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49 Cards in this Set

  • Front
  • Back
Overview of the renal anatomy.
*Paired ovoid organs: both retroperitoneal.
*Right kidney – Anterior is liver, duodenum at hilum, hepatic flexure inferiorly.
*Left kidney: spleen is superior and lateral, pancreas at hilum, jejunum inferiorly.
*Posterior to both are quadratu...
*Paired ovoid organs: both retroperitoneal.
*Right kidney – Anterior is liver, duodenum at hilum, hepatic flexure inferiorly.
*Left kidney: spleen is superior and lateral, pancreas at hilum, jejunum inferiorly.
*Posterior to both are quadratus lumborum and psoas muscles.
*Capping both are the adrenal glands.
Review the external anatomy relationship to kidney location.

What do the kidneys weigh?
*Male kidney 150 grams; female kidney 135 g.

*More superior on the left.
*11th rib on left.
*11th interspace on right.
*Both are embedded in fat.
*Male kidney 150 grams; female kidney 135 g.

*More superior on the left.
*11th rib on left.
*11th interspace on right.
*Both are embedded in fat.
Anatomy of infant and adult kidneys:
*Infants' are lobular; adrenal is very large.
*Hilus is the medial margin.
*Whole thing is surrounded by a fibrous capsule.
*Infants' are lobular; adrenal is very large.
*Hilus is the medial margin.
*Whole thing is surrounded by a fibrous capsule.
Longitudinally sectioned anatomy of the kidney:
*Outer is cortex; Inner is medulla.
*Medullary pyramids--> papilla
*Renal columns are b/t pyramids (collections of tubules).
*Renal pelvis is proximal part of ureter.
*Calyces feed into the pelvis.
*Papilla--> calyx--> pelvis--> ureter.
*Ren...
*Outer is cortex; Inner is medulla.
*Medullary pyramids--> papilla
*Renal columns are b/t pyramids (collections of tubules).
*Renal pelvis is proximal part of ureter.
*Calyces feed into the pelvis.
*Papilla--> calyx--> pelvis--> ureter.
*Renal sinus is normally filled with fatty tissue.
Anatomy of the nephron:
*Two types of nephrons, distinguished by location!

*Renal corpuscle consists of glomerulus and Bowman’s capsule.

*PCT, loop of Henle, DCT.
*Connecting tubule.
*Collecting tubule connects the two 'types' of nephrons, although they don't c...
*Two types of nephrons, distinguished by location!

*Renal corpuscle consists of glomerulus and Bowman’s capsule.

*PCT, loop of Henle, DCT.
*Connecting tubule.
*Collecting tubule connects the two 'types' of nephrons, although they don't communicate; they just both empty into the papilla via the same collecting tubule.

*JG apparatus consists of wall of afferent arteriole and macula densa of DCT.
*Macula densa is key to regulating GFR.
Vascular supply of the kidneys:
Aorta to left of and slightly posterior to IVC. 

Renal arteries arise directly from aorta just below the superior mesenteric artery.

RRA longer; passes posterior to IVC, RRV, and head of pancreas.

LRA posterior to LRV and body of pancreas...
Aorta to left of and slightly posterior to IVC.

Renal arteries arise directly from aorta just below the superior mesenteric artery.

RRA longer; passes posterior to IVC, RRV, and head of pancreas.

LRA posterior to LRV and body of pancreas.

At hilum – order anterior to posterior – vein, artery, renal pelvis.
Blood supply TO the kidney:
Renal artery--> segmental--> interlobar--> arcuate--> interlobular--> afferent arteriole to glomerulus--> efferent arteriole--> peritubular capillary system--> interlobular vein.
Juxtaglomerular nephrons: Renal artery--> segmental--> interlobar--> arcuate--> interlobular--> afferent arteriole to glomerulus--> efferent arteriole--> peritubular capillary system--> interlobular vein.

Juxtamedullary nephrons: Renal artery--> segmental--> interlobar--> arcuate--> interlobular--> afferent arteriole to glomerulus--> efferent arteriole--> peritubular capillary system AND vasa recta--> interlobular vein.
Venous outflow of the kidney:
At hilum veins are anterior to arteries.

Left longer than Rt.     

LRV receives left ovarian or testicular vein and left adrenal vein.

On right these veins enter directly into IVC.
At hilum veins are anterior to arteries.

