They are usually characterized as "simple" cysts, meaning they have a thin wall and contain water-like fluid. Several formulas are available for this calculation, and calculators and on-line sites are available to simplify the calculations. Each time a professor says 'nephron', a student gets a headache. The most common cause is renal artery stenosis (see Fig. Unenhanced MRI can also be used to diagnose obstruction and identify the source (Fig. The kidney also has endocrine functions, helping to control blood pressure, bone mineralization, and erythrocyte production. Simple kidney cysts aren't cancer and rarely cause problems. In other cases, both kidneys can be fused, usually at the inferior poles, which is a congenital state called the horseshoe kidney. In this region, the anterior and posterior. In most cases, unenhanced CT is performed when the duration and cause of renal failure are unknown because exposure to iodinated contrast media could impair recovery of renal function. The ureter and calyces were not dilated (not shown), helping to differentiate this anatomic variant from obstruction. Chronic glomerulonephritis usually causes bilateral increased renal echogenicity with smooth atrophy, whereas renal artery stenosis usually causes a similar but unilateral appearance (Fig. Read More Created for people with ongoing healthcare needs but benefits everyone. Because an extrarenal pelvis is not confined by the renal parenchyma, there is a tendency for it to expand. Note origin of inferior accessories near inferior poles on each side. . and grab your free ultimate anatomy study guide! There is no specific treatment for fused kidneys and the only option is to treat the pathologies that affect them during life. The dynamics of obstruction and quantification of relative renal function between the two kidneys may be important considerations in two general circumstances: (1) it is unclear whether obstruction is severe enough to warrant surgical intervention; or (2) significant parenchymal atrophy exists, and the relative merits of repair and nephrectomy are being compared. So in the filtered fluid that goes to the renal tubule, we have both necessary and unnecessary substances. a bifid renal pelvis, ultimately drained by a common ureter. Cells in our body constantly produce hydrogen ions. Reading time: 23 minutes. This is just a peek into the kidney physiology. A furosemide challenge is often administered after initial excretion is observed to measure the impact of diuresis on the clearance of radiotracer from the renal pelvis. The anterior surface faces towards the anterior abdominal wall, whereas the posterior surface is facing the posterior abdominal wall. 18-2). This kidney measured 14 cm in length. Bone scan and chest x-ray to find out if the cancer has spread. Table 18-7 Causes of Unilateral Small Smooth Kidney, Only gold members can continue reading. The portion of the kidney between the poles is called the interpolar region and contains the renal hilum (Fig. The fused kidneys can have a variety of orientations, including side by side, in-line, or perpendicular. Calcifications and renal calculi are notoriously poorly demonstrated with MRI. Despite the complexity of renal physiology, many attempt to assess renal function with a simple quantitative measure, the serum creatinine. IVC, Inferior vena cava. They are branches of the abdominal aorta and all together are called the extrahilar renal arteries. Internal Anatomy. Calculation of the estimated renal volume is considered by some to be the most accurate assessment of renal size available with ultrasound, although renal length alone is more commonly reported. 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. Figure 18-8 Junctional cortical line seen on a long-axis ultrasound image of the right kidney. Look carefully for accessory arteries at upper and lower poles (Fig. 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. Reviewer: A, Soft-tissue windows demonstrate no filling defect. Note that there is no contrast in the aorta. Sometimes, one or both kidneys fail to develop, which causes unilateral or bilateral renal agenesis. Now that weve mastered the borders, it will be easier to take a closer look at the anatomical relations that the kidneys share with other abdominal structures. Hypotension is a stimulus for the kidneys to increase the retention of fluid and thus increase blood pressure. D, If pressure on the papilla persists, the ischemic papilla undergoes necrosis, allowing the calyx to protrude outward toward the cortex. Created for people with ongoing healthcare needs but benefits everyone. IVC, Inferior vena cava. Each kidney should always be evaluated in long axis (coronal, sagittal, or both, depending on sonographic window) and axial to the kidney. If this appearance were present bilaterally, chronic renal disease such as chronic glomerulonephritis would be a more likely explanation. In the medulla, 5-8 renal pyramids are separated by connective tissue renal columns. 