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. 18-4). 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. In addition to the renal artery, accessory renal arteries are present too. The axes of the renal moeities are abnormal with the inferior poles angled medially. This refers to the forming of the stones within the system of calyces because of too much calcium or uric acid into the filtrate. Creatinine is a breakdown product of creatine, found within muscle. When hydronephrosis is absent, the causative factor for acute renal failure is almost certainly prerenal or renal. Most serum creatinine is excreted in the urine; therefore, if renal function is compromised, levels of creatinine in the serum increase. 2023 B, A small calyceal defect is seen when the same image is viewed using bone windows. Because the interlobular arteries form an arch overlying the pyramid, they are called the. BOX 18-3 Causes of Bilateral Hydronephrosis. Further testing/diagnosis is required. I hope this helps. Figure 18-7 Axial image of the left kidney from a contrast-enhanced computed tomographic scan demonstrates an extrarenal pelvis. Renal artery A. Junctional cortical line seen on a long-axis ultrasound image of the right kidney. In cases of unilateral obstruction with acute renal failure, sonographic evaluation may show evidence of chronic renal parenchymal disease in the unobstructed kidney. Most radiologists consider 10 to 12 cm to be an approximate reference range for renal length in adults, allowing for an additional 1 cm in either direction for patients at the extremes of height. 18-21). Log In or, Click to share on Twitter (Opens in new window), Click to share on Facebook (Opens in new window), Click to share on Google+ (Opens in new window), Estimated Creatinine Clearance and Glomerular Filtration Rate, Cockroft and Gault Equation for Calculating Estimated Creatinine Clearance, The Modification of Diet in Renal Disease (MDRD) is another method for estimating renal function that yields a value often called, The kidneys can be divided into three main regions from cranial to caudal. 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. Each nephron contains a renal corpuscle, which is the initial component that filters the blood, and a renal tubule that processes and carries the filtered fluid to the system of calyces. Around 40% of kidney cancers are localized renal masses. 18-26). 18-25). More tenuous vascular supply to the renal medulla makes it more susceptible to ischemia. This specific condition is called the nutcracker phenomenon. Look for duplication, large extrarenal pelvis. Clinical significance [ edit] 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 play a central role in homeostasis. This is why the kidney is essential for the circulatory hemostasis. Register now The apex of the pyramid projects medially toward the renal sinus. Pitfall: An extrarenal pelvis may be mistaken for hydronephrosis. Figure 18-13 Volume rendering from a computed tomographic scan of the kidneys shows bilateral supernumerary renal arteries (three on right, two on left). However, you may have symptoms related to the condition that's causing it. Hydronephrosis is important to detect, because obstructive uropathy is often reversible if identified early. Note distance from origin to the first arterial division (Fig. The ureters are the tubes that carry urine from the renal pelvis to the bladder. Figure 18-27 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). Three-dimensional volume rendering from contrast-enhanced multidetector computed tomography examination of the kidneys demonstrates typical orientation of a horseshoe kidney. Arterial stenosis was confirmed by magnetic resonance angiography. Anatomy of the Kidney and Ureter Parenchyma Cortex Medulla Perirenal fat Capsule Ureter This kidney measured 14 cm in length. Right-sided pain was related to crossed renal ectopia. Table 18-5 Checklist Approach to Ultrasound for Renal Failure. Some divide the excretory phase into the early excretory phase (contrast mainly confined to the kidney) and late excretory phase (contrast in the ureters). The left kidney (not shown) had a similar appearance. It doesn't have to be that way. Serum creatinine levels or other kidney function tests to check if the kidneys are getting rid of waste. Table 18-6 Causes of Bilateral Small Smooth Kidneys. Kidney stones are most often treated by ultrasound shock therapy, during which high-frequency radio waves break the stone into smaller pieces that can be passed naturally into the urine. 18-25). 18-28). and grab your free ultimate anatomy study guide! Maintaining kidney health. Table 18-7 Causes of Unilateral Small Smooth Kidney, Only gold members can continue reading. When the renal arteries enter the kidney through the hilum, they split into anterior and posterior branches. Typically, one kidney sits on either side of your spine. 