Left longer than Rt.

LRV receives left ovarian or testicular vein and left adrenal vein.

On right these veins enter directly into IVC.
Anatomy of the ureters:
Ureters are retroperitoneal structures. Note close relationship to uterine arteries and veins and parametrium.
Ureters are retroperitoneal structures. Note close relationship to uterine arteries and veins and parametrium.
How does the ureter get to the bladder?
The ureter follows an oblique course through the bladder wall to open in the TRIGONE at a point (in the distended adult bladder) about 5 cm. from the opening of the contralateral ureter. The normal oblique course is NEEDED to prevent VU reflux.
The ureter follows an oblique course through the bladder wall to open in the TRIGONE at a point (in the distended adult bladder) about 5 cm. from the opening of the contralateral ureter. The normal oblique course is NEEDED to prevent VU reflux.
Anatomy of the Renal cortex:
*Corpuscle= glomerulus + BC. Space is urinary space.
*Proximal tubules have pinkish cytoplasm.
*Distal ones have smaller diameter.
*Corpuscle= glomerulus + BC. Space is urinary space.
*Proximal tubules have pinkish cytoplasm.
*Distal ones have smaller diameter.
RENAL CORPUSCLE anatomy:
JUXTAGLOMERULAR APPARATUS anatomy:
Glomerulus anatomy:
*Afferent arteriole--> glomerular capillary--> efferent arteriole.
*JG cells produce RENIN!
*Glomerulus has a VASCULAR pole opposite a TUBULAR pole.
*Afferent arteriole--> glomerular capillary--> efferent arteriole.
*JG cells produce RENIN!
*Glomerulus has a VASCULAR pole opposite a TUBULAR pole.
Anatomy of GLOMERULAR CAPILLARIES AND PODOCYTE:
*Note processes of the podocytes (pedicels).
*Note processes of the podocytes (pedicels).
Anatomy of the MESANGIUM:
*This is a xs of the glomerular capillaries.
*Podocyte processes are "hairy" looking.
*Mesangial cells are structural cells of the glomerulus.
*This is a xs of the glomerular capillaries.
*Podocyte processes are "hairy" looking.
*Mesangial cells are structural cells of the glomerulus.
Anatomy of the normal GLOMERULAR FILTRATION BARRIER:
*Note hairy looking foot processes.
*Proteinuria and "minimal change disease" will lead to fusion of the processes!

*Bottom pic: lower portion is a capillary lumen. Cytoplasm of an endothelial cell is to the left of the arrowhead. Gap indicate...
*Note hairy looking foot processes.
*Proteinuria and "minimal change disease" will lead to fusion of the processes!

*Bottom pic: lower portion is a capillary lumen. Cytoplasm of an endothelial cell is to the left of the arrowhead. Gap indicated by arrowhead is a fenestrae. Basal lamina looks quite dense. Note foot processes.
*Filtration slit and "slit diaphragm" indicated by arrow.
Histology of normal RENAL CORTEX:
*TP = tubular pole.
*Arrow points to a capillary b/t cells.
*TP = tubular pole.
*Arrow points to a capillary b/t cells.
Histology of normal RENAL MEDULLA:
*CDs, thin and thick loops. Identifying specific components isn't terribly important.
*CDs, thin and thick loops. Identifying specific components isn't terribly important.
Histology of URETERS:
*Transitional epithelium here.
*Transitional epithelium here.
Ureter. Transitional epithelium lines all of the urinary tract from the calyces to the distal urethra.
Ureter. Transitional epithelium lines all of the urinary tract from the calyces to the distal urethra.
Describe Renal Embryology-- the pronephros and the mesonephros:
1) Pronephros:
-Appears in early 4th week.
-Transient and NON-functional.

2) Mesonephros:
-Appears in late 4th week.
-Connects to mesonephric (Wolffian) duct (originally pronephric ducts).
-Ducts open into CLOACA.
-Functions for a SHORT t...
1) Pronephros:
-Appears in early 4th week.
-Transient and NON-functional.

2) Mesonephros:
-Appears in late 4th week.
-Connects to mesonephric (Wolffian) duct (originally pronephric ducts).
-Ducts open into CLOACA.
-Functions for a SHORT time.

*Paramesonephric ducts = Mullerian ducts (female).
*Mesonephric ducts= Wolffian ducts (male).
Describe Renal Embryology-- the metanephros:
*Metanephros: the definitive kidney!
*Begins to develop in the 5th week.
*Functions in the early fetal period.

