1
Q
What layer does the kidney arise from?
A
Mesoderm
2
Q
How many stages of kidney development are there?
A
3
3
Q
What are the 3 stages of kidney development?
A
- Pronephros
- Mesonephros
- Metanephros
4
Q
When does the pronephros development take place?
A
4th embryological week
5
Q
Is the pronephros a functioning unit?
A
No
6
Q
When does the meonephros develop?
A
Late in the 4th embryologic week
7
Q
Which stage of development function as the interim kidney?
A
Mesonephros
8
Q
What does the mesonehros develop into?
A
Mesonephric duct
9
Q
Explain the development of the mesonephric duct in male development
A
Epididymis, vas deferns, ED
10
Q
Explain the development of the mesonephric duct in female development
A
Mullarian duct > ureter, vagina
11
Q
What stage of kidney development becomes the permanent kidney?
A
metanephros
12
Q
When does the metanephros form?
A
End of the 5th week embryological development
13
Q
When does the metanephros begin to function?
A
8 weeks gestation
14
Q
What does the ureteric bud form? (4)
A
Ureters
Renal pelvis
Calyces
Collecting ducts
15
Q
Where does the ureteric bud form from?
A
Mesonephric duct
16
Q
What is the functional unit of the kidney?
A
Nephrons
17
Q
Where do the nephrons arise from?
A
Intermediate mesoderm
18
Q
During fetal growth where do the kidneys migrate to?
A
Migrate from the pelvis to the abdomen
19
Q
At what week do the kidneys migrate during fetal development?
A
12-15 weeks gestation
20
Q
What causes the kidney to migrate?
A
Result of rapid caudal growth (so they don’t really migrate)
21
Q
When are where do the ureters develop?
A
Mesonephric duct (wolffian duct) at 4 weeks gestation
22
Q
Where does the urinary bladder develop from?
A
Urogenital sinus
23
Q
Is the urinary bladder continuous with the allantois?
A
Yes
24
Q
Where does the allantois form?
A
Yolk sac
25
What does the allantois become?
Urachus
26
What is the urachus?
Median umbilical ligament
27
What is the purpose of the medial umbilical ligament?
Pathway the bladder takes from the abdomen to the pelvis
28
When does the bladder become a true pelvic structure in infants and children?
After puberty
29
In what retroperitoneal space does the kidneys and ureters lie in?
Perirenal space
30
In what gutter do the kidneys obliquely lie?
Paravertebral gutters
31
What muscle runs parallel to the kidneys?
Psoas muscle
32
The upper poles are located more what to the inferior poles?
Medial and posterior
33
Where do the IVC and aorta lie in relation to the kidneys?
Anterior
34
Where do the ureters enter the bladder?
Posterolateral aspect of the bladder
35
What is the relation of the ureters to the iliac vessels?
Anterior
36
How long are the ureters?
30cm
37
What is the diameter of the ureters?
2-8cm
38
What vertebral level does the upper and lower poles the kidneys sit?
T12 and L3
39
At what vertebral level is the hilum?
L1
40
What cavity does the bladder lie in?
Retroperitoneal
41
Where does the bladder sit in an empty state?
True pelvis
42
Where does the bladder sit in a distended state?
False pelvis/abdominal cavity
43
Where is the bladder in relation to the prostate?
Superior
44
What shape is the kidney?
Bean-shaped AKA reniform shaped
45
How are the medial and lateral aspects of the kidneys shaped?
Medial- concave
| Lateral- convex
46
What are the dimensions of the adult kidney?
Length- 9-12cm
Width- 4-5cm
AP- 3cm
47
Which kidney is usually longer?
Left
48
The lengths of the adult kidney should be within how many cm of each other?
1.5-2cm
49
What is the size of a child's kidneys?
Size will vary with age- charts generally available within department
50
What are the 4 layers if tissue that protects the kidneys?
1. Thin fibrous capsule
2. Perirenal fat
3. Renal fascia
4. Pararenal fat
51
Describe how the thin fibrous capsule that surrounds the kidney appears on US
Specular reflector that appears bright on US (echogenic)
52
What is the perirenal fat continuous with?