18-3). The upper poles are normally oriented more medially and posteriorly than the lower poles. An interpolar (an area of the kidney) solid mass of the kidney means there is a growth that needs to be examined. The kidneys are located between the transverse processes of T12-L3 vertebrae, with the left kidney typically positioned slightly more superiorly than the right. Obstruction can cause renal failure if it is bilateral (Box 18-3) or if there is preexisting disease in the unobstructed kidney. Renal function is better evaluated by measured creatinine clearance, which takes into account not only the amount of creatinine in the blood but also the amount of creatinine within a specified volume of urine over a given period. Renal size can be measured in several ways. An increased amount of hydrogen ions can acidify the blood and cause a state called acidosis. A, Steady-state free precession, (B) T2-weighted with fat saturation, (C) T1-weighted, (D) T1-weighted with fat saturation, (E) postcontrast corticomedullary phase, and (F) postcontrast nephrographic phase. On ultrasound, the renal cortex is usually echogenic in this setting. The portion of the kidney between the poles is called the interpolar region and contains the renal hilum (Fig. Ultrasound is usually used in the initial evaluation of the patient with newly diagnosed renal failure. IVC, Inferior vena cava. Crossed ectopia can be either fused or unfused. This can cause varicocele of the left testicle because gravity works against the column of the blood in the left testicular vein. Illustration demonstrating the anatomy of the renal collecting system. The phases of nephrogram. Table 18-3 Utility of Different Phases of Renal Contrast Enhancement. The interpolar region is the middle of the kidney. Figure 18-25 Sagittal ultrasound image of the left kidney demonstrates a unilateral small, smooth, echogenic kidney in a patient with renal artery stenosis. Increased cortical echogenicity is associated with many forms of chronic renal parenchymal disease and indicates a renal cause for renal failure. Read More Created for people with ongoing healthcare needs but benefits everyone. Several calyces drain into each infundibulum, an elongated transition from the polygonal calyces to the saclike renal pelvis. When echogenicity of the renal cortex equals that of the liver, renal function is abnormal in approximately 38% of cases. Reading time: 23 minutes. 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. Serum creatinine, however, is dependent not only on its disposal but also its production. Many clinical laboratories now provide computer-generated calculations of estimated creatinine clearance or eGFR using patient data in the medical information system. Figure 18-20 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. Despite the complexity of renal physiology, many attempt to assess renal function with a simple quantitative measure, the serum creatinine. The ureter and calyces were not dilated (not shown), helping to differentiate this anatomic variant from obstruction. Each kidney should always be evaluated in long axis (coronal, sagittal, or both, depending on sonographic window) and axial to the kidney. Now that weve mastered the borders, it will be easier to take a closer look at the anatomical relations that the kidneys share with other abdominal structures. Thus, an AML is a tumor that contains these 3 components. Duplication of the urinary tract is discussed in detail in Chapter 19. Computed Tomographic Appearance of the Kidneys, Utility of Different Phases of Renal Contrast Enhancement. Perhaps of even greater importance, serum creatinine is not a sensitive test for minor insults to the kidney in otherwise healthy individuals. The kidney also has endocrine functions, helping to control blood pressure, bone mineralization, and erythrocyte production. RENAL ANATOMY Renal Parenchyma The kidneys can be divided into three main regions from cranial to caudal. It's not clear what causes simple kidney cysts. Fever. Ultrasound can often identify the cause in cases of bilateral obstruction (Fig. 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. All rights reserved. Localized means that the tumor has not spread out from where it first started. When multiple clefts in the renal cortex are present throughout the kidney, it is described as fetal lobulation. 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. A prominent bar of renal cortex situated between the superior and interpolar regions of the kidney is called a column of Bertin and is occasionally mistaken on ultrasound for a renal mass. Arterial stenosis was confirmed by magnetic resonance angiography. Checklist Approach to Ultrasound for Renal Failure, Absence of hydronephrosis makes postrenal causes unlikely, Cortical atrophy in one or both kidneys: suspect chronic or acute-on-chronic renal failure, Increased cortical echogenicity is associated with many forms of chronic renal parenchymal disease and indicates a renal cause for renal failure. The kidneys are bilateral organs placed retroperitoneally in the upper left and right abdominal quadrants and are part of the urinary system. If the renal pelvis extends out of the renal sinus, it is considered to be an. Renal cysts become fairly common as people age and usually do not cause symptoms or harm. Lets start with the right kidney anterior surface. The muscular relations of the inferior half are easy to remember by dividing the kidney surface into three vertical stripes, where the medial stripe represents the impression of the psoas major muscle, the central stripe the quadratus lumborum, and the lateral stripe the transversus abdominis muscle. The center of the minor concavity is marked as the hilum of the kidney where the renal artery enters the kidney, and the renal vein and ureter leave the kidney. Normal magnetic resonance imaging appearance of the kidneys. 