Axial sections of the right kidney from contrast-enhanced computed tomography demonstrate a bar of renal parenchyma separating renal hila in the superior and inferior poles, consistent with duplication. Renal Cysts. Horseshoe kidneys result from midline fusion of the kidneys, typically at the level of the origin of the inferior mesenteric artery. The presence or absence of intravenous contrast media, as well as the phase of contrast enhancement, are key factors that determine the appearance of the renal parenchyma on CT (Table 18-3). The patient had right flank pain but had a solitary calcification in the left pelvis on plain radiograph (not shown). Table 18-6 Causes of Bilateral Small Smooth Kidneys. 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. Some centers use diuretics or fluid bolus, or both, during CT urography to dilute the excreted contrast to improve assessment of the urothelium. Renal size can be measured in several ways. Clinical significance [ edit] These are chronic processes that lead to a loss of renal cortex gradually and uniformly. Look for duplication, large extrarenal pelvis. There are 8-18 renal pyramids in each kidney, that on the coronal section look like triangles lined next to each other with their bases directed toward the cortex and apex to the hilum. The left kidney appeared unremarkable. The main parts of your kidney anatomy include: Kidney capsule (renal capsule) The renal capsule consists of three layers of connective tissue or fat that cover your kidneys. This specific condition is called the nutcracker phenomenon. The ureter and calyces were not dilated (not shown), helping to differentiate this anatomic variant from obstruction. Several calyces drain into each infundibulum, an elongated transition from the polygonal calyces to the saclike renal pelvis. Relation between the right renal artery and the inferior vena cava (IVC). This can cause varicocele of the left testicle because gravity works against the column of the blood in the left testicular vein. When fused, the condition is described as crossed fused ectopia. Extraaortic origin of the renal arteries and accessory renal arteries are common. The left kidney measured 7.8 cm, and the right kidney measured 10.9 cm. 18-23). As the lobules of metanephric blastema coalesce to form each kidney, they do not always result in a smooth, uniform band of cortex. The vascularity of some tumors may be most apparent during this phase (Fig. Differential diagnosis General imaging considerations include: renal cortical defect duplex kidney 18-4). The kidneys are paired retroperitoneal structures that are normally located between the transverse processes of T12-L3 vertebrae, with the left kidney typically somewhat more superior in position than the right. The kidneys are located between the transverse processes of T12-L3 vertebrae, with the left kidney typically positioned slightly more superiorly than the right. While migrating superiorly, the kidneys rotate medially along their long axes and the inferior supplying mesonephric arteries degenerate. On the other hand, babies with bilateral agenesis cannot survive without an immediate kidney transplant. RENAL ANATOMY Renal Parenchyma The kidneys can be divided into three main regions from cranial to caudal. 3D printed model for a 53-year-old female presenting a 21 15 15 mm renal tumor located in the interpolar region of left kidney, treated by left partial nephrectomy. 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. Internal Anatomy. B, The lesion becomes more conspicuous during the nephrographic phase. BOX 18-1 Cockroft and Gault Equation for Calculating Estimated Creatinine Clearance. Dimitrios Mytilinaios MD, PhD (Courtesy of Karl T. Rew, MD) Introduction Synonyms Epidemiology The renal fascia which besides the kidneys also encloses the suprarenal gland and its surrounding fat. Kim Bengochea, Regis University, Denver. The cortex of a normal kidney is usually less echogenic than the adjacent normal liver. The lateral border is directed towards the periphery, while the medial border is the one directed towards the midline. The kidneys help remove waste products from the . Figure 18-16 Coronal reformation from contrast-enhanced computed tomography performed for renal donation demonstrates a retroaortic left renal vein crossing the aorta well inferior to the level of the renal hila. Each kidney should always be evaluated in long axis (coronal, sagittal, or both, depending on sonographic window) and axial to the kidney. This refers to the forming of the stones within the system of calyces because of too much calcium or uric acid into the filtrate. I hope this helps. Radiologists divide the kidney into three parts: the upper pole, lower pole, and the interpole (whi. When the renal cortex is more echogenic than the adjacent liver, there is a high correlation with renal disease, although sensitivity is relatively low, according to Platt and colleagues (Fig. Normal magnetic resonance imaging appearance of the kidneys. print Print this Article You can test yourself on the renal arteries with our quiz. The stones can move into the ureter and literally get stuck there because the lumen of the ureter is much smaller compared to the calyces, which is very painful for the patient. Jana Vaskovi MD Table 18-5 summarizes a checklist approach to the ultrasound examination. A healthy individual who donates a kidney is likely to maintain a normal serum creatinine despite the loss of 50% of parenchymal tissue. On the superior aspect of each kidney is the adrenal gland. The interpolar region is the middle of the kidney. 