*Formation of permanent kidney requires contact b/t the ureteric bud and the metanephric mesoderm.
*Metanephros: the definitive kidney!
*Begins to develop in the 5th week.
*Functions in the early fetal period.

*Formation of permanent kidney requires contact b/t the ureteric bud and the metanephric mesoderm.
What does the kidney system look like during the 5th week of development?
*Pro- and meta- are still there.
*Metanephros just getting started.
*Cloaca in place.
*Pro- and meta- are still there.
*Metanephros just getting started.
*Cloaca in place.
Describe the DEVELOPMENT OF the MESONEPHROS between the 5th - 11th WEEKS:
*Note that the mesonephros, while only functional for a short time, has its own system of glomeruli and ducts.
*Note that the mesonephros, while only functional for a short time, has its own system of glomeruli and ducts.
Describe the DEVELOPMENT OF the PERMANENT KIDNEY between the 5th and 8th WEEKS:
B: Ureteric bud interacts with metanephrogenic blastema.

*Kidney "proper" is derived from metanephrogenic blastema.
*The system of ducts/tubules is actually developed from the outpouching of the mesonephric duct.
B: Ureteric bud interacts with metanephrogenic blastema.

*Kidney "proper" is derived from metanephrogenic blastema.

*The system of ducts/tubules is actually developed from the outpouching of the mesonephric duct.
Discuss the Ureteric Bud:
*A.k.a. metanephric diverticulum.

*Arises from Wolffian duct, near the entry into the cloaca.

*The ureteric bud acts as the primordium of the ureter, renal pelvis, calyces, and collecting tubules.
*A.k.a. metanephric diverticulum.

*Arises from Wolffian duct, near the entry into the cloaca.

*The ureteric bud acts as the primordium of the ureter, renal pelvis, calyces, and collecting tubules.
Discuss the Metanephric Mesoderm:

AKA?
*A.k.a. metanephrogenic blastema.

*Derived from the nephrogenic cord in the urogenital ridge.

*Will form nephrons.
*A.k.a. metanephrogenic blastema.

*Derived from the nephrogenic cord in the urogenital ridge.

*Will form nephrons.

*Forms the Wilms Tumor!
What are some pathologies of the Ureteric Bud and Metanephric Mesoderm?
*Absence of one or both or failure to meet and properly interact results in renal AGENESIS.

*Incomplete or aberrant juxtaposition and/or interaction results in renal dysplasia with or without cysts.
How do the ureteric bud and metanephric mesoderm interact?
*Ureteric bud is induced to undergo tree-like branching giving rise to ureter, pelvis, calyces and collecting tubules.

*Cells of the metanephrogenic blastema are induced to take on a stem cell phenotype.
What do nephrons arise from?

What do CTs arise from?
*Nephrons from metanephric mesoderm.

*CTs from ureteric bud which is derived from the mesonephric duct.
Describe the development of nephrons:
*Branches of the renal artery form glomeruli.
*There's more activity occurring toward the medulla than there is toward the cortex.
*Branches of the renal artery form glomeruli.
*There's more activity occurring toward the medulla than there is toward the cortex.
How does the Formation of nephrons occur?
*The stem cells of the innermost portion are the first to undertake glomerular formation and tubular formation.

*As they mature the next outermost layer goes to work, etc.

*Mesenchymal cells become mature epithelial cells of the tubules by gaining a basement membrane, cell-cell junctions, and cellular apico-basal polarity.
When is the formation of nephrons complete?
*During embryonal and fetal life the formation of additional nephrons continues until about the 35th week of gestation in a standard fashion that allows rough DATING of gestation on the basis of the NUMBER of LAYERS seen microscopically in renal sections.