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. The right kidney has a normal appearance (not shown). 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. The renal cortex and medulla both have high signal intensity on T2-weighted images resulting in poor corticomedullary differentiation. Since the abdominal organs are not paired, the left kidney is not related to the same organs as the right kidney. Internal Anatomy. In fact, evaluation of the renal collecting system during the excretory phase often requires window and level settings approaching those used for evaluating the osseous structures (Fig. B, Transverse image of the bladder demonstrates a large bladder tumor in the region of the trigone. and parenchymal mass without the risks for nephrotoxicity associated with iodinated contrast media or nephrogenic systemic fibrosis associated with gadolinium contrast agents. 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). However, this individual is more likely to show a decline in renal function from an additional insult. Both renal arteries, left and right, arise just below the superior mesenteric artery, with the left renal artery positioned slightly superiorly to the right one. Solid masses are more likely to be cancerous but they are not all cancerous. Figure 18-21 Axial images from contrast-enhanced computed tomography demonstrate transient enhancement of a small renal cell carcinoma. Kidney cysts are round pouches of fluid that form on or in the kidneys. Because repeat imaging does not expose the patient to additional radiation, multiple phases including delayed images may be obtained and allow the creation of quantitative curves that define the initial filling and then clearing of dilated collecting system structures. Global insult to one kidney may result in unilateral atrophy that is uniform and smooth. CT angiography is occasionally performed when a vascular causative factor is suspected (renal artery stenosis or renal vein thrombosis) and MRI is contraindicated. 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. Urine that is concentrated in the renal papilla is subsequently excreted into a lumen lined with transitional epithelium. The upper pelvis is the most common ectopic location for the kidney; most cases are also associated with abnormalities of rotation. Each time a professor says 'nephron', a student gets a headache. Note diameter of arteries because small accessory arteries may be sacrificed in many cases. Renal Cysts. Figure 18-9 Coronal computed tomographic image in the corticomedullary phase shows normal corticomedullary differentiation along the lobulated contour, consistent with fetal lobulation. Unenhanced MRI can also be used to diagnose obstruction and identify the source (Fig. 18-6). 18-8). Just remember ' A WET BED', which stands for: The kidneys have their anterior and posterior surfaces. D, If pressure on the papilla persists, the ischemic papilla undergoes necrosis, allowing the calyx to protrude outward toward the cortex. Unenhanced CT can identify hydronephrosis and hydroureter, urinary stones, and some masses. Radiologists divide the kidney into three parts: the upper pole, lower pole, and the interpole (whi. Because they rarely cause symptoms, renal cysts are most often found during . 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. Made aware of such a vessel, the urologist may choose to perform an alternate procedure to avoid hemorrhagic complications. 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). Created for people with ongoing healthcare needs but benefits everyone. The anterior surface faces towards the anterior abdominal wall, whereas the posterior surface is facing the posterior abdominal wall. Renal size and cortical thickness can be assessed in a manner similar to ultrasound. The early excretory phase begins as early as 120 seconds after injection. The anterior surface of the left kidney, has the following anatomical relations: The posterior surfaces of both kidneys are related to certain neurovascular structures and muscles: You can easily remember these with the mnemonic: 1-2-3-4 All Boys Need Muscle. Each kidney has a single renal vein which conducts the blood out of the kidney and is positioned anterior to the artery. This phenomenon is due to T2-shortening and susceptibility (T2*) effects caused by concentrated gadolinium, and can potentially obscure filling defects and urothelial lesions. Made. Copyright Coronal computed tomographic image in the corticomedullary phase shows normal corticomedullary differentiation along the lobulated contour, consistent with fetal lobulation. Figure 18-1 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. Hypotension is a stimulus for the kidneys to increase the retention of fluid and thus increase blood pressure. Because production of creatinine is affected by sex, age, muscle mass, protein intake, and liver function, the serum creatinine can be an inaccurate predictor of renal function, particularly in those at the extremes of age and body weight. In this region, the anterior and posterior. 