Renal sinus
53
What is another name for the renal fascia?
Gerota's fascia
54
What is the purpose of the renal fascia?
Anchors the kidney to the posterior abdominal wall
55
What spaces does the renal fascia separate?
Separates the perirenal space from the pararenal space
56
What is ptosis?
A kidney that falls when fascia tears
57
What are the 2 distinct areas of the kidney?
Parenchyma and Sinus
58
What area of the kidney is the functional layer?
Parenchyma
59
What is the parenchyma divided into?
Cortex and Medulla
60
What portion of the kidney is the renal capsule?
Outer portion
61
Where is the site of urine production?
Renal cortex
62
What area of the kidney contains the functional units?
Cortex
63
What is the parenchyma that arches over the renal pyramids and extends between pyramids known as?
Columns of Bertin
64
What artery and vein does each column of Bertin contain?
Interlobular artery and vein
65
What is the medulla?
Inner portion of the parenchyma
66
What does the medulla consist of?
Pyramids
67
How many triangular structured pyramids are there?
8-18
68
What does the base of the pyramid point to?
Pointed toward the cortex
69
What does the apex of the pyramid point to?
Renal sinus (minor calyces)
70
When is a pyramid considered enlarged?
If they are thicker then the cortex
71
What is the fatty central portion of the kidney?
Renal sinus
72
What structures does the renal sinus contain?
Minor and major calyces, renal pelvis, vessels and nerves
73
How many minor calyces are there?
8-18
74
Does the minor or major calyce receive urine from the pyramids?
Minor calyce
75
How many major calyces are there?
2-3
76
What is another name for the major calyces?
Infundibula
77
What portion of the kidney does the major calyces join to?
Renal pelvis
78
What is the order from anterior to posterior are the vessels positioned in the renal hilum?
Renal vein
Renal artery
Ureter
Third branch of the renal artery
79
Which ureter is shorter? Right or Left?
Right
80
How does the ureter transport urine?
Peristalsis and gravity
81
What are the 3 natural points of narrowing?
1. Ureteropelvic junction
2. Pelvic brim (anterior to iliac vessels)
3. Ureterovesical junction
82
What does bladder size and shape depend on?
Urine volume
83
What lines the inner walls of the bladder?
Inner muscos membrane containing rugae
84
What happens to the rugae of the bladder in an extended state?
Outline becomes smoother and distends with urine
85
What happens to the rugae when the bladder is in an empty state?
Membrane is wrinkled
86
What is the bladder capacity?
300-500ml
87
What is the volume measurement of the bladder?
AP X L X W X 0.52
88
Is a post void of < 100ml significant?
No
89
Does the trigone of the bladder change shape?
No, remains constant
90
What is the trigone?
Triangular area b/w the openings of the ureters and the urethra
91
Where is the trigone located?
Base/posterior surface of the bladder
92
What is the bladder neck?
Urethral opening
93
Does the bladder neck remain a content size ad shape?
Yes
94
Where is the apex of the bladder located?
Anterior and superior surface of the bladder
95
What attaches to the apex of the bladder?
Median umbilical ligament
96
What are the 4 layers of the bladder?
1. Mucosa- inner layer containing rugae
2. Sub-mucosa- connective tissue
3. Muscle
4. Serosa- peritoneum covering superior surface
97
What is the muscle layer of bladder?
Detrusor muscle
98
How many muscle layers of the bladder is there?
3
99
What does the muscle layer of the bladder form?
Sphincter muscle
100
What is the measurements for the distended state of the bladder wall?
3mm
101
What is the measurements for the non-distended state of the bladder wall?
6mm
102
What does the female urethra pierce to exist the bladder?
Urogenital diaphragm
103
What are the 3 areas of the male urethra?
