The kidney also has endocrine functions, helping to control blood pressure, bone mineralization, and erythrocyte production. Internal Anatomy. Axial image of the left kidney from a contrast-enhanced computed tomographic scan demonstrates an extrarenal pelvis. The kidneys can be divided into three main regions from cranial to caudal. Illustration demonstrating the relation between the renal papilla and calyx. 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. In order to understand the functions of the kidney, we must first learn its anatomy. The vessel which brings blood into the glomerulus is the afferent arteriole, whereas the vessel that carries the rest of the blood out that hasnt been filtered out of the glomerulus is called the efferent arteriole. The isthmus connecting the kidneys is variable, ranging from normal renal cortex to a thin fibrous band. Look for duplication, large extrarenal pelvis. The upper poles are normally oriented more medially and posteriorly than the lower poles. When multiple clefts in the renal cortex are present throughout the kidney, it is described as fetal lobulation. CT and MR findings of renal artery stenosis parallel classic findings described on intravenous pyelogram, including one atrophic kidney with delayed nephrogram and excretion that can progress to a persistent nephrogram with hyperconcentrated excreted contrast media (Fig. A simple calyx receives urine from a single papilla; a compound calyx receives urine from multiple papillae (Fig. One of the most commonly used (and least complicated) equations is shown in Box 18-1. Use of MR contrast agents in renal failure poses a lower risk than iodinated contrast material for exacerbating renal failure, but there is evidence that gadolinium-based MR contrast media pose some risk for systemic complications (nephrogenic systemic fibrosis) and should be used with caution in patients with severe or acute renal insufficiency. It is important to note, however, that the appearance of hydronephrosis does not necessarily indicate urinary obstruction (see Hydronephrosis and Its Mimics section later in this chapter). Many clinical laboratories now provide computer-generated calculations of estimated creatinine clearance or eGFR using patient data in the medical information system. 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. Parasympathetic innervation enhances the peristalsis while sympathetic innervation inhibits it. Calculation of the estimated renal volume is considered by some to be the most accurate assessment of renal size available with ultrasound, although renal length alone is more commonly reported. The nephrons within the cortex comprise some of the most highly perfused parenchymal tissue in the body. But more often, kidney cysts are a type called simple kidney cysts. The defect is the extension of sinus fat into the cortex, usually at the border of the upper pole and interpolar region of the kidney. When fused, the condition is described as crossed fused ectopia. Made. Aggressive tumors form, grow and spread very quickly. Retrograde urogram shows a calculus in the left ureter. The main symptom is severe sharp pain that starts suddenly, usually in your belly or one side of your back, and it may go away just as quickly. Imaging must provide detailed images of the renal parenchyma and a survey of arterial, venous, and ureteral anatomy. Dialysis. This illustrates the amount of reserve function that must be compromised before renal injury can be detected with a serum creatinine level. Table 18-7 lists causes of unilateral smooth renal atrophy. Advantages of scintigraphy include accurate quantitative measurement of function. 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. Computed Tomographic Evaluation for Renal Failure, Magnetic Resonance Evaluation for Renal Failure. Get instant access to this gallery, plus: Introduction to the musculoskeletal system, Nerves, vessels and lymphatics of the abdomen, Nerves, vessels and lymphatics of the pelvis, Infratemporal region and pterygopalatine fossa, Meninges, ventricular system and subarachnoid space. Medullary cystic disease is encountered only rarely, and in addition to the echogenic atrophic cortex, the medullary pyramids are particularly hypoechoic. The kidneys are bilateral organs placed retroperitoneally in the upper left and right abdominal quadrants and are part of the urinary system. . Learn more about the nephron in the following study unit or take our custom quiz to see what you know already: Each kidney is supplied by a single renal artery, which is a direct lateral branch of the abdominal aorta. It can be caused by a variety of factors, but most often arises because of the ischemia of the kidney and the toxic effect of some medications, resulting in the failure of all kidney functions. More tenuous vascular supply to the renal medulla makes it more susceptible to ischemia. A, A low-attenuation lesion is difficult to identify during the corticomedullary phase. Figure 18-4 Illustration demonstrating the relation between the renal papilla and calyx. BOX 18-2 Crossing Vessels in Ureteropelvic Junction Obstruction. Chronic glomerulonephritis usually causes bilateral increased renal echogenicity with smooth atrophy, whereas renal artery stenosis usually causes a similar but unilateral appearance (Fig. 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. It is also permeable for the products of the metabolism, such are creatinine and drug metabolites. 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. Other symptoms can include abnormal urine color, blood in your urine, fever, chills, nausea, and vomiting. Association between Renal Cortical Echogenicity and Renal Parenchymal Disease. Most serum creatinine is excreted in the urine; therefore, if renal function is compromised, levels of creatinine in the serum increase. I hope this helps. 18-27). Kidneys are located just below your ribcage and behind your belly. 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. IVC, Inferior vena cava. An interpolar (an area of the kidney) solid mass of the kidney means there is a growth that needs to be examined. Figure 18-5 Illustration demonstrating the anatomy of the renal collecting system. normal kidney size in adults normal kidney size in children Structure Cells in our body constantly produce hydrogen ions. The shape of the calyx is formed by the impression of the renal papilla. 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. Renal artery In this case, the right kidney had more favorable anatomy for laparoscopic donor nephrectomy. When hydronephrosis is absent, the causative factor for acute renal failure is almost certainly prerenal or renal. Supernumerary kidneys are quite rare and have been associated with aortic coarctation, vaginal atresia, and urethral duplications. 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. Note that there is no contrast in the aorta. The small portion of the lumen surrounding the papilla is called the calyx. Since they are located deep retroperitoneally, the easiest way to examine them is from the patients back. In this way, the consistency of blood is preserved and no important substances are lost. The kidneys are located between the transverse processes of T12-L3 vertebrae, with the left kidney typically positioned slightly more superiorly than the right. 18-4). A frontal section through the kidney reveals an outer region called the renal cortex and an inner region called the medulla. 18-24). 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. Diagnostic ultrasound uses sound wave technology to look at parts of your body, including: Brain Heart and blood vessels Breast Abdominal Organs Eyes Thyroid Skin and muscles Types of Ultrasound. The renal pelvis then tapers like a funnel to join the ureter. The small portion of the lumen surrounding the papilla is called the. Other methods include classical surgical removal of the stone, either through the ureter or by open surgery. 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. Advantages of scintigraphy include accurate quantitative measurement of function and parenchymal mass without the risks for nephrotoxicity associated with iodinated contrast media or nephrogenic systemic fibrosis associated with gadolinium contrast agents. However, T1-weighted images provide good corticomedullary differentiation. 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. Normal magnetic resonance imaging appearance of the kidneys. The corticomedullary phase is prolonged in the presence of ureteral or venous obstruction and can persist for days in cases of acute tubular necrosis (ATN; Fig. 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. Identify abnormal course of main or accessory right renal artery anterior rather than posterior to inferior vena cava (Fig. 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. Our engaging videos, interactive quizzes, in-depth articles and HD atlas are here to get you top results faster. During the 6th to 9th weeks of life, the kidneys begin to ascend from their position in the pelvis to the level of T12-L1, inferior to the adrenal glands. This is why the kidney is essential for the circulatory hemostasis. 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. 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