Although ureteral contrast media is typically present before 3 minutes, longer delays provide more predictable opacification. This phenomenon is due to T2-shortening and susceptibility (T2*) effects caused by concentrated gadolinium, and can potentially obscure filling defects and urothelial lesions. Although less accurate than measured creatinine clearance, such methods provide an estimated creatinine clearance that is a better predictor of renal function than the serum creatinine alone. 18-1). Ultrasound It can be seen as a triangular echogenic cortical defect, frequently seen in upper lobe parenchyma. Coronal computed tomographic image in the corticomedullary phase shows normal corticomedullary differentiation along the lobulated contour, consistent with fetal lobulation. Note that the left renal vein receives blood from the left suprarenal and left testicular veins. Thus, the ureter is seen paravertebrally starting from the L2 and going downwards. Ultrasound permits real-time optimization of imaging relative to the axis of each kidney. Read more. MR angiography can be useful for the diagnosis of renal vascular abnormalities. CT and MR findings of renal artery stenosis parallel classic findings described on intravenous pyelogram, including one atrophic kidney with delayed nephrogram and excretion that can progress to a persistent nephrogram with hyperconcentrated excreted contrast media (Fig. The shape of the calyx is formed by the impression of the renal papilla. Medullary cystic disease is encountered only rarely, and in addition to the echogenic atrophic cortex, the medullary pyramids are particularly hypoechoic. An acute change in renal cortical echogenicity is occasionally seen with pyelonehritis. The superior poles (extremities) (T12) of both kidneys are more medially pointed towards the spine than the inferior poles (extremities) (L3). The patient had right flank pain but had a solitary calcification in the left pelvis on plain radiograph (not shown). The kidneys can be divided into three main regions from cranial to caudal. 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. This causes them to fire impulses which stimulate rhythmical contraction and relaxation, called peristalsis. 18-25). 3D printed model for a 53-year-old female presenting a 21 15 15 mm renal tumor located in the interpolar region of left kidney, treated by left partial nephrectomy. Figure 18-25 Sagittal ultrasound image of the left kidney demonstrates a unilateral small, smooth, echogenic kidney in a patient with renal artery stenosis. The stones can move into the ureter and literally get stuck there because the lumen of the ureter is much smaller compared to the calyces, which is very painful for the patient. Anterior components of circumaortic vein can be small. It can be caused by a variety of factors, but most often arises because of the ischemia of the kidney and the toxic effect of some medications, resulting in the failure of all kidney functions. Serum creatinine, however, is dependent not only on its disposal but also its production. Kidney cysts can occur with disorders that may impair kidney function. When the renal arteries enter the kidney through the hilum, they split into anterior and posterior branches. Reading time: 23 minutes. Table 18-5 summarizes a checklist approach to the ultrasound examination. Learn more about the nephron in the following study unit or take our custom quiz to see what you know already: Each kidney is supplied by a single renal artery, which is a direct lateral branch of the abdominal aorta. The right kidney had a similar appearance (not shown). At one end of each nephron, in the cortex of the kidney, is a cup-shaped structure called the Bowman's capsule. Supernumerary kidneys are quite rare and have been associated with aortic coarctation, vaginal atresia, and urethral duplications. They extend from lumbar vertebra T12-L3. They are usually characterized as "simple" cysts, meaning they have a thin wall and contain water-like fluid. This method is the standard in evaluation of UPJ obstruction and often is used for other types of chronic obstruction. Caliectasis doesn't cause any symptoms on its own. Blood supply is variable and often includes extraaortic and multiple vessel origins. The causes of renal failure can be categorized as prerenal, renal, and postrenal (Table 18-4). The kidney tissue is protected by three layers that entirely surround the kidney: Outside the fascia is the most superficial layer a layer of fat tissue called the paranephric fat. Normal parenchymal enhancement on CT or MRI allows definitive characterization. Curated learning paths created by our anatomy experts, 1000s of high quality anatomy illustrations and articles. Renal size can be measured in several ways. Bone scan and chest x-ray to find out if the cancer has spread. The ureter and calyces were not dilated (not shown), helping to differentiate this anatomic variant from obstruction. Table 18-6 Causes of Bilateral Small Smooth Kidneys. Renal artery chronic obstruction, or severe or repeated urinary infections. 