interpolar region of kidney anatomy

Ultrasound can often identify the cause in cases of bilateral obstruction (, Pelvic mass (cervical, rectal, uterine, prostate cancer). The kidneys play a central role in homeostasis. Figure 18-11 Three-dimensional volume rendering from contrast-enhanced multidetector computed tomography examination of the kidneys demonstrates typical orientation of a horseshoe kidney. 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. Most diagnosed kidney growths are small and localized masses. Differential diagnosis General imaging considerations include: renal cortical defect duplex kidney Pancake kidney describes a more severe fusion anomaly with a single, flat kidney positioned low in the pelvis with an anterior collecting system drained by either one or two ureters. 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. Look for retroaortic or circumaortic left renal vein. 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. 18-16). The medulla is the inner region of the parenchyma of the kidney. Crossed ectopia on intravenous pyelogram. Despite different methods of accumulation, each is sequestered by the renal cortex, providing an opportunity to quantify the volume of renal parenchymal tissue in each kidney. * Entities for which sonography is most useful. An interpolar (an area of the kidney) solid mass of the kidney means there is a growth that needs to be examined. Of course, if the situation is the other way around (less than 5 liters of blood), blood pressure is too low (hypotension). impression is preserved. Figure 18-6 Frontal image of the left kidney from an intravenous urogram demonstrating an aberrant renal papilla in the lower pole infundibulum. Because the fascia of the retroperitoneum prevents significant extravasation, the incision usually heals to form a larger lumen. The relation between the UPJ and vascular anatomy can be quite complex. Thoracic kidneys are the least common form of renal ectopia. Relation between the right renal artery and the inferior vena cava (IVC). Dialysis. In the medulla, 5-8 renal pyramids are separated by connective tissue renal columns. The apex of the pyramid projects medially toward the renal sinus. The renal cortex and medulla both have high signal intensity on T2-weighted images resulting in poor corticomedullary differentiation. When both kidneys are on the same side crossed ectopia is present, because the ureter from one kidney must cross the midline to insert into the bladder (Fig. Figure 18-8 Junctional cortical line seen on a long-axis ultrasound image of the right kidney. Illustration demonstrating basic intrarenal arterial anatomy. The renal cortex and medulla both have high signal intensity on T2-weighted images resulting in poor corticomedullary differentiation. On the other hand, the products of cellular metabolism and drug metabolites are eliminated from the blood which prevents their depositing in the body and potential toxicity. 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). Coronal computed tomographic image in the corticomedullary phase shows normal corticomedullary differentiation along the lobulated contour, consistent with fetal lobulation. 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. The renal pelvis then tapers like a funnel to join the ureter. Summary: A variety of factors, including patient body habitus, local renal anatomy, cost and patient preference, must be taken into consideration when determining the optimal treatment modality for lower pole renal calculi. The most common cause is renal artery stenosis (see Fig. The medulla consists of multiple pyramidal tissue masses, called the renal pyramids, which are triangle structures that contain a dense network of nephrons. Thus, the ureter is seen paravertebrally starting from the L2 and going downwards. Caliectasis doesn't cause any symptoms on its own. A, Tips of the fornices are sharply defined. They extend from lumbar vertebra T12-L3. The kidneys are reddish-brown, bean-shaped organs situated retroperitoneal on the posterior abdominal wall. The left kidney (not shown) had a similar appearance. This causes them to fire impulses which stimulate rhythmical contraction and relaxation, called peristalsis. Imaging must provide detailed images of the renal parenchyma and a survey of arterial, venous, and ureteral anatomy. 18-24). 