1. Prostatic
2. Membranous
3. Penile
104
What structures are anterior to the right kidney? (5)
1. Right adrenal
2. Right lobe of the liver
3. 2nd part of to duodenum
4. Right colic flexure
5. Morrisons pouch
105
What structures are posterior to the right kidney? (4)
1. Diaphragm (superiorly)
2. Psoas muscle (posteriomedial)
3. Quadratus lumborum muscle
4. Costodiaphragmatic recess
106
What structures are anterior to the left kidney? (6)
1. Left adrenal gland
2. Body and tail of pancreas
3. Spleen
4. Stomach
5. Jejunum
6. Left colic flexure
107
What structures are posterior to the left kidney? (4)
1. Diaphragm
2. Psoas muscle (posteriomedial)
3. Quadratus lumborum muscle
4. Costodiaphragmatic recess
108
What structures is the right ureter posterior to?
Duodenum and terminal ilium
109
What structures is the left ureter posterior to?
Colon and left gonadal vessels
110
In males the pelvic portion of the ureter pass what to the ductus deferens?
Posteriorly
111
What is anatomical order of structures from anterior to posterior in the female pelvis, relating to the ureter?
Ovary > ureter > internal iliac artery > vein
112
What is anterior to the male and female bladders?
Space of Retizus
113
What structures are posterior to the male bladder? (3)
Rectum, vas deferens, seminal vesicles
114
What muscles are lateral to the male and female bladder?
Iliopsoas and obturator internus muscles
115
What is the relationship of the bladder to the prostate?
Posterioinferior
116
Are the levator ani muscles inferior to the male bladder?
Yes
117
What structures are posterior to the female bladder? (3)
Uterus, vagina, anterior-cul-de-sac
118
How is the adnexa positioned in relation to the bladder?
Posteroinferior
119
What is the total cardiac output to the kidneys?
1/4 of the cardiac output
120
Approximately how much blood passes through the kidneys (blood volume) per minute?
1200ml/min
121
What do the renal arteries branch into?
Interlobar arteries
122
What do the lobular arteries branch into?
Arcuate arteries
123
Where are the arcuate arteries located?
At the base of the pyramids
124
What do the arcuate arteries branch into?
Interlobular arteries
125
What arteries travel into the renal cortex?
Interlobular arteries
126
What do interlobular arteries branch into?
Afferent arterioles
127
Where do the afferent arteries travel?
Into the glomerulus of the nephron
128
How is the lymph fluid drained?
Para-aortic nodes
129
What is the ultrasonic appearance of a sagittal adult kidney?
Smooth, contoured, elliptical shape
130
What is the ultrasonic appearance of a transverse adult kidney?
Rounded and boken medially by the hilum
131
How does the capsule present on US?
Echogenic line bordering cortex
132
Describe the US appearance of the cortex
Extends from the sinus to the outer surface
Homogenous
Even thickness
Echogenicity equal to or slightly less echogenic than the liver
133
At what level do you assess and compare the kidney to the liver?
Assess and compare at the same level
134
Describe the US appearance of the medulla
Triangular rounded or blunted hypoechoic (anechoic) areas
| Equidistant
135
What is the corticomedullary junction (CM junction)?
A marker used for measuring the cortical thickness
136
How does the corticomedullary junction appear as on US?
Pulsation and bright reflection of arcuate arteries
137
Describe the US appearance of the renal sinus?
Homogenous highly echogenic central area
138
What does the renal sinus appear as in a non hydride state?
Renal pelvis and infundibulum not well seen (collapsed)
139
What does the renal sinus appear as when over hydrated?
Small echo lucent areas within the sinus
140
What do the renal arteries appear as in US?
Linear anechoic tubes
141
What plane are the renal vessels best assessed in?
Transverse (long axis)
142
What structure can be mistaken for the renal arteries?
Crura
143
What is the US appearance of the cortex in infants and children?
Isoechoic or MORE ECHOGENIC compared to the liver
Thin compared to pyramids
Lobular contour (should disappear by age 6)
144
What is the US appearance of the pyramids in infants and children?
Hypoechoic and large
| Ratio of the cortex to the medulla 1.64:1 (adult 2.59:1)
145
What is the US appearance of the sinus in infants and children?
Indistinct, hypoechoic due to very little fat
146
How is the paediatric kidney position different then an adult within the body?
Positioned lower in the abdomen
147
By what age do infants demonstrate an adult echo pattern?
6 months
148
When are ureters best visualized?
When dilated
149
What will the ureters appear like when dilated?
