Kidney Test

when do the pronephros and mesonephros appear?

around 4-5 weeks gestational age

when do the metanephros (permanent kidneys) appear?

about 5 weeks gestational age

where do the kidneys initially lie before the embryo starts to grow?

in the pelvic cavity

paired embryologic ducts that drain the embryologic kidneys into the cloaca

the wolffian ducts mesonephric ducts)

chamber in which some or all of the digestive, urinary, and reproductive tracts discharge their contents

cloaca

the wolffian duct closes-regresses from a lack of testosterone in ________.

female

the wolffian duct develops into normal testicular anatomy in the ________.

male

what make up the upper urinary system?

the kidneys and ureters

what make up the lower urinary system?

the bladder and urethra

what are the functions of the urinary system?

1\.) detox

2\.) blood pressure regulation

3\.) regulation of blood composition

inner layer encapsulating the kidney; AKA the true capsule

renal capsule

middle layer

layer of perinephric fat

outer layer; AKA renal fascia; anchors the kidneys and assists in preventing infection spread from surrounding organs

gerota’s fascia

dark, bean-shaped organs located in the retroperitoneum

the kidneys

the medial, concave area where the renal arteries/veins and ureters enter the kidneys; also contains lymphatic vessels

renal hilum

made up of the renal cortex and the renal medulla

the peripheral parenchyma

outer portion of the parenchyma; contains the renal corpuscle, prox and dist convoluted tube

the renal cortex

inner portion of the parenchyma consisting of 8-18 medullary pyramids; contains the loops of henle

the renal medulla

AKA collecting system; the central portion of the kidney; is made up of the infundibulum and the renal pelvis

the renal sinus

portion of the renal sinus that contains the major calyces and the minor calyces

the infundibulum

proximal, expanded portion of the ureter that contains receives urine from the infundibulum

the renal pelvis

AKA medullary pyramids; cone-shaped structures that drain into the minor calyces

renal pyramids

band of cortical tissue separating the medullary pyramids from each other

the column of bertin

cavities in the renal infundibulum in which urine collects before flowing into the renal pelvis

the renal calyces (calyx)

AKA apex of the medullary pyramid; indents into each major calyx

renal papilla

what supplies blood to the kidney (through the nephron)?

the main renal artery

lateral branches of the AO just inferior to the SMA

the renal arteries (RAs)

what are the branches of the renal arteries?

1\.) segmental arteries

2\.) interlobar arteries

3\.) arcuate arteries

4\.) interlobular arteries

what drains cleansed blood back into circulation?

the renal veins (RVs)

order of blood supply to the kidney

1\.) renal artery

2\.) segmental artery

3\.) interlobar arteries

4\.) arcuate arteries

5\.) interlobular arteries

order of blood draining out of the kidney

1\.) interlobular veins

2\.) arcuate veins

3\.) interlobar veins

4\.) segmental vein

5\.) renal vein

where do the ureters begin?

at the kidney at the renal pelvis

where do the ureters sit?

in the retroperitoneum

which ureter is slightly longer than the other?

the LK

what are the 3 layers of the ureters?

1\.) the inner mucosal layer

2\.) the middle smooth muscle layer

3\.) the outer fibrous layer

what are the three structures along the ureters course?

1\.) where the ureter leaves the renal pelvis (UPJ)

2\.) where it kinks as it crosses the pelvic brim

3\.) where it pierces the bladder wall (UVJ)

large, muscular bag above/behind the pubic bone

the bladder

where do the ureters enter the bladder?

posterior/laterally

portion of the bladder defined by imaginary lines between the ureter insertion and the internal urethral orifice

trigone

what are the four layers of the bladder wall?

1\.) the inner mucosal layer

2\.) the submucosal layer

3\.) the muscularis layer (3 layers called the detrusor muscle)

4\.) the outer serosa layer

a hollow, membranous canal that transports urine from the bladder to the outside world

the urethra

approximately, how long is the male urethra

20cm

approximately, how long is the female urethra?

3\.5cm

what are the three parts of the male urethra?

1\.) prostate portion

2\.) membranous portion

3\.) penile portion

what is the primary function of the kidneys?

to create urine and maintain homeostasis in the body (regulate water/electrolytes)

what does failure of both kidneys lead to?

uremia

what is the functional unit of the kidney?

the nephron

what is the primary function of the ureters?

transport urine from the kidneys to the urinary bladder

what is the primary function of the urinary bladder?

to collect and store urine

what is the primary function of the urethra?

to carry waste outside the body

nephrons function by moving metabolic products from an area of ____ concentration to an area of ____ concentration.

high; low

what percentage of blood components goes back into circulation?

99%

what percentage of the components is excreted as waste?

1%

urine is __ water and ___ percent nitrogenous waste.

95%; 5%

what is another name for the nephron unit?

renal tubule

what is the nephron responsible for?

filtering the blood and producing urine from the waste products

what are the three processes of urine production?