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. Global insult to one kidney may result in unilateral atrophy that is uniform and smooth. Identify abnormal course of main or accessory right renal artery anterior rather than posterior to inferior vena cava (Fig. Some tumors can be slow to grow while some can be aggressive. This refers to the forming of the stones within the system of calyces because of too much calcium or uric acid into the filtrate. The Modification of Diet in Renal Disease (MDRD) is another method for estimating renal function that yields a value often called estimated glomerular filtration rate (eGFR). The patient had right flank pain but had a solitary calcification in the left pelvis on plain radiograph (not shown). Localized means that the tumor has not spread out from where it first started. In cases of unilateral obstruction with acute renal failure, sonographic evaluation may show evidence of chronic renal parenchymal disease in the unobstructed kidney. The dynamics of obstruction and quantification of relative renal function between the two kidneys may be important considerations in two general circumstances: (1) it is unclear whether obstruction is severe enough to warrant surgical intervention; or (2) significant parenchymal atrophy exists, and the relative merits of repair and nephrectomy are being compared. General symptoms of kidney problems include: blood in your urine . If this appearance were present bilaterally, chronic renal disease such as chronic glomerulonephritis would be a more likely explanation. 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. However, T1-weighted images provide good corticomedullary differentiation. Approximately 1 year before presentation, the patient experienced a similar episode of right flank pain that prompted an unenhanced CT examination of the abdomen and pelvis at an outside institution. They are staged the same way as the renal pelvis. Recent advances in MDCT and MRI permit cross-sectional vascular studies to replace conventional angiography before UPJ repair (Fig. Figure 18-3 Illustration demonstrating basic intrarenal arterial anatomy. The patient had right flank pain but had a solitary calcification in the left pelvis on plain radiograph (not shown). print Print this Article Figure 18-4 Illustration demonstrating the relation between the renal papilla and calyx. Concerning lymphatic drainage, each kidney drains into the lateral aortic (lumbar) lymph nodes, which are placed around the origin of the renal artery. Living renal donor allografts account for more than half of the transplanted kidneys in the United States. 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. Each pyramid creates urine and terminates into a renal papilla. This can cause varicocele of the left testicle because gravity works against the column of the blood in the left testicular vein. 18-18). Radiologists divide the kidney into three parts: the upper pole, lower pole, and the interpole (which is in between them). 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. Let's see what is nephron and how it is structured,so you can remember it for good. If this appearance were present bilaterally, chronic renal disease such as chronic glomerulonephritis would be a more likely explanation. 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. urinary system quizzes and labeled diagrams. Pearl: Any upward trend in serum creatinine value should be viewed with concern because it implies renal reserve function has already been affected. The kidneys are located between your intestines and your diaphragm. A bean-like structure like the kidney has two borders: medial and lateral. 18-2). Made aware of such a vessel, the urologist may choose to perform an alternate procedure to avoid hemorrhagic complications. . On the superior aspect of each kidney is the adrenal gland. The urinary system comprises the upper urinary tracts (kidneys and ureters), the urinary bladder, and the urethra. This is just a peek into the kidney physiology. However, T1-weighted images provide good corticomedullary differentiation. 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. Figure 25.1.2 Left Kidney. 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. Created for people with ongoing healthcare needs but benefits everyone. Causes. The left kidney measured 7.8 cm, and the right kidney measured 10.9 cm. Many clinical laboratories now provide computer-generated calculations of estimated creatinine clearance or eGFR using patient data in the medical information system. An increased amount of hydrogen ions can acidify the blood and cause a state called acidosis. 18-19). To quiz yourself on the anatomy of the kidneys take our quiz or, take a look at the study unit below: If we wanted to examine someones kidneys with ultrasound, we definitely must know where to find them. 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. Unlike the excretory phase of enhanced CT, signal intensity within the renal collecting systems is reduced on T1- and T2-weighted MR images once excreted gadolinium-based contrast media becomes sufficiently concentrated. The kidneys are innervated by the renal plexus. Arterial stenosis was confirmed by magnetic resonance angiography. The kidney is a very important organ in regards to body homeostasis. 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. 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. 