Questions and Answers
What are the two main parts the structural overview of the renal system can be divided into?
Upper: Kidneys, Lower: Ureters, Bladder, Urethra
What landmark is posterior to rib 11-12?
Superior part of the kidney
What is the main difference between Haemofiltration and Hemodialysis?
Haemofiltration solution contains replacement solution while Hemodialysis circulates the blood.
What arteries supply the superior segmental region of the kidney?
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Renal cysts are common findings during ultrasound examinations and dissection of cadavers.
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What is the primary function of Peritoneal Dialysis?
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Living kidney donors have a better long-term survival rate compared to deceased kidney donors.
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Renal transplantation involves replacing the functions of the kidneys, and the native kidneys may come from deceased or living donors; the latter are associated with a better long-term ____.
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What is the lifetime risk of developing urinary tract stones?
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Which type of stone is most common and radio-opaque?
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Is renal cell carcinoma more common in men than women?
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Renal cell carcinomas arise from proximal tubular ________.
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Match the clinical features with the corresponding percentages:
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What does BPH stand for in relation to prostate enlargement?
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What is CKD used as an abbreviation for?
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AKI is an abrupt deterioration in renal function, usually over hours or days. AKI may cause sudden, life-threatening biochemical disturbances as a medical emergency. Oliguria is often a feature of AKI, which is the production of abnormally small amounts of ______.
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AKI is usually reversible within hours or days.
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Study Notes
Structural Overview of the Renal System
- The renal system can be divided into two parts: the upper part (kidneys, retroperitoneal, abdominal) and the lower part (bladder and urethra).
- The superior urinary organs include kidneys, ureters, adrenal glands, pancreas, and duodenum.
- The landmarks of the left kidney include the suprarenal gland, pancreas, and spleen, while those of the right kidney include the liver and adrenal gland.
- The kidneys are located between the 11th and 12th thoracic vertebrae.
Structural and Functional Overview
- The renal artery enters the kidney from the abdominal aorta at the 11-12th thoracic vertebrae.
- The renal cortex receives 10 times more blood than the medulla.
- The renal vascular anatomy is important, particularly when undertaking partial nephrectomy.
- Each kidney has around 1.4 million nephrons, which originate from the cortex.
- The DCT is in contact with the macula densa in the inner medulla.
Histology of the Renal Corpuscle
- The renal corpuscle consists of the parietal layer, visceral layer, and Bowman's space.
- The visceral layer is formed by podocytes (pedicels) and has two membranes: the basement membrane and the parietal membrane.
- Podocytes have processes called pedicels that wrap around the capillaries to filter blood.
- The filtrate does not include large proteins, such as RBCs.
Common Pathologies
- Renal agenesis is the absence of one or both kidneys, which can be unilateral or bilateral.
- Unilateral renal agenesis is found in roughly 1/1000 live births, while bilateral renal agenesis is fatal.
- Ectopic kidneys form in an abnormal site, usually the pelvis, but are otherwise structurally normal.
- Horseshoe kidneys result from the fusion of the two nephrogenic blastemas during fetal life.
- Renal cysts are common findings during ultrasound examinations and dissection of cadavers.
- Adult polycystic disease of the kidneys is an important cause of renal failure and is inherited as an autosomal dominant trait.
Nephrolithiasis
- Nephrolithiasis, also called renal calculi or urolithiasis, usually occurs in the upper urinary tract.
- It is very common worldwide, with a lifetime risk of about 10%.
- Causes of urinary tract stones include dehydration, hypercalcaemia, hypercalciuria, hyperoxaluria, hyperuricaemia, and infection.
- Types of urinary tract stones include calcium oxalate, calcium phosphate, struvite, and uric acid stones.
Clinical Features of Nephrolithiasis
- Ureteric colic occurs when a stone enters the ureter and either obstructs it or causes spasm during its passage down the ureter.
- Pain radiates from the flank to the iliac fossa, testis, or labia, and is accompanied by pallor, sweating, and vomiting.
Investigations of Nephrolithiasis
- Dipsticks are used to test for red cells, protein, and glucose in urine.
- Serum urea, electrolyte, creatinine (eGFR), and calcium levels should be measured.
