exit point for the kidney vessels and ureter. Note number of veins by inspecting inferior vena cava along entire length of kidney. The hilum of the kidney usually projects at the level of the L2 vertebra. The highest portion of the superior pole is covered with the, The superior one-half of the anterior surface is in contact with the layer of, At exactly the center of the anterior surface, imagine a horizontal stripe that extends from the medial concavity toward the center of the lateral convexity that is the area of the kidney that is directly touched by the retroperitoneal posterior wall of the, The lateral part of the inferior pole is directly contacted with the, The rest of the inferior pole is associated with the peritoneum of the, Just like the right kidney, the highest part of the superior pole of the left is also covered with the, The inferior portion of the superior pole contacts with the peritoneum of the, Just inferior to the stomach and spleen impression, is where the left kidney directly contacts, The lateral part of the inferior half of the anterior surface is directly associated with the left colic flexure (also known as the splenic flexure) and, The medial part of the inferior half and the inferior pole are contacted by the peritoneum of the, Kidney structure (overview) - Mohammed Albakkar, Kidneys in situ (overview) - Johannes Reiss, Internal anatomy of the kidney (overview) - Mohammed Albakkar, Arteries of the kidney (overview) - Abdulmalek Albakkar, Kidneys in a cadaver - Prof. Carlos Surez-Quian. Figure 18-14 Axial maximum intensity projection image from the arterial phase of a contrast-enhanced computed tomographic scan from a prospective renal donor demonstrates early prehilar branching of the left renal artery. 18-23). Ultrasound It can be seen as a triangular echogenic cortical defect, frequently seen in upper lobe parenchyma. Ultrasound permits real-time optimization of imaging relative to the axis of each kidney. Although this dilatation of the renal pelvis may occasionally mimic hydronephrosis, delicate and sharply defined calyces and thin infundibula can be used to differentiate an extrarenal pelvis from obstruction. There are many clinical states related to kidney malfunction. It is important to remember this order of vessels and ducts since this is the only thing that will make you able to orient the kidney and differentiate the left one from the right when they are outside of the cadaver. Figure 18-17 Coronal maximum intensity projection image from a contrast-enhanced computed tomographic scan demonstrates a dilated and tortuous lumbar veins joining the left renal vein. The medulla consists of multiple pyramidal tissue masses, called the renal pyramids, which are triangle structures that contain a dense network of nephrons. Caliectasis doesn't cause any symptoms on its own. Poorly functioning kidneys with little residual parenchymal volume may be removed because preservation offers opportunities for future complications (infection, hypertension) without contributing significantly to renal function. In this region, the anterior and posterior hilar lip is identified (Fig. Read more. 18-6). Technetium 99m dimercaptosuccinic acid (DMSA) and glucoheptonate (GHA) are both used for evaluation of renal parenchyma. Because the interlobular arteries form an arch overlying the pyramid, they are called the. If the renal pelvis extends out of the renal sinus, it is considered to be an. The kidneys are reddish-brown, bean-shaped organs situated retroperitoneal on the posterior abdominal wall. (Courtesy of Karl T. Rew, MD) Introduction Synonyms Epidemiology The most common cause is renal artery stenosis (see, Delayed but increasingly dense nephrogram, Delayed but hyperconcentrated contrast excretion, Imaging Evaluation of Acute Abdominal Pain, A Multidimensional Approach to Abdominal Imaging. Figure 18-6 Frontal image of the left kidney from an intravenous urogram demonstrating an aberrant renal papilla in the lower pole infundibulum. Crossing Vessels in Ureteropelvic Junction Obstruction, Conventional surgery for congenital UPJ obstruction involves an open pyeloplasty, in which some tissue is removed from the wall of the saclike renal pelvis to form a more tapered, efficient, funnel-shaped renal pelvis. T2-weighted maximum intensity projection image from a magnetic resonance urogram performed to evaluate urinary obstruction identified in a patient with an obstructing soft tissue mass in the pelvis on unenhanced computed tomography (CT). Figure 18-22 Axial images of the left kidney from a three-phase renal computed tomographic scan demonstrate improved conspicuity of low-attenuation lesions of the renal medulla during the nephrographic phase. Chronic obstruction, however, results in damage to the papilla, evident in the clubbed calyx of papillary necrosis (Fig. Each pyramid creates urine and terminates into a renal papilla. 18-28). and grab your free ultimate anatomy study guide! Learn how we can help 1.2k views Reviewed Dec 09, 2022 Thank Dr. Frank Kuitems and 4 doctors agree 3 thanks Any excessive amount of fluid will increase the pressure on the arterial wall and cause the blood pressure to rise (hypertension). Let's see what is nephron and how it is structured,so you can remember it for good. The ureters are the tubes that carry urine from the renal pelvis to the bladder. The apex of the pyramid projects medially toward the renal sinus. Serum creatinine, however, is dependent not only on its disposal but also its production. The portion of the kidney between the poles is called the interpolar region and contains the renal hilum (Fig. Because the interlobular arteries form an arch overlying the pyramid, they are called the arcuate arteries. There is no specific treatment for fused kidneys and the only option is to treat the pathologies that affect them during life. The kidneys are bilateral organs placed retroperitoneally in the upper left and right abdominal quadrants and are part of the urinary system. 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