Escolar Documentos
Profissional Documentos
Cultura Documentos
and Physiology
By: Wong Ann Cheng
MD (UKM) MRCPCH (UK)
Renal Anatomy and
Physiology
Macroscopic Physiology
anatomy Excretory function
Embrology Nitrogenous
Gross metabolic waste:
Procedures urea, uric acid, creat
Investigations
Homeostatic
function
Microscopic Water and salt
anatomy regulation
Glomerular Renin angiotensin
Tubular mechanism
Acid/ base balance
Endocrine function
Erythropoeitin
Embrology
◆Mesonephros
◆Metanephros
colic Colon
flexure ◆Jenunum
Macroscopic anatomy
Nephrology / Urology
Renal
Renal Capsule The thin but tough covering of the kidney. It helps protect the kidney.
During a kidney biopsy, may feel a "pop" as the needle goes through the renal
capsule
Renal Cortex The outer shell of the kidney between the renal capsule and the renal medulla.
The renal cortex contains the renal corpuscles (particularly the glomeruli) and
most of the renal tubules (except for the loop of Henle). It is about 1 centimeter
thick and also goes down between the renal pyramids. Many kidney diseases
affect the glomeruli so the goal of a kidney biopsy is to sample this area.
Renal Medulla The innermost area of the kidney. It is separated into 8 to 18 cone-shaped
sections called the medullary pyramids. If the biopsy needle goes in too far, you
may only get medulla and the biopsy will likely have to be repeated.
Medullary Pyramid An important part of the inner kidney. It consists primarily of collecting tubules
as well as loops of Henle. The base of the medullary pyramid is next to the
cortex and it tapers to form the renal papillae. There are between 8 to 18
medulla pyramids in each kidney.
Calyx An extension of the renal pelvis that surrounds the renal papillae. It collects
urine from the papillary ducts. Several minor calyces drain into a major calyx
and then onto the renal pelvis.
Renal Pelvis The area where the urine collects before entering the ureters. Two or three
major calices come together to enter the renal pelvis. Cancers and kidney
stones can form in renal pelvis and cause blood to be lost in the urine.
Renal Sinus A cavity in the kidney that contains the calices and the renal pelvis. It also
contains the blood vessels, nerves, and fat.
Physiologic anatomy
Retroperitoneal organ
Weight: 150gm each
Size: ~clenched fist size
Location
Right: hilum at L1-2
Left: hilum at L1
Divided into cortex and medulla
Each ~1million unit nephrons and kidney
cannot regenerate new nephrons.
paired organs.
(1 in 1,000) only one kidney develops called congenital
agenesis.
1. Glomerular permeability
-capillary and bowman capsule endothelium, glomerular
basement mambrane.
Normal: ♂ 90-140ml/min
♀ 80-125ml/min
Creatinine clearance
Physiologic control of GFR and
Renal blood flow
1. Sympathetic NS Hormone or Effect on GFR
activation: all blood autocoid
vessels are richly Norepinephrine ↓
innervated.
Most important during Epinephrine ↓
severe acute
disturbances Endothelin ↓
Endothelial ↑
derived NO
Prostaglandin ↑
Autoregulation of GFR & Renal
blood flow
Renin Angiotensin
Aldosterone System
Powerful mechanism for controlling
pressure
Renin: small protein released by
kidneys when arterial pressure falls
too low
Synthesized and stored in an inactive
form called prorenin in the JG cells of the
kidneys
JG cells are modified smooth muscle
cells located in the walls of the afferent
arterioles immediately proximal to the
Two principal effects of
Angiotensin II that can
elevate AP
Vasoconstriction –
Decreased
occurs rapidly excretion of both
Intense in the salt and water –
arterioles and less slowly increases
extent in veins the ECF volume,
Constriction in increases AP over
arterioles increases period of hours and
peripheral
resistance, raising
days
AP Even more powerful
than acute
Mild constriction in
vasoconstrictor
veins promotes
mechanism in
increase venous
eventually returning
return to the heart,
AP back to normal
Two ways by which
Angiotensin causes salt and
water retention
Angiotensin acts directly on the
kidneys to cause salt and water
retention
Angiotensin causes the adrenal
glands to secrete aldosterone, and
the aldosterone in turn increases salt
and water reabsorption by the
kidneys tubules
Procedure anatomy
Orientation and
surroundings
The medial border of each kidney is anterior to
the lateral border (psoas). Thus the coronal
plane of the kidney is at 30 degrees to the
coronal plane of the body.
◆Layers surrounding
the kidney
◆Outside the renal
capsule is perirenal fat
◆Then is the renal
fascia which also
surrounds the adrenals
◆This is embedded in
extraperitoneal fat
(pararenal fat)
RENAL BIOPSY
Normal anatomy
Kidney Structure
•Number of Kidneys: agenesis
•Shape of the Kidneys: horseshoe kidney
•Location of the Kidneys: ectopic kidney.