renal anatomy

Located in the retroperitoneum

kidneys

Lie just below the diaphragm, protected by the lower ribs

kidneys

which kidney lies more inferior

right

what is the normal length of the adult kidney

9-13cm

there is a problem if the kidneys measure greater than _____ from each other

2cm

what is the normal width (TRV) of the adult kidneys

5-5.5cm

part of the kidney that sits closer to the spine, more medial

superior pole

part of the kidneys that sit further away from the spine, more lateral

inferior pole

part of the kidney where vessels and the ureter enter/exit

renal hilum

the outer part of the kidney

cortex

part of the kidney that appears hypoechoic

cortex

inner part of the kidney

renal sinus

part of the kidney that appears echogenic

sinus

should you see the collecting system in a normal renal US?

no

what does it mean if you see the collecting system on US?

its obstructed

a fibrous capsule that surrounds the kidney, most internal

true capsule

layer of fat that surrounds the kidney, external to true capsule

perinephric fat

layer of fascia that encases the kidney, fat, and adrenal gland; external to perinephric fat

perinephric fascia (Gerota’s fascia)

muscle that is medial and posterior to the kidney

psoas muscle

muslce that is posterior to the kidney

quadratus lumborum muscle

muscle that is lateral and slightly posterior to the kidneys

transverse abdominis

level where we measure across kidney in transverse

break in cortex; hilum

how should the right kidney look in TRV

forward C

how should the left kidney look in TRV

backward C

how do we measure the kidney in TRV

medial → lateral; across, hilum to cortex

sits superior, more medial, and anterior to each kidney

suprarenal gland

the Rt adrenal gland is ________ to the Rt kidney

anterior

the liver is ________ to the Rt kidney

anterior

the second portion of the duodenum is ________ to the Rt kidney

anterior

the Rt colic flexure is ________ to the Rt kidney

anterior

Morison’s pouch is ________ to the Rt kidney

anterior

the Lt adrenal gland is ________ to the Lt kidney

anterior

the spleen is ________ to the Lt kidney

anterior

the stomach is ________ to the Lt kidney

anterior

the pancreas is ________ to the Lt kidney

anterior

the Lt colic flexure is ________ to the Lt kidney

anterior

the jejunum is ________ to the Lt kidney

anterior

the diaphragm is _________ to the Rt kidney

posterior

the costodiaphragmatic recess of the pleura is _________ to the Rt kidney

posterior

the 12th rib is _________ to the Rt kidney

posterior

the quadratus lumborum muscle is _________ to the Rt kidney

posterior

the psoas muscle is _________ to the Rt kidney

posterior

the transversus abdominus muscle is _________ to the Rt kidney

posterior

the diaphragm is _________ to the Lt kidney

posterior

the costodiaphragmatic recess of the pleura is _________ to the Lt kidney

posterior

the 11th and 12th ribs are _________ to the Lt kidney

posterior

the psoas muscle is _________ to the Lt kidney

posterior

the quadratus lumborum muscle is _________ to the Lt kidney

posterior

the transversus abdominus muscle is _________ to the Lt kidney

posterior

what is the order of structures in the renal hilum from anterior to posterior?

RV, RA, uretur

renal ______ course posterior to the renal ______

arteries; veins

exits renal hilum anteriorly

renal vein

enters renal hilum between the vein and ureter

renal artery

exits renal hilum posteriorly

ureter

outer renal parenchyma from renal sinus to renal capsule

renal cortex

inner portion of kidney from base of pyramids to center of kidney

renal medulla

inner hyperechoic portion which contains fat, calyces, renal pelvis, connective tissue, renal vessels and lymphatics

renal sinus

medullary portion of the kidney

pyramids

appears more hypoechoic than the cortex

pyramids

patient should ______ before US and is allowed to take ____

hydrate; meds

what are the positions we may have the patient in during renal US

supine, prone, LLD, and RLD

what 2 planes do we image the renals in?

long and transverse

measuring this is required in renal protocol

LNG, trv may be required per protocol

in long, we scan from ______ to _______

medial; lateral

in trv, we scan from ________ to ________

superior; inferior

how should the echogenicity be in renal US

medulla < cortex < sinus (sinus should be the brightest, then cortex, then medulla being the darkest)