*When the process is complete there is usually NO RESIDUAL metanephrogenic blastema remaining in the kidney.
*A kidney at 6-7 weeks. Some early tubular structures.
*The really dark cells clustered in the outer layer are the metanephrogenic blastema. They will ultimately form the proximal and convoluted tubules.
*A kidney at 6-7 weeks. Some early tubular structures.
*The really dark cells clustered in the outer layer are the metanephrogenic blastema. They will ultimately form the proximal and convoluted tubules.
*Kidney at 27 weeks. 
*Cortex is to the right; medulla to left. You can see primitive tubules and nephrogenic activity in the cortex region.
*Kidney at 27 weeks.
*Cortex is to the right; medulla to left. You can see primitive tubules and nephrogenic activity in the cortex region.
Describe the ROTATION AND RELOCATION OF the KIDNEYS. When does it occur?
*Occurs in weeks 6-9.
*They begin development low and move up.
*Occurs in weeks 6-9.
*They begin development low and move up.
*Kidney at 28 weeks. Note the lobules; they define the locations of renal pyramids.
*Kidney at 28 weeks. Note the lobules; they define the locations of renal pyramids.
What are the Derivatives of Mesonephric Tubules in males and females?
*In Male: Efferent ductules of testis.

*In Female: Tubules of epoophoron and paroophoron.
List the Derivatives of the Wolffian (Mesonephric) Duct:

5 in males.
Females? 2
*In Males:
-Epididymis
-Vas deferens
-Seminal vesicle
-Ejaculatory ducts
-Appendix epididymis (can undergo torsion)

*Only vestigial structures in females:
-Gartner’s duct
-longitudinal duct of epoophoron
List the Derivatives of the Müllerian (Paramesonephric) Duct:

Females? 3
Males? 2
*In Females:
-Fallopian tubes and hydatids of Morgagni
-Uterus
-Upper vagina

*Only vestigial structures in males:
-Appendix testis
-Prostatic utricle
What is the Cloaca?

What does it become? In males and females?
*The urorectal septum divides the cloaca into ventral and dorsal portions.

*The dorsal portion (hindgut) becomes the rectum and part of anal canal.

*The ventral portion is the UG sinus which forms bladder and urethra in both sexes, prostate ...
*The urorectal septum divides the cloaca into ventral and dorsal portions.

*The dorsal portion (hindgut) becomes the rectum and part of anal canal.

*The ventral portion is the UG sinus which forms bladder and urethra in both sexes, prostate in male, and vagina in female.
How does the urinary bladder develop?
*Note the allantois and the cloaca.

*The bladder, urethra, prostate, and bulbourethral glands form from the UG sinus.

*The distal portion of the mesonephric duct which is  now part of the vas deferens enters the prostatic urethra. 

*The s...
*Note the allantois and the cloaca.

*The bladder, urethra, prostate, and bulbourethral glands form from the UG sinus.

*The distal portion of the mesonephric duct which is now part of the vas deferens enters the prostatic urethra.

*The seminal vesicle is an outpouching from the vas deferens.

*The caudal portion of the ureteric bud (now the distal portion of the ureter) loses connection with the mesonephric duct and enters the bladder directly through a process of wall incorporation.

*Faulty development of the entry into the bladder leads to vesicoureteral reflux.
What does the UG sinus give rise to?
The bladder, urethra, prostate, and bulbourethral glands form from the UG sinus.
Where does the bladder's epithelium come from?

What pathology can result if something goes wrong?
*Bladder epithelium is derived from endoderm of the UG sinus.

*There is caudal migration of mesoderm from the umbilical region to form the anterior abdominal wall.

*Deficiencies of such migration will cause bladder exstrophy.
Immunologic diseases affect the _____.

Toxic and infectious diseases affect the ____ and ____.
*Immunologic diseases usually affect glomeruli.

*Toxic and infectious agents usually affect tubules and interstitium.

*End result of severe disease starting in any unit is destruction of all units--> end-stage kidney.
What do the renal pelvis, ureters, and the bladder all have in common? What's a pathologic implication of this?
*Epithelium is the same as that of bladder and is subject to the same TUMORS and INFECTIONS.
How does pathological diagnosis of renal disease happen?
*Clinical pathology .

*Cytopathology.

*Anatomical pathology:
1) Biopsy; needle or open
2) Nephrectomy
3) Autopsy
What are some Special Stains and Techniques used to see the kidney in pathology?
*Periodic acid Schiff (PAS) stains mesangium, GBM, TBM pink.

*Silver impregnation stains GBM and TBM black.

*Trichrome and lipid stains.

*Other special stains for fibrin and amyloid.

*Especially important to see the BASEMENT MEMBRANE!

*Immunofluorescence and immuno-peroxidase for immunoglobulins, antigens, and complement.

*Electron microscopy for ultrastructure of glomerulus including immune complex deposits.