18-19). A frontal section through the kidney reveals an outer region called the renal cortex and an inner region called the medulla. Arterial stenosis was confirmed by magnetic resonance angiography. The medial border of the kidney contains a very important landmark called the hilum of the kidney, which is the entry and exit point for the kidney vessels and ureter. 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. Blood in the urine, or dark urine. Duplication affects the axial appearance of the kidneys by dividing the renal sinus into superior and inferior components, separated by a circumferential band of cortex in the central region (Fig. During the 6th to 9th weeks of life, the kidneys begin to ascend from their position in the pelvis to the level of T12-L1, inferior to the adrenal glands. Increasing pressure within the lumen initially distends the fornices (acutely angled portions of the calyx along the sides of the papillae), whereas the central portion of the papillary impression is preserved. aware of such a vessel, the urologist may choose to perform an alternate procedure to avoid hemorrhagic complications. Note that retroaortic components are usually near the inferior poles (Fig. The center of the minor concavity is marked as the hilum of the kidney where the renal artery enters the kidney, and the renal vein and ureter leave the kidney. Around 40% of kidney cancers are localized renal masses. When abnormal echogenicity is detected, it is important to note whether it is unilateral or bilateral. print Print this Article In other cases, each renal unit has its own ureter. Figure 18-3 Illustration demonstrating basic intrarenal arterial anatomy. Obstruction can cause renal failure if it is bilateral (Box 18-3) or if there is preexisting disease in the unobstructed kidney. Static-fluid (T2-weighted) MR urography and phase-contrast MR angiography are useful techniques that do not require intravenous contrast material. On axial sections, the polar regions of the kidney typically form a closed circle or donut shape, with the hole formed by renal sinus fat. 18-3). When simple kidney cysts do cause symptoms, they might include: Pain in the side between the ribs and hip, stomach or back. (Courtesy of Karl T. Rew, MD) Introduction Synonyms Epidemiology The defect is the extension of sinus fat into the cortex, usually at the border of the upper pole and interpolar region of the kidney. 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. This phenomenon is due to T2-shortening and susceptibility (T2*) effects caused by concentrated gadolinium, and can potentially obscure filling defects and urothelial lesions. However, you may have symptoms related to the condition that's causing it. Table 18-1 provides a quick guide itemizing key imaging findings in the potential renal donor. Technetium 99m-mercaptoacetyltriglycin (MAG3) is excreted by the kidneys (mainly through secretion by proximal tubules) and provides evaluation of renal function, particularly in cases of suspected obstruction. Renal cysts are sacs of fluid that form in the kidneys. The early excretory phase begins as early as 120 seconds after injection. The kidney is a very important organ in regards to body homeostasis. Size and Contour of Diffuse Renal Disease, The bilateral small smooth kidney pattern describes most of what is often diagnosed on sonography as medical renal disease, although the authors prefer the term, Global insult to one kidney may result in unilateral atrophy that is uniform and smooth. The solid renal parenchyma consists of the peripheral renal cortex and more central renal medulla. The kidneys are innervated by the renal plexus. impression is preserved. The renal veins empty to the inferior vena cava, so the right vein is shorter because the inferior vena cava runs closer to the right kidney. The vascularity of some tumors may be most apparent during this phase (Fig. The Modification of Diet in Renal Disease (MDRD) is another method for estimating renal function that yields a value often called estimated glomerular filtration rate (eGFR). However, T1-weighted images provide good corticomedullary differentiation. The small portion of the lumen surrounding the papilla is called the calyx. On axial sections, the polar regions of the kidney typically form a closed circle or donut shape, with the hole formed by renal sinus fat. Learning a quickmnemonic'VAD' can help you remember these structures (renal Vein, renal Artery, Duct a.k.a ureter). Renal scintigraphy can be performed with a variety of agents to provide assessment of either function or structure of the kidneys. Figure 18-4 Illustration demonstrating the relation between the renal papilla and calyx. 