T3 L2: Kidney and urinary tract

• What are the retroperitoneal (behind the peritoneum) organs of the urinary tract?

  1. Suprarenal glands
  2. Kidneys
  3. Ureters

  
• What are the subperitoneal (below peritoneum) organs of the lower abdomen?

  1. Uterus and uterine tubes
  2. Urinary bladder
  3. distal ureters
  4. rectum (lower 1/3rd)

  
• What peritoneal space is there in males?

  Rectovesical pouch

  
• What peritoneal spaces are there in females?

  Rectouterine pouch 'Pouch of Douglas' (rectum-uterus)

  Vesicouterine pouch (uterus-bladder)

  
• When supine, rectouterine and rectovesical pouches are the most inferior part of the peritoneal cavity. What does this make them a potential site of?

  potential site of fluid accumulation
• Why is the left kidney higher than the right?

  liver pushes right kidney down
• Where are the kidneys located?

  Between T12-L3

  Right kidney: 12th rib

  Left kidney: 11th & 12th rib

  move 2cm during respiration

  
• What are the coverings of the kidneys, from deep to superficial?

  1. Renal capsule: closely adherent to surface
  2. Perinephric fat: within perirenal space
  3. Renal fascia: condensation of areaolar connective tissue. Continuous with: transversalis fascia & fascia over diaphragm
  4. Paranephric fat

  
• What is the function of the coverings of the kidneys?

  support

  hold in position against posterior abdominal wall
• What is Nephroptosis?

  kidney falls by 2 vertebrae when patient moves from supine to erect

  due to deficient support of perinephric structures

  mainly asymptomatic

  can get symptoms; eg cause ischaemia

  
• What are the components of the internal anatomy of the kidney?

  1. Fibrous capsule: tough fibrous layer
  2. Renal cortex: bound of pale tissue that surround inner medulla. Contains glomeruli.
  3. Renal columns: extension of renal cortex
  4. Pyramid: within inner medulla. Contains loops of Henle and collecting ducts.
  5. Renal papilla: base of pyramid opening into minor calyx
  6. Minor calyx
  7. Major calyx
  8. Hilum of kidney: renal vein, renal artery, ureter (from ant to post)
  9. Renal pelvis: funnel-end dilated part of ureter
  10. Renal sinus: all of renal pelvis and calyxes

  
• How do the components of the renal hilum run, from anterior to posterior?

  Renal Vein, renal artery, ureter

  
• What does the renal sinus contain?

  renal pelvis (upper expanded part of the ureter)

  perinephric fat continues into the hilum and sinus of the kidney and surrounds all these structures

  
• How is the development of the kidneys like?

  originally develop in pelvis

  ascend into abdomen:

  • growth and straightening of lumbar and sacral spines
  • ureter elongates
• What is an ectopic kidney?

  also known as pelvic kidney

  congenitally misplaced kidney

  usually normal structure and function

  malposition of ureters; predisposes them to obstruction → hydronephrosis (build up of urine in kidney)

  
• What are the suprarenal glands?

  adrenal glands

  lie on upper pole of kidney; however separated by fascia

  two parts: yellow cortex and brown medulla

  1. Right suprarenal gland: pyramidal shaped
  2. Left suprarenal gland: crescent shaped

  
• What type of movement do the ureters make?

  peristaltic contractions
• What is the course of ureter in abdomen?

  1. Descends anterior to psoas major muscle
  2. Crosses anterior to genitofemoral nerve
  3. Obliquely crossed by gonadal vessels
  4. Crosses bifurcation of common iliac artery
  5. enter pelvis

  
• Close relationship between the uterine artery and ureter needs to be considered during ligation of uterine artery, eg during a hysterectomy.
• What is the course of the ureter in the pelvis?

  5. Runs in front of internal iliac artery to reach ischial spine

  6. Turns forward and medially to enter upper lateral angle of bladder

  7. Crossed anteriorly by vas deferens (males) and uterine artery (females)

  8. Passes obliquely through wall of bladder before opening into bladder cavity

  
• What are the three ureteric constrictions?

  The ureter had constrictions at three points which are potential sites of obstruction and stone impaction:

  1. Ureteropelvic junction (renal pelvis - ureter)
  2. Crossing of common iliac artery / pelvic inlet
  3. Bladder entrance

  
• What are renal / ureteric calculi?

  Kidney stones

  may cause distension of muscular tube

  complete / intermittent obstruction of urinary flow

  pain referred from 'loin-to-groin'

  
• What is Ureteric colic?

  severe intermittent pain due to contraction of ureteric muscles to overcome an obstruction, usually due to stone or clot formation
• What is the arterial supply to the kidneys?

  1. Renal artery
  2. Segmental arteries (x 5): distributed into segments of the kidney
  3. Interlobar arteries: runs towards cortex
  4. Arcuate arteries: arch over base of pyramid
  5. Interlobular arteries: ascend into cortex; give off afferent glomerular arterioles
  6. Ureteral branches

  
• What is the general blood supply to kidneys and suprarenal glands?

  1. Gonadal arteries: branches of abdominal aorta
  2. Left renal artery: Branch of aorta; L1-L2; right longer than left (as aorta is on left)
  3. Left inferior suprarenal artery: branch of left renal artery
  4. Left middle suprarenal artery: branch from abdominal aorta
  5. Left superior suprarenal artery: branch of left inferior phrenic artery

  
• How does the right renal artery travel in relation to IVC?

  posterior
• What could an aneurysm in the superior mesenteric artery cause?

  can compress left renal vein

  
• How is the venous supply to the kidneys and suprarenal glands?

  1. Left renal vein: anterior to aorta; 3x longer than right
  2. Right renal vein
  3. Left suprarenal vein: tributary of left renal vein
  4. Left gonadal vein: drains into left renal vein
  5. Right suprarenal vein: tributary of IVC
  6. Right gonadal vein: drains into IVC

  
• How is the arterial supply to the ureter?

  1. Renal artery
  2. Gonadal artery
  3. Common iliac artery
  4. Internal iliac artery