18-19). Some tumors can be slow to grow while some can be aggressive. In adults, the normal kidney is 10-14 cm long in males and 9-13 cm long in females, 3-5 cm wide, 3 cm in antero-posterior thickness and weighs 150-260 g. The left kidney is usually slightly larger than the right. Anterior components of circumaortic vein can be small. This can cause varicocele of the left testicle because gravity works against the column of the blood in the left testicular vein. The renal cortex and medulla both have high signal intensity on T2-weighted images resulting in poor corticomedullary differentiation. Internal Anatomy. 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. When abnormal echogenicity is detected, it is important to note whether it is unilateral or bilateral. Figure 18-5 Illustration demonstrating the anatomy of the renal collecting system. MR angiography can be useful for the diagnosis of renal vascular abnormalities. normal kidney size in adults normal kidney size in children Structure The ureter and calyces were not dilated (not shown), helping to differentiate this anatomic variant from obstruction. When the renal cortex is more echogenic than the adjacent liver, there is a high correlation with renal disease, although sensitivity is relatively low, according to Platt and colleagues (Fig. Bilateral echogenic kidneys with renal hypertrophy can be seen associated with human immunodeficiency virus disease (see Fig. Size disparity greater than 1.5 cm between kidneys should raise suspicion that one kidney is abnormal. The left kidney measured 7.8 cm, and the right kidney measured 10.9 cm. The glomerular membrane is designed in a way in which it is not permeable for big and important molecules in blood, such as plasma proteins, but it is permeable to the smaller substances such as sodium, potassium, amino acids and many others. Unilateral renal agenesis occurs in approximately 1 in 1000 individuals with minimal impact on health, although it is sometimes associated with other congenital anomalies of the genitourinary tract and musculoskeletal system. 18-26). The kidneys serve important . Prominent extrarenal pelves are typically positioned anteriorly (Fig. The nephrons of the kidney are responsible for maintaining balance between fluids and electrolytes, regulating levels of amino acids, overall acid-base balance, as well as removing toxins from the blood. Coronal computed tomographic image in the corticomedullary phase shows normal corticomedullary differentiation along the lobulated contour, consistent with fetal lobulation. 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. Last reviewed: December 28, 2022 Right-sided pain was related to crossed renal ectopia. The medial border of the kidney contains a very important landmark called the hilum of the kidney, which is the entry and exit point for the kidney vessels and ureter. The defect is the extension of sinus fat into the cortex, usually at the border of the upper pole and interpolar region of the kidney. 18-5). IVC, Inferior vena cava. The kidneys help remove waste products from the . At the Brady Urological Institute, we believe in the adage, "An ounce of prevention is worth a pound of cure," so we place great emphasis on a thorough metabolic evaluation, so that therapies can be appropriately directed towards reducing the risk of recurrent stone disease. Kim Bengochea, Regis University, Denver. Several small stones are visible in the left kidney, and the left kidney is somewhat atrophied from chronic obstruction. Figure 18-25 Sagittal ultrasound image of the left kidney demonstrates a unilateral small, smooth, echogenic kidney in a patient with renal artery stenosis. Blood in the urine, or dark urine. Since they are located deep retroperitoneally, the easiest way to examine them is from the patients back. 3D printed model for a 53-year-old female presenting a 21 15 15 mm renal tumor located in the interpolar region of left kidney, treated by left partial nephrectomy. 18-11). B, Axial CT image from a different patient demonstrates the more common location of the right renal artery posterior to the IVC. B, Transverse image of the bladder demonstrates a large bladder tumor in the region of the trigone. 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. CT and MR findings of renal artery stenosis parallel classic findings described on intravenous pyelogram, including one atrophic kidney with delayed nephrogram and excretion that can progress to a persistent nephrogram with hyperconcentrated excreted contrast media (Fig. More tenuous vascular supply to the renal medulla makes it more susceptible to ischemia. 18-3). 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 relation between the UPJ and vascular anatomy can be quite complex. 