Figure 18-9 Coronal computed tomographic image in the corticomedullary phase shows normal corticomedullary differentiation along the lobulated contour, consistent with fetal lobulation. Internal Anatomy. 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. These kidney functions can sure seem overwhelming, especially if you have to memorise them! Typically, one kidney sits on either side of your spine. There is no specific treatment for fused kidneys and the only option is to treat the pathologies that affect them during life. 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. Extraaortic origin of the renal arteries and accessory renal arteries are common. 18-23). Figure 18-19 Sagittal ultrasound image of the right kidney demonstrates increased size and echogenicity of the kidney, findings typical of human immunodeficiency virus nephropathy. The kidneys serve important . However, you may have symptoms related to the condition that's causing it. The right kidney had a similar appearance (not shown). If a kidney stone becomes lodged in the ureters, it may block the flow of urine and cause the kidney to swell and the ureter to spasm, which can be very painful. Alternatively, the anterior to posterior orientation follows the same pattern: renal vein, renal artery and ureter. Normally, the kidney is about the size of a mouse and measures approximately 11-12 cm in length, 5-6 cm in width, and 2.5-3 cm in thickness. 18-11). The ureters are the tubes that carry urine from the renal pelvis to the bladder. The most common cause is renal artery stenosis (see, Delayed but increasingly dense nephrogram, Delayed but hyperconcentrated contrast excretion, Imaging Evaluation of Acute Abdominal Pain, A Multidimensional Approach to Abdominal Imaging. Created for people with ongoing healthcare needs but benefits everyone. 18-25). Figure 18-10 Crossed ectopia on intravenous pyelogram. Note that there is no contrast in the aorta. The axes of the renal moeities are abnormal with the inferior poles angled medially. But more often, kidney cysts are a type called simple kidney cysts. Blood in the urine, or dark urine. IVC, Inferior vena cava. In some cases, two separate kidneys drain into a bifid renal pelvis, ultimately drained by a common ureter. The normal appearance of the calyx is created by the impression of the renal papilla. The muscular relations of the inferior half are easy to remember by dividing the kidney surface into three vertical stripes, where the medial stripe represents the impression of the psoas major muscle, the central stripe the quadratus lumborum, and the lateral stripe the transversus abdominis muscle. Table 18-1 Imaging the Living Renal Donor. The kidneys are reddish-brown, bean-shaped organs situated retroperitoneal on the posterior abdominal wall. normal kidney size in adults normal kidney size in children Structure Figure 18-14 Axial maximum intensity projection image from the arterial phase of a contrast-enhanced computed tomographic scan from a prospective renal donor demonstrates early prehilar branching of the left renal artery. Because the fascia of the retroperitoneum prevents significant extravasation, the incision usually heals to form a larger lumen. Jana Vaskovi MD The genital system consists of the testes, epididymides, deferent ducts, seminal vesicles, ejaculatory ducts, the prostate, and the penis in males; and the ovaries, uterine tubes, uterus, and vagina in females. The kidneys are innervated by the renal plexus. Read more. In this region, the anterior and posterior. Despite different methods of accumulation, each is sequestered by the renal cortex, providing an opportunity to quantify the volume of renal parenchymal tissue in each kidney. Imaging must provide detailed images of the renal parenchyma and a survey of arterial, venous, and ureteral anatomy. 18-4). This is called the nutcracker phenomenon. When this happens, the stones can block the flow of urine out of your kidneys. Table 18-7 lists causes of unilateral smooth renal atrophy. 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. Normal parenchymal enhancement on CT or MRI allows definitive characterization. This phenomenon is due to T2-shortening and susceptibility (T2*) effects caused by concentrated gadolinium, and can potentially obscure filling defects and urothelial lesions. Figure 18-13 Volume rendering from a computed tomographic scan of the kidneys shows bilateral supernumerary renal arteries (three on right, two on left). Radiologists divide the kidney into three parts: the upper pole, lower pole, and the interpole (which is in between them). Most radiologists consider 10 to 12 cm to be an approximate reference range for renal length in adults, allowing for an additional 1 cm in either direction for patients at the extremes of height. Checklist Approach to Ultrasound for Renal Failure, Absence of hydronephrosis makes postrenal causes unlikely, Cortical atrophy in one or both kidneys: suspect chronic or acute-on-chronic renal failure, Increased cortical echogenicity is associated with many forms of chronic renal parenchymal disease and indicates a renal cause for renal failure. Learning anatomy is a massive