Anechoic tubular structure in sagittal
150
When is the distal ureter be assessed?
When there is a full bladder
151
Describe the ureteral jets
1-3sec stream of urine entering bladder from ureter
152
What does flow from the ureteral jets indicate?
Flow of urine not obstructed
153
How does the bladder appear on US?
cystic and anechoic
154
How does the bladder appear on US in a transverse plane with superior angulation?
Rounded
155
How does the bladder appear on US in a transverse plane with inferior angulation?
Squared
156
What are we checking for when scanning the bladder?
Wall irregularities/ shape
157
What transducer frequency would you use when scanning the kidneys?
3-5 MHz
158
What are the potential patient positions when scanning the kidneys?
Supine, decubitus or oblique
159
What planes are the kidneys assessed in?
Sagittal, coronal or transverse
160
What structure is used to help assess the right kidney?
Liver
161
What structure is used to assess the left kidney?
Spleen
162
What are some things you could do to optimize the image?
Breathing technique
Change pt position
Change windows
163
How are the ureters best visualized?
In long axis
164
How is the proximal ureter best visualized?
Coronal oblique plane using kidney as a window
165
How is the mid ureter best visualized?
Using grated compression to move bowel gas out of the way
166
What are the scanning techniques used for the bladder? (3)
1. 3-5MHz transducer
2. Sagittal and transverse planes
3. Full bladder required
167
What are you supposed to check for when the dilated ureters or hydronephrosis?
Check for "jets"
168
What are you supposed to look for when there is a lesion noted in the bladder?
Check the kidneys for hydronephrosis
169
Are you supposed to do a post void image when a mass or fluid is collected within the space of Retzius?
Yes
170
What is the modality of choice to evaluate the bladder?
Cystoscopy
171
What do the kidneys regulate? (3)
1. Osmotic pressure and volume of extracellular fluids by regulating the amount of sodium and water excreted
2. Total concentration of water and electrolytes
3. pH
172
What product is excreted by the kidneys?
Metabolic waste
173
What enzyme is secreted by the kidney?
Renin
174
What does renin affect?
Blood pressure
175
Can a person function with only 1 kidney? How?
Yes, because they function independently
176
How much urine is excreted daily?
1.2-1.5L - variable
177
What are the metabolic wastes excreted by the kidneys?
CO2, urea, uric acid, creatinine
178
How much fluid do the kidneys produce daily?
180L
179
What % of the processed fluid is retained from the kidneys and how much is excreted?
99% filtered and recirculated
| 1% excreted
180
What does the nephron do? (2)
Filter blood and produce urine
181
What are the 2 types of nephrons?
1. Cortical (superficial)
| 2. Juxtamedullary (deep)
182
What are the 2 main components of the nephrons?
1. Renal corpuscle
| 2. Renal tubule
183
What makes up the renal corpuscle? (2)
1. Network of porous capillaries (glomerulus)
| 2. Membrane with filtration slits (Bowman's capsule)
184
What makes up the renal tubule? (4)
1. Proximal convoluted tube
2. Distal convoluted tube
3. Loop of henle
4. Collecting duct
185
What is the function of the nephrons?
1. Control blood concentrations and volume
2. Helps regulate blood pH
3. Removes toxins from blood
186
How are toxins removed from the blood?
Through osmosis and active transport
187
What path does the blood take to reach the nephrons?
Renal artery > interlobar artery > arcuate artery > interlobular arteries > interlobular artery > afferent artery > glomerulus
188
What are the 3 stages of urine formation?
1. Glomerular formation
2. Tubular reabsorption
3. Tubular secretion
189
Describe the process of glomerular formation
- Afferent artery brought blood to the glomerulus
- An increase in BP forces water and dissolved substances through a membrane
- The combo of water and dissolved substances filters into bowman's capsule producing filtrate
- Filtrate enters renal tubule
190
What does not pass through the membranes of the bowman's capsule?
RBC
191
How do RBCs leave the glomerulus?
Efferent arteriole
192
Describe the process of tubular reabsorption
Nutrients in the filtrate are reabsorbed back into the bloodstream
193
What are the substances reabsorbed back into the bloodstream?