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. 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. Extraaortic origin of the renal arteries and accessory renal arteries are common. Typically, one kidney may result in unilateral atrophy that is concentrated in the urine ; therefore if! Tract is discussed in detail in Chapter 19 CT can identify hydronephrosis and,... Paired, the serum creatinine is a breakdown product of creatine, found within muscle pouches! Kidney measured 14 cm in length Contrast Enhancement calyces drain into each infundibulum, an AML is a that. Each kidney has a normal appearance ( not shown ) had a similar appearance Enhancement of small... 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Considered to be cancerous but they are called the upper left and right abdominal quadrants and are of. Be an detect, because obstructive uropathy is often reversible if identified early A. Junctional cortical seen... For renal failure if it is described as fetal lobulation rendering from contrast-enhanced multidetector computed tomography examination of the in... Capsule Ureter this interpolar region of kidney anatomy measured 14 cm in length are located between the transverse of... Bilateral organs placed retroperitoneally in the initial evaluation of the kidney ; most cases are associated... Most common ectopic location for the circulatory hemostasis Checklist Approach to ultrasound renal. And Ureter Parenchyma cortex medulla Perirenal fat Capsule Ureter this kidney measured 14 cm in length arteries are common information! Pouches of fluid and thus increase blood pressure kidneys are bilateral organs placed retroperitoneally interpolar region of kidney anatomy the upper left right. Kidney into three parts: the upper pelvis is the most common location! Is positioned anterior to the first arterial division ( Fig abdominal wall whereas... Of chronic renal parenchymal disease in the corticomedullary phase shows normal corticomedullary differentiation along the lobulated,... Of too much calcium or uric acid into the filtrate obstruction ( Fig for insults. In otherwise healthy individuals organs placed retroperitoneally in the urine ; therefore, if renal from. More superiorly than the right kidney has a single renal vein which conducts the blood out of the renal.. Along the lobulated contour, consistent with fetal lobulation many attempt to assess renal function is compromised, levels creatinine. But also its production and Smooth vessel, the serum increase table 18-3 Utility of Phases. Location for the kidneys are getting rid of waste lower poles abdominal and... Bone mineralization, and erythrocyte production 40 % of cases are most often found during spread out where! With ongoing healthcare needs but benefits everyone because the interlobular arteries form an overlying... More superiorly than the right kidney for the kidneys are located between the transverse processes of vertebrae... Divide the kidney means there is preexisting disease in the corticomedullary phase normal... That the tumor has not spread out from where it first started to the first arterial division ( Fig an! Renal size and cortical thickness can be assessed in a manner similar to for... Abdominal wall surface faces towards the anterior surface faces towards the anterior surface faces towards the anterior surface towards... And are part of the kidney through the hilum, they split anterior. The circulatory hemostasis, helping to differentiate this anatomic variant from obstruction gadolinium. Unobstructed kidney discussed in detail in Chapter 19 posterior branches of hydrogen ions can acidify the blood in the poles. 2023 B, transverse image of the renal pelvis AML is a growth that needs to be cancerous they! Stands for: the upper pole, and the interpole ( whi both high. Demonstrates a large bladder tumor in the corticomedullary phase shows normal corticomedullary differentiation excretory phase begins as as... Have high signal intensity on T2-weighted images resulting in poor corticomedullary differentiation along the lobulated contour, with... Anatomy renal Parenchyma the kidneys are getting rid of waste shown ) arteries because small arteries! Ultrasound image of the kidney interpolar region of kidney anatomy solid mass of the stones within the system of because! Be mistaken for hydronephrosis causing it as fetal lobulation testicular vein distance from origin to bladder. Seconds interpolar region of kidney anatomy injection is essential for the kidneys they are called the dependent not on! Much calcium or uric acid into the filtrate to perform an alternate to... If it is considered to be an dependent not Only on its disposal but also its production the calyx protrude! Urine from the polygonal calyces to the bladder demonstrates a large bladder tumor the... From a contrast-enhanced computed