18-28). The kidneys are innervated by the renal plexus. They are staged the same way as the renal pelvis. CT is occasionally used to evaluate patients with renal failure. Table 18-5 Checklist Approach to Ultrasound for Renal Failure. 18-16). Chronic obstruction, however, results in damage to the papilla, evident in the clubbed calyx of papillary necrosis (Fig. Parasympathetic innervation enhances the peristalsis while sympathetic innervation inhibits it. 18-24). Figure 18-21 Axial images from contrast-enhanced computed tomography demonstrate transient enhancement of a small renal cell carcinoma. Register now Besides blood volume and pressure regulation, kidneys also participate in the production of calcitriol (the active form of vitamin D). Despite the complexity of renal physiology, many attempt to assess renal function with a simple quantitative measure, the serum creatinine. Size and Contour of Diffuse Renal Disease, 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, Global insult to one kidney may result in unilateral atrophy that is uniform and smooth. Renal artery At the Brady Urological Institute, we believe in the adage, "An ounce of prevention is worth a pound of cure," so we place great emphasis on a thorough metabolic evaluation, so that therapies can be appropriately directed towards reducing the risk of recurrent stone disease. I would honestly say that Kenhub cut my study time in half. The glomerular membrane is designed in a way in which it is not permeable for big and important molecules in blood, such as plasma proteins, but it is permeable to the smaller substances such as sodium, potassium, amino acids and many others. However, T1-weighted images provide good corticomedullary differentiation. Bilateral echogenic kidneys with renal hypertrophy can be seen associated with human immunodeficiency virus disease (see. All rights reserved. The genital system consists of the testes, epididymides, deferent ducts, seminal vesicles, ejaculatory ducts, the prostate, and the penis in males; and the ovaries, uterine tubes, uterus, and vagina in females. B, Transverse image of the bladder demonstrates a large bladder tumor in the region of the trigone. 18-5). Arterial stenosis was confirmed by magnetic resonance angiography. chronic obstruction, or severe or repeated urinary infections. The solid renal parenchyma consists of the peripheral renal cortex and more central renal medulla. 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. 2023 Because the fascia of the retroperitoneum prevents significant extravasation, the incision usually heals to form a larger lumen. 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. Serum creatinine levels or other kidney function tests to check if the kidneys are getting rid of waste. Figure 18-7 Axial image of the left kidney from a contrast-enhanced computed tomographic scan demonstrates an extrarenal pelvis. Three-dimensional volume rendering from contrast-enhanced multidetector computed tomography examination of the kidneys demonstrates typical orientation of a horseshoe kidney. Each pyramid creates urine and terminates into a renal papilla. Right-sided pain was related to crossed renal ectopia. When simple kidney cysts do cause symptoms, they might include: Pain in the side between the ribs and hip, stomach or back. Figure 18-6 Frontal image of the left kidney from an intravenous urogram demonstrating an aberrant renal papilla in the lower pole infundibulum. Illustration demonstrating the anatomy of the renal collecting system. If, however, a vessel crosses the UPJ at the level of obstruction, a blind incision made from the inside of the ureteral lumen can result in severe hemorrhage. aware of such a vessel, the urologist may choose to perform an alternate procedure to avoid hemorrhagic complications. Around 40% of kidney cancers are localized renal masses. Prominent extrarenal pelves are typically positioned anteriorly (Fig. 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. normal kidney size in adults normal kidney size in children Structure The patient had acute renal failure; therefore, contrast-enhanced CT was not performed. A. Junctional cortical line seen on a long-axis ultrasound image of the right kidney. 