1\.) glomerular filtration (primary filter)

2\.) tubular reabsorption (absorbing the useful material)

3\.) tubular secretion (getting rid of the bad material)

filters blood (bowman’s capsule and glomerulus)

renal corpuscle

filtered fluid moves through and substances the body needs get reabsorbed here (prox convoluted tubule, loop of henle, dist convoluted tubule, collecting duct)

renal tubule

what course of urine after it’s gone through the nephron

1\.) pyramids

2\.) minor calyces

3\.) major calyces

4\.) renal pelvis

5\.) ureter

raised levels of urea and nitrogenous wastes in the blood; these waste products are normally eliminated by normally functioning kidneys and are elevated when the kidneys are damaged

uremia

formed from the breakdown of nucleic acids; certain food are higher in uric acid content; high uric acid can lead to gout

uric acid

a waste product that comes from the normal wear and tear on muscles of the body; everyone has this in their bloodstream

creatinine

the urine acidic or alkaline, important in kidney stone management

urine pH

measures the kidney’s ability to concentrate urine; the darker the urine, the higher to specific gravity; the lighter the urine, the lower the specific gravity

specific gravity

can suggest trauma, neoplasm, calculi, renal dysfunction, vascular inflammatory process, etc

hematuria

present in urine whenever damage to RBCs occurs, this injures the kidney and can cause ARF

hemoglobin

found in urine when glomerular damage is present

protein

occurs with hemorrhage secondary to disease or bunt trauma

hematocrit (HCT)

there is a decrease of albumin in the blood with neoplasms, stones, chronic infection, pyelonephritis

serum albumin

the concentration of urea nitrogen in the blood; elevates secondary to impaired renal function; relative to degree of renal dysfunction; low in liver disease, high in renal disease

blood urea nitrogen (BUN)

elevates due to renal dysfunction; said to be more specific than BUN

serum creatinine (Cr)

what should the wall of the bladder measure?

3mm or less

what is considered a full bladder?

200cc/mL

hypertrophied extensions of the normal columns; exaggerated with pts with a duplex collecting system

prominent columns of bertin

a bulge of cortical tissue on the lateral surface of a kidney from a surrounding organ pushing on the kidney parenchyma

dromedary hump

a triangular, echogenic area along the cortex extending into the collecting system; results from incomplete embryonic fusion of ranunculi

junctional parenchymal defect

usually present in children up to 5 yrs but may be persistent in up to 51% of adults; the cortex of the kidney is scalloped and didn’t smooth out with age

fetal lobulation

the presence of the renal pelvis outside the confines of the renal hilum; appears as a central cystic area

extrarenal pelvis

the failure of a kidney to form; may be unilateral or bilateral (bilateral is incompatible with life)

renal agenesis

complete duplication of a collecting system; two separate collecting systems each with their own ureter entering the bladder on one side

duplex collecting system

most common congenital anomaly in the neonate; consists of two collecting systems and two ureters, but only one ureter enters the bladder

incomplete duplication of a ureter

a kidney that is not in its usual position; results when a kidney does not ascend from the pelvis into the abdomen during embryologic development; pelvic kidney is most common

renal ectopia (ectopic kidney)

type of ectopic kidney where both kidneys are found on the same side; may be fused or nonfused (fused occurs more often)

crossed-renal ectopia

the most common renal anomaly of renal fusion; fusion of lower poles; the kidneys are connected by a bridge of renal parenchyma called an isthmus

horseshoe kidney

a cyst-like enlargement of the lower end of the ureter caused by congenital or acquired stenosis of the distal end of the ureter; found more often in adults than in children; may be unilateral or bilateral

ureterocele

the most common renal mass; the origin is likely unknown; it is estimated that they occur in 50% of the population

simple renal cyst

opposite of simple cyst; considered malignant until proven otherwise; may contain cals, septations, thick walls, internal echoes, or mural nodularity

complex cyst

cysts originating from the renal sinus and are most likely lymphatic in origin; they do not connect with the collecting system, they sit within it

parapelvic cysts (renal sinus cysts)

a cyst with a suspension of calcium salts occuring in calyces

milk of calcium cysts

an autosomal dominant genetic disorder; high incidence of cortical renal cysts found-if kidneys are involved there is an increased chance of RCC; present in 30s-50s

von hipple-lindau

found in native kidneys of pts on dialysis (dialysis does not cause it; the RF does)

acquired cystic kidney disease

fairly rare genetic disease on chromosome 6; dilation of the renal collecting tubules; causes renal failure and in later stages liver disease; there are four kinds: perinatal, neonatal, infantile, and juvenile

autosomal recessive polycystic kidney disease (ARPKD/infantile PKD)

genetic disorder previously known as adult polycystic kidney disease; can be caused by spontaneous genetic mutation; bilateral disease; two types: ADPKD1 (most common) and ADPKD2; by age 60 50% of pts will have ESRD

autosomal dominant polycystic disease (ADPKD)

most common form of cystic disease in the neonate; consequence of early in utero urinary tract obstruction; nonhereditary; unilateral (bilateral is incompatible with life)

multicystic dysplastic kidney (MCDK)

most common of all renal tumors; two times as common in males than females; occurs in 60s-70s; associated with acquired cystic kidney disease, and tuberous scelrosis

renal cell carcinoma (RCC/grawitz’s tumor)

accounts for 90% of malignancies that involve the renal pelvis, ureters, and bladder

transitional cell carcinoma (TCC)

rare with poor prognosis; associated with long-standing nephrolithiasis/staghorn calculi

squamous cell carcinoma

renal cancer in pediatric pt; most common abdominal malignancy in children and the most common solid renal tumor in peds 1-8 y/o; two to eight more times likely in pts with horseshoe kidney; 40% have renal vein thrombosis

nephroblastoma (wilms’ tumor)

the most common benign tumor; more common in females and the RK; comprised of fat, muscle, and blood vessels

renal angiomyolipoma (AML)