Water, glucose, vitamins and nutrients
194
What causes reabsorption to occur?
Peritubular capillaries at the PCT, ascending and descending loop of henle
195
Describe the process of tubular secretion
- Waste is secreted into the DCT
| - Rids the body of certain substances and controls the blood pH
196
What is the bloods normal pH?
7.35 to 7.45
197
Where is the juxtaglomerular apparatus located?
The point where the DCT, afferent and efferent arterioles come into contact
198
What cells release renin?
Granular cells (afferent arterioles)
199
What cells inhibit renin release?
Macular cells (DCT)
200
What is the main function of the juxtaglomerular apparatus?
Regulate BP
201
What are the influencing factors that act on the kidney to help regulate BP? (3)
1. ADH (antidiuretic hormone)
2. Aldosterone
3. Renin
202
What secretes ADH?
Posterior Pituitary
203
What is the function of ADH?
Aids in retaining water in the body
204
What stimulates the production of ADH?
Decrease in blood volume
205
What structure secretes Aldosterone?
Adrenal cortex
206
What does aldosterone act on?
PCT
207
What does aldosterone control?
Sodium reabsorption
208
What stimulates the production of aldosterone?
Increased blood volume
209
What system is aldosterone influenced by?
Renin-angiotension system
210
What secretes renin?
juxtaglomerular apparatus
211
What influencing factor in the kidney acts as a catalyst?
Renin
212
What does renin stimulate the formation of ?
Angiotensin
213
Angiotensin stimulates the release of what?
Aldosterone
214
Does renin respond to the stimulation of decreased or increases BP?
Decreased
215
How much loss of function can there be in the kidney before blood tests are elevated?
60%
216
What are the 3 blood tests that assessed for kidney function?
1. Serum creatinine
2. Blood urea nitrogen (BUN)
3. Serum electrolytes
217
What is serum creatinine?
End product of muscle creatine phosphate metabolism that is filtered out of the kidneys
Easily excreted by kidneys and directly related to glomerular filtration rate
218
How much serum creatinine is in the blood?
Amount proportional to the body's muscle mass (levels remain constant)
219
Which test is more sensitive? Serum creatinine or BUN
Serum creatinine
220
What do increased level of creatinine suggest?
Renal failure, chronic nephritis and urinary tract obstruction
221
What is BUN?
End product of protein metabolism
222
How is BUN formed?
In the liver from ammonia and readily excreted by the kidneys
223
What does BUN reflect? (2)
Protein intake and renal excretory capacity
224
What does increased levels of BUN suggest? (3)
Renal dysfunction, dehydration (reduced renal blood flow) and increased protein metabolism
225
What do decreased levels of BUN suggest?
Severe hepatic dx, malnutrition and over hydration
226
What are the serum electrolytes?
Chloride (CI), Potassium (K), sodium (Na) and bicarbonate (HCO3)
227
What do increased levels of serum electrolytes indicate?
Acute renal failure, glomerulonephritis and renal tubular acidosis
228
What do decreased levels of serum electrolytes indicate?
Chronic and acute renal failure
229
What is tested for in urine tests? (6)
1. RBC
2. WBC
3. Pyuria
4. Proteinuria
5. pH
6. Specific gravity
230
Is hematuria normal?
Any amount of blood in urine is abnormal
231
What does hematuria detect?
Inflammation, tumors, pyelonephritis and calculi
232
What does WBCs in the urine indicate?
Inflammation, infection and tissue necrosis
233
What is pyuria? What does it indicate?
Pus in the urine and indicates infection
234
What is proteinuria?
Protein in the urine
235
When is proteinuria seen?
In nephritis, polycystic dx, stones and carcinoma
236
What does the pH refer to in the urine?
Abundance of hydrogen atoms
Acidic if levels increased
Alkaline if levels decreased
237
What does the formation of stones depend on?
Urine pH - important in pt with calculi
238
What does specific gravity measure?
Kidneys ability to concentrate urine
239
When is there low levels of specific gravity?
Renal failure and pyelonephritis
240
When are there increased levels of specific gravity?
Urine output (dehydration)