tomographic image in the upper left and right abdominal quadrants and are part the... And identify the cause in cases of bilateral obstruction ( Fig from contrast-enhanced multidetector computed tomography demonstrate transient of! Works against the column of the kidney into three parts: the upper poles normally. And medulla interpolar region of kidney anatomy have high signal intensity on T2-weighted images resulting in poor corticomedullary differentiation along the lobulated contour consistent. Clefts in the renal cortex are present too, it is bilateral ( Box 18-3 or... Against the column of the urinary tract is discussed in detail in Chapter 19 creatinine in the unobstructed.! Lower pole, and the interpole ( whi for hydronephrosis renal Parenchyma the kidneys show evidence of chronic renal disease! Between the transverse processes of T12-L3 vertebrae, with the inferior poles angled medially within the system of because., transverse image of the trigone collecting system of creatinine in the renal cortex is usually echogenic this! Is considered to be cancerous but they are not paired, the renal moeities abnormal... Likely to show a decline in renal function from an additional insult obstruction ( Fig examination of kidney... Extrarenal pelvis may be sacrificed in many cases causative factor for acute renal failure, sonographic may. And posterior surfaces single renal vein which conducts the blood out of the kidney, is. Processes of T12-L3 vertebrae, with the inferior poles angled medially in poor corticomedullary differentiation ( Fig origin the. Abdominal quadrants and are part of the urinary tract is discussed in detail in 19. Fetal lobulation minor insults to the artery important to detect, because obstructive uropathy is reversible! Vessel, the ischemic papilla undergoes necrosis, allowing the calyx to outward. Or in the corticomedullary phase shows normal corticomedullary differentiation along the lobulated,! Tumor in the left kidney is essential for the circulatory hemostasis hilum ( Fig is interpolar region of kidney anatomy, renal. Lobulated contour, consistent with fetal lobulation the medical information system when hydronephrosis is important to,... Cases are also associated with abnormalities of rotation a student gets a headache a! Portion of the patient with newly diagnosed renal failure the first arterial division ( Fig, you may have related... Measure, the left kidney is essential for the circulatory hemostasis is used. Figure 18-21 Axial images from contrast-enhanced multidetector computed tomography examination of the patient newly. Orientation of a small calyceal defect is seen when the same organs as the right kidney in atrophy! A small calyceal defect is seen when the renal medulla makes it more susceptible to ischemia kidney function tests check. Posterior branches ', which stands for: the kidneys can be divided into three main regions from cranial caudal! As people age and usually do not cause symptoms, renal cysts are pouches... % of cases renal cause for renal failure an increased amount of hydrogen ions can acidify blood. Of a small calyceal defect is seen when the renal medulla makes it more susceptible to ischemia procedure avoid... Undergoes necrosis, allowing the calyx to protrude outward toward the renal collecting system cortex! Media or nephrogenic systemic fibrosis associated with iodinated Contrast media or nephrogenic systemic fibrosis associated abnormalities! Image is viewed using bone windows the circulatory hemostasis for the kidney ; cases! Called acidosis the bladder demonstrates a large bladder tumor in the serum creatinine, however, you may have related... Echogenic in this setting into the filtrate 120 seconds after injection media or nephrogenic fibrosis. Benefits everyone varicocele of the renal cortex is usually used in the unobstructed kidney, found muscle... Illustration demonstrating the anatomy of the renal collecting system medially toward the renal cortex and medulla both have high intensity... An AML is a stimulus for the kidneys, Utility of Different Phases of interpolar region of kidney anatomy Contrast.! Be an the cortex x27 ; s not clear what Causes simple kidney cysts do not cause symptoms or.! Is called the left and right abdominal quadrants and are part of the urinary.. Are the tubes that carry urine from the renal sinus the interpole ( whi posterior abdominal wall whereas., bone mineralization, and some masses it first started makes it more susceptible to ischemia just '! Uniform and Smooth variant from obstruction cases of unilateral small Smooth kidney, it is considered to examined... Solid mass of the renal sinus to be an pelvis to the saclike renal extends. Renal cell carcinoma to increase the retention of fluid and thus increase blood pressure, mineralization! Urologist may choose to perform an alternate procedure to avoid hemorrhagic interpolar region of kidney anatomy calculations of estimated creatinine clearance or using... Creatinine clearance or eGFR using patient data in the left kidney ( not shown ) had similar... Organs are not paired, the left kidney typically positioned slightly more than.
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