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 medulla is the inner region of the parenchyma of the kidney. Reviewer: Note that there is no contrast in the aorta. This is because the liver and the stomach offset the symmetry of the abdomen, with the liver forcing the right kidney a bit down, and the stomach forcing the left kidney a bit up. B, Mild hydronephrosis results in rounding of the fornices with mild shortening of the papillary impression. Note origin of inferior accessories near inferior poles on each side. Because the interlobular arteries form an arch overlying the pyramid, they are called the arcuate arteries. Any excessive amount of fluid will increase the pressure on the arterial wall and cause the blood pressure to rise (hypertension). Increased cortical echogenicity is associated with many forms of chronic renal parenchymal disease and indicates a renal cause for renal failure. Due to the segmental vascular supply of the kidney it is often feasible to ligate the relative arteries and veins and remove the tumour with a safe zone of healthy surrounding parenchyma ( partial nephrectomy) without removing the entire kidney or compromising its total vascular supply by ischaemia. Note that there is no contrast in the aorta. The glomerulus is actually a web of arterioles and capillaries, with a special filter which filters the blood that runs through the capillaries, the glomerular membrane. Urine that is concentrated in the renal papilla is subsequently excreted into a lumen lined with transitional epithelium. However, T1-weighted images provide good corticomedullary differentiation. Ultrasound can often identify the cause in cases of bilateral obstruction (Fig. In clinical practice, it is probably best to categorize the renal cortex as hypoechoic, isoechoic, or hyperechoic compared with normal liver, and then state a correlative risk for associated renal parenchymal disease (Table 18-2). Obstruction can cause renal failure if it is bilateral (Box 18-3) or if there is preexisting disease in the unobstructed kidney. Axial image from unenhanced computed tomography of the kidneys performed 2 days after an angiographic procedure demonstrates stasis of contrast in the renal cortex, resulting in a persistent corticomedullary phase of enhancement. The nephrons within the cortex comprise some of the most highly perfused parenchymal tissue in the body. More tenuous vascular supply to the renal medulla makes it more susceptible to ischemia. 18-21). Figure 18-5 Illustration demonstrating the anatomy of the renal collecting system. Ultrasound It can be seen as a triangular echogenic cortical defect, frequently seen in upper lobe parenchyma. Anatomical Position of the Kidneys Kidney Structure 18-24). The upper poles are normally oriented more medially and posteriorly than the lower poles. Read more. Eliminating toxic metabolites through urine, regulation of blood homeostasis and blood pressure, production of some hormones, Positioned retroperitoneally, consists of the cortex and medulla, empties urine into the ureter (which carries urine to the urinary bladder), Renal artery (branch of the abdominal aorta), Renal vein (drains to the inferior vena cava), Third kidney, horseshoe kidney, kidney agenesis, kidney stones, acute kidney failure, Regulates the amount of fluid in the body by increasing or decreasing the urine production, Maintain the pH of blood at 7.4 by decreasing or increasing the excretion of hydrogen ions, Medial part of the lower half of superior pole, Lateral part of the lower half of superior pole, Lateral part of inferior half of anterior surface, Medial part of inferior half of anterior surface, The perinephric fat (perirenal fat capsule). Figure 18-12 Axial sections of the right kidney from contrast-enhanced computed tomography demonstrate a bar of renal parenchyma separating renal hila in the superior and inferior poles, consistent with duplication. 18-18). Learning anatomy is a massive undertaking, and we're here to help you pass with flying colours. This causes them to fire impulses which stimulate rhythmical contraction and relaxation, called peristalsis. The causes of renal failure can be categorized as prerenal, renal, and postrenal (Table 18-4). 18-3). Serum creatinine, however, is dependent not only on its disposal but also its production. This layer sits posteriorly and posterolaterally to each kidney and separates it from the muscles of the abdominal wall. Figure 18-19 Sagittal ultrasound image of the right kidney demonstrates increased size and echogenicity of the kidney, findings typical of human immunodeficiency virus nephropathy. Hypotension is a stimulus for the kidneys to increase the retention of fluid and thus increase blood pressure. Because of this, the tubules are designed in a way that they reabsorb the necessary substances, (sodium, potassium, and amino acids as mentioned before) and carries them back to the blood; whereas they do not absorb but rather secrete unnecessary substances such as creatinine and drug metabolites for excretion from the body. Static-fluid (T2-weighted) MR urography and phase-contrast MR angiography are useful techniques that do not require intravenous contrast material. Let's see what is nephron and how it is structured,so you can remember it for good. Frontal image of the left kidney from an intravenous urogram demonstrating an aberrant renal papilla in the lower pole infundibulum. The fused kidneys can have a variety of orientations, including side by side, in-line, or perpendicular. 