The small portion of the lumen surrounding the papilla is called the. The superior half of each kidney is covered by the diaphragm, which is why the kidneys move up and down during respiration. Urine that is concentrated in the renal papilla is subsequently excreted into a lumen lined with transitional epithelium. The renal pelvis then tapers like a funnel to join the ureter. IVC, Inferior vena cava. Concerning lymphatic drainage, each kidney drains into the lateral aortic (lumbar) lymph nodes, which are placed around the origin of the renal artery. The most common cause is renal artery stenosis (see Fig. Note that retroaortic components are usually near the inferior poles (Fig. Thus, any upward trend in the serum creatinine value should be viewed with concern when considering the administration of potentially nephrotoxic or renally excreted intravenous contrast media. Parasympathetic innervation enhances the peristalsis while sympathetic innervation inhibits it. Further testing/diagnosis is required. 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. CT angiography is occasionally performed when a vascular causative factor is suspected (renal artery stenosis or renal vein thrombosis) and MRI is contraindicated. 18-25). 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. The kidneys serve important . Figure 18-2 Annotated axial image of the right kidney from a contrast-enhanced computed tomographic scan demonstrates hilar anatomy of the kidney. Maintaining kidney health. The left testicular vein must ascend higher and it drains to the left renal vein at a right angle, unlike the right testicular vein which joins the inferior vena cava directly. Typically, one kidney sits on either side of your spine. A. Junctional cortical line seen on a long-axis ultrasound image of the right kidney. The superior poles (extremities) (T12) of both kidneys are more medially pointed towards the spine than the inferior poles (extremities) (L3). A, Axial image demonstrates the dilated renal pelvis and crossing vessel. The calcium or uric acid will precipitate and form stones. 18-27). 18-16). This phenomenon is due to T2-shortening and susceptibility (T2*) effects caused by concentrated gadolinium, and can potentially obscure filling defects and urothelial lesions. Pain that radiates to the lower abdomen and groin. The patient had acute renal failure; therefore, contrast-enhanced CT was not performed. The medulla is the inner region of the parenchyma of the kidney. Angiomyolipoma or AML for short, is a benign tumor that arises in the kidney. Read more. In order to understand the functions of the kidney, we must first learn its anatomy. Note distance from origin to the first arterial division (Fig. Each kidney should always be evaluated in long axis (coronal, sagittal, or both, depending on sonographic window) and axial to the kidney. Look carefully for accessory arteries at upper and lower poles (Fig. A, A low-attenuation lesion is difficult to identify during the corticomedullary phase. Advantages of scintigraphy include accurate quantitative measurement of function. B, Axial CT image from a different patient demonstrates the more common location of the right renal artery posterior to the IVC. The renal corpuscle has two components: the glomerular (Bowmans) capsule in which sits the glomerulus. The interpolar region is the middle of the kidney. The kidneys are a pair of bean-shaped organs located below the rib cage, one on each side of the spine. 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. The visible contrast seen in the excretory phase has been concentrated many-fold. Pitfall: An extrarenal pelvis may be mistaken for hydronephrosis. Crossed ectopia can be either fused or unfused. Table 18-7 Causes of Unilateral Small Smooth Kidney, Only gold members can continue reading. The presence of contour irregularity usually indicates scarring, suggesting prior infection, reflux, or infarction. In adults, the normal kidney is 10-14 cm long in males and 9-13 cm long in females, 3-5 cm wide, 3 cm in antero-posterior thickness and weighs 150-260 g. The left kidney is usually slightly larger than the right. Figure 18-23 Axial image of the left kidney obtained in the excretory phase of a computed tomographic urogram demonstrates the effects of window settings on visualizing structures near excreted contrast. Ultrasound to get images of your kidneys. Figure 18-8 Junctional cortical line seen on a long-axis ultrasound image of the right kidney. The defect proved to be blood clot from papillary necrosis. As the lobules of metanephric blastema coalesce to form each kidney, they do not always result in a smooth, uniform band of cortex. In some cases, two separate kidneys drain into a bifid renal pelvis, ultimately drained by a common ureter. The pyramids contain the functional units of the kidney, the nephrons, which filter blood in order to produce urine which then is transported through a system of the structures called calyces which then transport the urine to the ureter. Figure 18-7 Axial image of the left kidney from a contrast-enhanced computed tomographic scan demonstrates an extrarenal pelvis. If the renal pelvis extends out of the renal sinus, it is considered to be an extrarenal pelvis (Fig. It participates in vital processes such as regulation of blood osmolarity and pH, regulation