18-26). The left kidney measured 7.8 cm, and the right kidney measured 10.9 cm. In most cases, the kidneys are situated with the inferior poles slightly. Increased cortical echogenicity is associated with many forms of chronic renal parenchymal disease and indicates a renal cause for renal failure. 18-4). Their shape resembles a bean, where we can describe the superior and inferior poles, as well as the major convexity pointed laterally, and the minor concavity pointed medially. Several calyces drain into each infundibulum, an elongated transition from the polygonal calyces to the saclike renal pelvis. Horseshoe kidneys result from midline fusion of the kidneys, typically at the level of the origin of the inferior mesenteric artery. BOX 18-2 Crossing Vessels in Ureteropelvic Junction Obstruction. People with unilateral agenesis often are unaware that they lack one kidney until an accidental discovery, since the one kidney that they have is able to functionally compensate for the other. Furthermore, since the left renal vein passes between the superior mesenteric artery and the abdominal aorta, an enlargement of the superior mesenteric artery can compress the left renalvein and cause an obstruction of drainage from all three structures that use the left renal vein for drainage (left suprarenal gland, left kidney, and left testicle). A. Junctional cortical line seen on a long-axis ultrasound image of the right kidney. The kidneys are paired retroperitoneal structures that are normally located between the transverse processes of T12-L3 vertebrae, with the left kidney typically somewhat more superior in position than the right. Each end of the kidney is commonly called a. Annotated three-dimensional volume rendering of the left kidney acquired using a combined nephrographic phase and excretory phase during computed tomographic urography demonstrates regional anatomy of the kidney. The left kidney measured 7.8 cm, and the right kidney measured 10.9 cm. Depending on where the cyst is located, it can affect how the kidney works. This is called the nutcracker phenomenon. BOX 18-3 Causes of Bilateral Hydronephrosis. Small renal shadows may be seen on radiographs, and reniform shape is preserved on cross-sectional imaging. Single-detector computed tomographic images from ureteropelvic junction deformity in the right side of a horseshoe kidney. Urine that is concentrated in the renal papilla is subsequently excreted into a lumen lined with transitional epithelium. 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. MR angiography can be useful for the diagnosis of renal vascular abnormalities. The most common indication for cortical scintigraphy is to evaluate kidneys that have been injured by vesicoureteral reflux, chronic obstruction, or severe or repeated urinary infections. (Courtesy of Karl T. Rew, MD) Introduction Synonyms Epidemiology February 12, 2018 - 2:17pm Global insult to one kidney may result in unilateral atrophy that is uniform and smooth. The interpolar region is the middle of the kidney. Chronic obstruction, however, results in damage to the papilla, evident in the clubbed calyx of papillary necrosis (Fig. Figure 18-18 Single-detector computed tomographic images from ureteropelvic junction deformity in the right side of a horseshoe kidney. Frontal image of the left kidney from an intravenous urogram demonstrating an aberrant renal papilla in the lower pole infundibulum. Perhaps of even greater importance, serum creatinine is not a sensitive test for minor insults to the kidney in otherwise healthy individuals. Figure 18-6 Frontal image of the left kidney from an intravenous urogram demonstrating an aberrant renal papilla in the lower pole infundibulum. The early excretory phase begins as early as 120 seconds after injection. 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. Volume rendering from a computed tomographic scan of the kidneys shows bilateral supernumerary renal arteries (three on right, two on left). Table 18-6 Causes of Bilateral Small Smooth Kidneys. 18-18). In most cases, the kidneys are situated with the inferior poles slightly more lateral and anterior than the superior poles. The shape of the calyx is formed by the impression of the renal papilla. Renal scintigraphy can be performed with a variety of agents to provide assessment of either function or structure of the kidneys. 18-7). It is important to note, however, that the appearance of hydronephrosis does not necessarily indicate urinary obstruction (see Hydronephrosis and Its Mimics section later in this chapter). Arterial stenosis was confirmed by magnetic resonance angiography. 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. Kidney cysts can occur with disorders that may impair kidney function. Normal parenchymal enhancement on CT or MRI allows definitive characterization. Figure 18-27 T2-weighted maximum intensity projection image from a magnetic resonance urogram performed to evaluate urinary obstruction identified in a patient with an obstructing soft tissue mass in the pelvis on unenhanced computed tomography (CT). 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