- Ultrasonography shows kidney stones and renal pelvis dilation well, but ureteric stones can be missed.
- Computed tomography of kidneys, ureters, and bladder (CT-KUB) is the best diagnostic test available.
Renal Cell Carcinoma
- Renal cell carcinomas (RCCs) arise from proximal tubular epithelium and account for 1-2% of all malignancies.
- RCCs are highly vascular tumours that affect men more often than women (2:1).
- Characteristics of RCCs include macroscopic haematuria, flank pain, and palpable flank mass.
Glomerulonephritis
- Glomerulonephritis is inflammation within the glomeruli, which can be acute or chronic.
- It usually stems from humoral immune reactions, regardless of the source.
- Immune complexes can elicit a local inflammatory response.
Pyelonephritis
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Pyelonephritis is an inflammation of the kidney and renal pelvis.
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Causative bacteria include E. coli, Klebsiella, and Proteus.### Urinary Tract Infections (UTIs)
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Hyperplasia in older men can cause urinary symptoms, such as uncomfortable urination.
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Vericouteral reflux is a condition where urine flows backward from the bladder to one or both kidneys.
Bladder Problems
- Cystitis is the most frequent problem involving the bladder, characterized by inflammation of the bladder mucosa.
- Cystitis can be caused by immunodeficiency, urinary catheterization, radiation, or chemotherapy.
- Chronic inflammation can lead to unstable epithelium and potentially bladder cancers.
Urethritis
- Urinary tract infections, usually involving coliform bacteria or Chlamydia, are more common in females due to shorter urethra.
- Such infections are accompanied by frequent urination, pain or difficulty during urination, and may produce polyuria.
Prostate Enlargement
- Causes of prostate enlargement include BPH and prostate cancer.
- Enlargement can block the flow of urine, leading to bladder outpouching, thickening of bladder walls, and Reno-brethren observation of a noticeable bulge.
Acute Kidney Injury (AKI)
- AKI is defined as an abrupt deterioration in renal function, usually over hours or days.
- Causes of AKI include direct injury to the renal parenchyma, blood supply problems, and damage to the tubules.
- AKI may cause sudden, life-threatening biochemical disturbances as a medical emergency, often featuring oliguria.
Chronic Kidney Disease (CKD)
- CKD is a descriptive term for deteriorating kidney function of any underlying cause.
- CKD can cause nausea, decreased mental acuity, and decreased urine output, and may require lab tests.
- Causes of CKD include congenital and inherited diseases, glomerular diseases, vascular diseases, tubulointerstitial nephritis, and idiopathic diseases.
Renal Replacement Therapies
- Renal replacement therapy involves maintaining normal plasma pH, supporting the elimination of nitrogenous waste, and preserving electrolyte homeostasis.
- Indications for renal biopsy include abnormal kidney function, proteinuria, and hematuria.
Haemodialysis
- Haemodialysis involves pumping anticoagulated blood through an extracorporeal circuit and a biocompatible, semipermeable membrane (dialyser) before returning it to the circulation.
- An arteriovenous fistula is surgically constructed to provide access for haemodialysis.
- Effective dialysis requires blood flows of between 250 and 450 mL/min.
Peritoneal Dialysis
- Peritoneal dialysis uses the peritoneal membrane as a semipermeable membrane for blood purification.
- This treatment avoids the need for extracorporeal circulation of blood.
Renal Transplantation
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Renal transplantation is the most complete form of renal replacement therapy, replacing the functions of the native kidneys.
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Transplants can come from deceased or living donors, with the latter associated with better long-term survival.
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Hazards of renal transplantation include immunosuppressive complications and increased risk of malignancies.### Renal System and Kidney Pathologies
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Reviewed the anatomy of the kidney
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Outlined common pathologies of the renal system
Kidney Injury and Disease
- Outlined the principal causes associated with acute kidney injury
- Outlined the principal causes associated with chronic kidney disease
Arterial Bypass
- Damaged artery can be ligated and bypassed using a saphenous vein graft
- Other ways to bypass include using a synthetic graft
- A vin graft may also be used
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Test your knowledge of the renal system, its anatomy, common pathologies, and causes of acute kidney injury and chronic kidney disease.