of blood volume and blood pressure, production of hormones, and filtration of foreign substances. The apex of the pyramid projects medially toward the renal sinus. The presence of significant renal parenchyma may justify surgical repair to maximize the functional contribution of that kidney. Thus, the ureter is seen paravertebrally starting from the L2 and going downwards. Kim Bengochea, Regis University, Denver. Learning a quickmnemonic'VAD' can help you remember these structures (renal Vein, renal Artery, Duct a.k.a ureter). MR angiography can be useful for the diagnosis of renal vascular abnormalities. The kidneys are highly vascular (contain a lot of blood vessels) and are divided into three main regions: the renal cortex (outer region which contains about 1.25 million renal tubules), renal medulla (middle region which acts as a collecting chamber), and renal pelvis (inner region which receives urine through the major calyces). 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). Other common kidney conditions are acquired through life, and one of the most common is nephrolithiasis (kidney stones). In this region, the anterior and posterior hilar lip is identified (Fig. At that point, you may experience these symptoms: Severe, sharp pain in the side and back, below the ribs. Weve mentioned that the most important functions of the kidney are the regulation of the blood homeostasis and blood pressure, so acute kidney failure can lead to a quick fall of blood pressure which presents as a state of shock. The main unit of the medulla is the renal pyramid. 18-18). Bilateral echogenic kidneys with renal hypertrophy can be seen associated with human immunodeficiency virus disease (see. All content published on Kenhub is reviewed by medical and anatomy experts. Chronic obstruction, however, results in damage to the papilla, evident in the clubbed calyx of papillary necrosis (Fig. The solid renal parenchyma consists of the peripheral renal cortex and more central renal medulla. Learning anatomy is a massive undertaking, and we're here to help you pass with flying colours. The kidneys are located between the transverse processes of T12-L3 vertebrae, with the left kidney typically positioned slightly more superiorly than the right. D, If pressure on the papilla persists, the ischemic papilla undergoes necrosis, allowing the calyx to protrude outward toward the cortex. Right-sided pain was related to crossed renal ectopia. Literature supports the use of either multidetector computed tomography (MDCT) or MRI in donor evaluation. Causes. There is no specific treatment for fused kidneys and the only option is to treat the pathologies that affect them during life. Simple kidney cysts aren't cancer and rarely cause problems. CT scan and MRI to help diagnose and stage kidney masses. 18-20). 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. Table 18-7 lists causes of unilateral smooth renal atrophy. If a kidney stone becomes lodged in the ureters, it may block the flow of urine and cause the kidney to swell and the ureter to spasm, which can be very painful. Note number of veins by inspecting inferior vena cava along entire length of kidney. Frontal image of the left kidney from an intravenous urogram demonstrating an aberrant renal papilla in the lower pole infundibulum. Renal scintigraphy can be performed with a variety of agents to provide assessment of either function or structure of the kidneys. Calcifications and renal calculi are notoriously poorly demonstrated with MRI. The calyces, however, will have a normal appearance with an unobstructed extrarenal pelvis but will be dilated in cases of urinary obstruction. 18-24). The presence of significant renal parenchyma may justify surgical repair to maximize the functional contribution of that kidney. 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. Obstruction can cause renal failure if it is bilateral (Box 18-3) or if there is preexisting disease in the unobstructed kidney. Reading time: 23 minutes. 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. Bilateral echogenic kidneys with renal hypertrophy can be seen associated with human immunodeficiency virus disease (see Fig. Even when there is another plausible explanation for decreased renal function (e.g., known prerenal causes), ultrasound offers the opportunity to rapidly and noninvasively identify a potentially correctible cause of renal failure. Relation between the right renal artery and the inferior vena cava (IVC). 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. You can test yourself on the renal arteries with our quiz. Each segmental branch of the renal artery divides into multiple interlobar arteries that course along the periphery of the medullary pyramids and causes small interlobular branches (Fig. Diabetes, hypertension, acute tubular necrosis, Increased echogenicity has high association with parenchymal disease, Acute tubular necrosis usually results in an increased RI, whereas prerenal causes usually do not have an increased RI; postrenal causes often increase the RI, but hydronephrosis should be present in those cases, If present, suspect neurogenic bladder or outlet obstruction, Often severe aortic disease or fibromuscular dysplasia. 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. 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