18-7). Figure 18-4 Illustration demonstrating the relation between the renal papilla and calyx. All content published on Kenhub is reviewed by medical and anatomy experts. Renal artery Retrograde urogram shows a calculus in the left ureter. Hydronephrosis is important to detect, because obstructive uropathy is often reversible if identified early. In other cases, each renal unit has its own ureter. Also, in situations with notable blood losses, kidneys release a hormone called erythropoietin, which stimulates bone marrow to produce more blood cells. Grounded on academic literature and research, validated by experts, and trusted by more than 2 million users. For most people, obstruction of a single ureter does not induce renal failure. Horseshoe kidneys result from midline fusion of the kidneys, typically at the level of the origin of the inferior mesenteric artery. The kidneys are positioned retroperitoneally, meaning that they are not wrapped with the peritoneal layers the way most abdominal organs are, but rather are placed behind it. Publication types Review MeSH terms Humans On the superior aspect of each kidney is the adrenal gland. Always include unenhanced computed tomographic images to look for renal stones. The fused kidneys can have a variety of orientations, including side by side, in-line, or perpendicular. The minor calyces unite to form a major calyx. They are branches of the abdominal aorta and all together are called the extrahilar renal arteries. At that point, you may experience these symptoms: Severe, sharp pain in the side and back, below the ribs. The upper pelvis is the most common ectopic location for the kidney; most cases are also associated with abnormalities of rotation. 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. Author: Curated learning paths created by our anatomy experts, 1000s of high quality anatomy illustrations and articles. 18-16). The left kidney (not shown) had a similar appearance. 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. 18-28). CT scan and MRI to help diagnose and stage kidney masses. 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 interpolar region is the middle of the kidney. Figure 18-13 Volume rendering from a computed tomographic scan of the kidneys shows bilateral supernumerary renal arteries (three on right, two on left). Some forms of congenital UPJ obstruction are now treated with transureteroscopic endopyelotomy in which an incision is made from within the ureter using a ureteroscope. 18-2). Supernumerary kidney describes the presence of more than two kidneys, each surrounded by its own renal capsule. Coronal maximum intensity projection image from a contrast-enhanced computed tomographic scan demonstrates a dilated and tortuous lumbar veins joining the left renal vein. 18-14). Most serum creatinine is excreted in the urine; therefore, if renal function is compromised, levels of creatinine in the serum increase. Note origin of inferior accessories near inferior poles on each side. Pitfall: An extrarenal pelvis may be mistaken for hydronephrosis. Each end of the kidney is commonly called a pole. Radiologists divide the kidney into three parts: the upper pole, lower pole, and the interpole (which is in between them). A frontal section through the kidney reveals an outer region called the renal cortex and an inner region called the medulla. This specific condition is called the nutcracker phenomenon. The shape of the calyx is formed by the impression of the renal papilla. Each kidney has a single renal vein which conducts the blood out of the kidney and is positioned anterior to the artery. and parenchymal mass without the risks for nephrotoxicity associated with iodinated contrast media or nephrogenic systemic fibrosis associated with gadolinium contrast agents. I would honestly say that Kenhub cut my study time in half. 18-23). 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. Some of them are congenital, such as a third kidney, which is usually atrophic. Read More Created for people with ongoing healthcare needs but benefits everyone. Each kidney should always be evaluated in long axis (coronal, sagittal, or both, depending on sonographic window) and axial to the kidney. Differential diagnosis General imaging considerations include: renal cortical defect duplex kidney When echogenicity of the renal cortex equals that of the liver, renal function is abnormal in approximately 38% of cases. Anatomy of the Kidney and Ureter Parenchyma Cortex Medulla Perirenal fat Capsule Ureter Ultrasound can often identify the cause in cases of bilateral obstruction (Fig. Note number of veins by inspecting inferior vena cava along entire length of kidney. Axial images from contrast-enhanced computed tomography demonstrate transient enhancement of a small renal cell carcinoma. Urine from the calyces flows to the renal sinus via tributaries called infundibula. But more often, kidney cysts are a type called simple kidney cysts. The early excretory phase begins as early as 120 seconds after injection. After looking at the overview of the kidneys in situ, it may seemas they are cluttered with all abdominal organs. Because of this, the tubules are designed in a way that they reabsorb the necessary substances, (sodium, potassium, and amino acids as mentioned before) and carries them back to the blood; whereas they do not absorb but rather secrete unnecessary substances such as creatinine and drug metabolites for excretion from the body. On ultrasound, the renal cortex is usually echogenic in this setting. Table 18-6 Causes of Bilateral Small Smooth Kidneys. In this way, the consistency of blood is preserved and no important substances are lost. 18-25). At one end of each nephron, in the cortex of the kidney, is a cup-shaped structure called the Bowman's capsule. If, however, a vessel crosses the UPJ at the level of obstruction, a blind incision made from the inside of the ureteral lumen can result in severe hemorrhage. In this region, the anterior and posterior. 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