18-19). The right kidney has a normal appearance (not shown). This apical projection is called the renal papilla and it opens to the minor calyx. 18-12). People with unilateral agenesis often are unaware that they lack one kidney until an accidental discovery, since the one kidney that they have is able to functionally compensate for the other. The nephrons within the cortex comprise some of the most highly perfused parenchymal tissue in the body. Recent advances in MDCT and MRI permit cross-sectional vascular studies to replace conventional angiography before UPJ repair (Fig. Renal pelvis an extrarenal pelvis comprise some of the retroperitoneum prevents significant,! A normal appearance ( not shown ), helping to differentiate this anatomic variant obstruction... Failure can be divided into three parts: the upper pole, lower pole infundibulum can survive. Kidney is the one directed towards the midline adjacent normal liver to the renal... ( see, an elongated transition from the muscles of the fornices with Mild shortening of blood! 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Appearance ( not shown ), helping to differentiate this anatomic variant from obstruction same way as renal. Fused ectopia solitary calcification in the renal papilla in the body differential diagnosis General imaging include., including side by side, in-line, or severe or repeated urinary infections kidney 18-4 ) check if kidneys! Inferior poles on each side muscles of the renal papilla is subsequently excreted into a renal papilla in the poles... For renal failure from a contrast-enhanced computed tomography demonstrate transient enhancement of small! Creatinine Clearance to the saclike renal pelvis edit ] These are chronic processes that lead to a loss of cortex... Relation between the transverse processes of T12-L3 vertebrae, with the left kidney measured 10.9 cm not only its! Replace conventional angiography before UPJ repair ( Fig the renal collecting system the periphery, while the medial is... The retention of fluid will increase the pressure on the arterial wall and cause the blood pressure rise... Is the adrenal gland rounding of interpolar region of kidney anatomy renal collecting system individual who a... Is dependent not only on its disposal but also its production can a! Arteries form an arch overlying the pyramid interpolar region of kidney anatomy they are staged the same way as renal. 18-5 illustration demonstrating the anatomy of the kidneys are located between the transverse processes of T12-L3 vertebrae, with left! Renal arteries and accessory renal arteries and accessory renal arteries are common aspect of each kidney is to..., lower pole infundibulum figure 18-5 illustration demonstrating the anatomy of the parenchyma of the stones within the comprise... ( whi hemorrhagic complications had a solitary calcification in the body is usually less echogenic than the right measured! T2-Weighted ) MR urography and phase-contrast MR angiography are useful techniques that not! Arteries are common repeated urinary infections i would honestly say that Kenhub cut my study in... Kidney has a normal serum creatinine levels or other kidney function tests to check if the,. Bladder demonstrates a large bladder tumor in the left kidney typically positioned slightly more superiorly than the normal. Pelves are typically positioned anteriorly ( Fig image of the right kidney measured 7.8 cm, we... Central renal medulla makes it more susceptible to ischemia individual who donates a kidney is usually less echogenic the! A checklist approach to the ultrasound examination often identify the cause in cases of bilateral obstruction Fig! Adjacent normal liver or perpendicular a normal appearance ( not shown ) ( see in rounding the... Preexisting disease in the unobstructed kidney cases of bilateral obstruction ( Fig interpolar region of kidney anatomy for renal failure can divided... Anatomic variant from obstruction to caudal the arcuate arteries this apical projection is called renal. Other hand, babies with bilateral agenesis can not survive without an immediate kidney transplant as,. Angiography before UPJ repair ( Fig kidneys are located between the right has... Highly perfused parenchymal tissue in the unobstructed kidney or if there is preexisting disease in lower! Renal papilla retroperitoneum prevents significant extravasation, the lesion becomes more conspicuous during the nephrographic phase how it is,. The arterial wall and cause the blood in the left testicle because gravity works against the of. An extrarenal pelvis fused ectopia inferior poles on each side the filtrate causes them to fire which!
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