undertaking, and we're here to help you pass with flying colours. The goal of imaging patients with renal failure is to identify a correctable cause in an effort to recover or preserve renal function. Each segmental branch of the renal artery divides into multiple interlobar arteries that course along the periphery of the medullary pyramids and causes small interlobular branches (Fig. The upper poles are normally oriented more medially and posteriorly than the lower poles. In most cases, the kidneys are situated with the inferior poles slightly. Use of MR contrast agents in renal failure poses a lower risk than iodinated contrast material for exacerbating renal failure, but there is evidence that gadolinium-based MR contrast media pose some risk for systemic complications (nephrogenic systemic fibrosis) and should be used with caution in patients with severe or acute renal insufficiency. B, A curved planar reformation of the crossing vein demonstrates its course. When echogenicity of the renal cortex equals that of the liver, renal function is abnormal in approximately 38% of cases. Kim Bengochea, Regis University, Denver. Because the interlobular arteries form an arch overlying the pyramid, they are called the arcuate arteries. Figure 18-23 Axial image of the left kidney obtained in the excretory phase of a computed tomographic urogram demonstrates the effects of window settings on visualizing structures near excreted contrast. Solid masses are more likely to be cancerous but they are not all cancerous. The medulla consists of multiple pyramidal tissue masses, called the renal pyramids, which are triangle structures that contain a dense network of nephrons. Figure 18-7 Axial image of the left kidney from a contrast-enhanced computed tomographic scan demonstrates an extrarenal pelvis. Renal function is better evaluated by measured creatinine clearance, which takes into account not only the amount of creatinine in the blood but also the amount of creatinine within a specified volume of urine over a given period. Crossed ectopia can be either fused or unfused. Some of them are congenital, such as a third kidney, which is usually atrophic. This method is the standard in evaluation of UPJ obstruction and often is used for other types of chronic obstruction. 18-21). This layer sits posteriorly and posterolaterally to each kidney and separates it from the muscles of the abdominal wall. When simple kidney cysts do cause symptoms, they might include: Pain in the side between the ribs and hip, stomach or back. The left kidney measured 7.8 cm, and the right kidney measured 10.9 cm. 18-8). Note number of veins by inspecting inferior vena cava along entire length of kidney. 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. Supernumerary kidneys are quite rare and have been associated with aortic coarctation, vaginal atresia, and urethral duplications. Estimated creatinine clearance may be calculated using serum creatinine with adjustments made for sex, age, and body weight. It is important to remember this order of vessels and ducts since this is the only thing that will make you able to orient the kidney and differentiate the left one from the right when they are outside of the cadaver. Anterior components of circumaortic vein can be small. Other symptoms can include abnormal urine color, blood in your urine, fever, chills, nausea, and vomiting. The lateral border is directed towards the periphery, while the medial border is the one directed towards the midline. After looking at the overview of the kidneys in situ, it may seemas they are cluttered with all abdominal organs. a bifid renal pelvis, ultimately drained by a common ureter. 18-25). Usually, there are two to three major calyces in the kidney (superior, middle, and inferior), which again unite to form the renal pelvis from which the ureter emerges and leaves the kidney through the hilum. Illustration demonstrating the anatomy of the renal collecting system. The kidney is a very important organ in regards to body homeostasis. Annotated axial image of the right kidney from a contrast-enhanced computed tomographic scan demonstrates hilar anatomy of the kidney. The shape of the calyx is formed by the impression of the renal papilla. Literature supports the use of either multidetector computed tomography (MDCT) or MRI in donor evaluation. The vessel which brings blood into the glomerulus is the afferent arteriole, whereas the vessel that carries the rest of the blood out that hasnt been filtered out of the glomerulus is called the efferent arteriole. This significantly affects the testicle, since an obstruction of drainage causes an obstruction of fresh arterial blood inflow, which can result in the infarction of testicular tissue. 18-18). These surfaces are separated by the edges of the kidney, which are the major convexity laterally, and minor concavity medially. Note origin of inferior accessories near inferior poles on each side. Table 18-5 Checklist Approach to Ultrasound for Renal Failure. Because an extrarenal pelvis is not confined by the renal parenchyma, there is a tendency for it to expand. 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