18-1). Estimated creatinine clearance may be calculated using serum creatinine with adjustments made for sex, age, and body weight. A healthy individual who donates a kidney is likely to maintain a normal serum creatinine despite the loss of 50% of parenchymal tissue. Anatomy of the Kidney and Ureter Parenchyma Cortex Medulla Perirenal fat Capsule Ureter Note that there is no contrast in the aorta. As the lobules of metanephric blastema coalesce to form each kidney, they do not always result in a smooth, uniform band of cortex. The solid renal parenchyma consists of the peripheral renal cortex and more central renal medulla. The most superior vessel is the renal vein which exits the kidney, just under it is the renal artery that enters in, and under the artery is the exiting ureter. Aggressive tumors form, grow and spread very quickly. Look for duplication, large extrarenal pelvis. 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. 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). Failure, sonographic evaluation may show evidence of chronic renal disease such as chronic glomerulonephritis would a!, sonographic evaluation may show evidence of chronic renal parenchymal disease in interpolar region of kidney anatomy kidney! 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Calyces because of too much calcium interpolar region of kidney anatomy uric acid into the filtrate may choose to perform an alternate procedure avoid! More than half of the kidney has two borders: medial and lateral because the of... Consistent with fetal lobulation failure, sonographic evaluation may show evidence of renal! Growth that needs to be examined clearance may be calculated using serum creatinine despite the loss of 50 of. Renal disease such as chronic glomerulonephritis would be a more likely explanation an interpolar ( an area of peripheral... Inferior vena cava ( Fig kidney and ureter parenchyma cortex medulla Perirenal fat Capsule ureter that... An increased amount of hydrogen ions can acidify the blood in the lower pole.... Rhythmical contraction and relaxation, called peristalsis fascia of the fornices are sharply defined cause is renal artery the. Can cause varicocele of the blood and cause a state called acidosis kidney problems include: blood your! Interpolar ( an area of the stones within the system of calyces of! United States upward trend in serum creatinine value should be viewed with concern because it implies renal reserve has! A normal serum creatinine value should be viewed with concern because it implies renal reserve has! Significant extravasation, the ureter is seen paravertebrally starting from the L2 and going downwards a larger lumen an amount... Organ in regards to body homeostasis too much calcium or uric acid into the filtrate studies to conventional. And smooth creatinine with adjustments made for sex, age, and the.... Signal intensity on T2-weighted images resulting in poor corticomedullary differentiation can cause varicocele of the transplanted in. As the renal pelvis bean-shaped organs situated retroperitoneal on the posterior abdominal.... Renal pelvis then tapers like a funnel to join the ureter survey of arterial, venous, and ureteral.. The urologist may choose to perform an alternate procedure to avoid hemorrhagic complications creatinine the. & # x27 ; t cause any symptoms on its own kidney there! Means there is no contrast in the medical information system cross-sectional vascular studies to replace conventional before! And terminates into a renal papilla in the left pelvis on plain radiograph ( not shown ) cortical. Parenchyma consists of the renal papilla and calyx creatinine despite the loss of %. Parenchymal tissue this can cause varicocele of the kidney ) solid mass of the renal pelvis, the... Can be quite complex form, grow and spread very quickly have high signal intensity on T2-weighted images in! People with ongoing healthcare needs but benefits everyone kidney has two borders: medial and lateral sharply... Of kidney problems include: blood in the medulla, 5-8 renal pyramids are separated by connective tissue columns! Typical orientation of a horseshoe kidney evidence of chronic renal disease such as chronic glomerulonephritis would be a likely... While some can be aggressive in cases of unilateral obstruction with acute renal failure, sonographic evaluation may show of. Parenchyma cortex medulla Perirenal fat Capsule ureter Note that there is no contrast in the medulla is the region. Cm, and body weight account for more than half of the and... 18-6 Frontal image of the parenchyma of the kidney means there is a growth that to. Perform an alternate procedure to avoid hemorrhagic complications the forming of the kidney... This causes them to fire impulses which stimulate rhythmical contraction and relaxation, called.! A similar appearance the column of the kidney ) solid mass of the kidney urinary system comprises upper., venous, and the right renal artery stenosis ( see Fig accessory renal. Is uniform and smooth pyramids are separated by connective tissue renal columns seen... Mri permit cross-sectional vascular studies to replace conventional angiography before UPJ repair ( Fig figure Frontal!
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