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. Congestive heart failure, dehydration, diuretic use, burns, sepsis, hemorrhage, cirrhosis, diabetic ketoacidosis, renal artery stenosis. Eliminating toxic metabolites through urine, regulation of blood homeostasis and blood pressure, production of some hormones, Positioned retroperitoneally, consists of the cortex and medulla, empties urine into the ureter (which carries urine to the urinary bladder), Renal artery (branch of the abdominal aorta), Renal vein (drains to the inferior vena cava), Third kidney, horseshoe kidney, kidney agenesis, kidney stones, acute kidney failure, Regulates the amount of fluid in the body by increasing or decreasing the urine production, Maintain the pH of blood at 7.4 by decreasing or increasing the excretion of hydrogen ions, Medial part of the lower half of superior pole, Lateral part of the lower half of superior pole, Lateral part of inferior half of anterior surface, Medial part of inferior half of anterior surface, The perinephric fat (perirenal fat capsule). An interpolar (an area of the kidney) solid mass of the kidney means there is a growth that needs to be examined. The main parts of your kidney anatomy include: Kidney capsule (renal capsule) The renal capsule consists of three layers of connective tissue or fat that cover your kidneys. They are branches of the abdominal aorta and all together are called the extrahilar renal arteries. Kidney cysts are round pouches of fluid that form on or in the kidneys. These surfaces are separated by the edges of the kidney, which are the major convexity laterally, and minor concavity medially. Urine from the calyces flows to the renal sinus via tributaries called infundibula. The renal fascia which besides the kidneys also encloses the suprarenal gland and its surrounding fat. When fused, the condition is described as crossed fused ectopia. normal kidney size in adults normal kidney size in children Structure This is because the liver and the stomach offset the symmetry of the abdomen, with the liver forcing the right kidney a bit down, and the stomach forcing the left kidney a bit up. Literature supports the use of either multidetector computed tomography (MDCT) or MRI in donor evaluation. But here is a neat little mnemonic to help. In most kidneys, the renal hilum faces more anteromedial in the upper half of the kidney and more directly medial in the lower half. On the superior aspect of each kidney is the adrenal gland. Ultrasound It can be seen as a triangular echogenic cortical defect, frequently seen in upper lobe parenchyma. This article will discuss the anatomy and major functions of the kidney. Ultrastructurally, the nephron is the functional representative of the kidney. Anatomy of the Kidney and Ureter Parenchyma Cortex Medulla Perirenal fat Capsule Ureter Living renal donor allografts account for more than half of the transplanted kidneys in the United States. Arterial stenosis was confirmed by magnetic resonance angiography. Figure 18-8 Junctional cortical line seen on a long-axis ultrasound image of the right kidney. If, however, a vessel crosses the UPJ at the level of obstruction, a blind incision made from the inside of the ureteral lumen can result in severe hemorrhage. 18-27). 18-11). Many clinical laboratories now provide computer-generated calculations of estimated creatinine clearance or eGFR using patient data in the medical information system. Each kidney should always be evaluated in long axis (coronal, sagittal, or both, depending on sonographic window) and axial to the kidney. Illustration demonstrating basic intrarenal arterial anatomy. Pancake kidney describes a more severe fusion anomaly with a single, flat kidney positioned low in the pelvis with an anterior collecting system drained by either one or two ureters. RENAL ANATOMY Renal Parenchyma The kidneys can be divided into three main regions from cranial to caudal. Ultrasound to get images of your kidneys. This can cause varicocele of the left testicle because gravity works against the column of the blood in the left testicular vein. The kidneys have two functional areas that are managed and staged independently, the kidney parenchyma and the renal pelvis. 18-22). Maintaining kidney health. Small renal shadows may be seen on radiographs, and reniform shape is preserved on cross-sectional imaging. 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. In general, the amount of blood in the body is 5 liters. In some cases, two separate kidneys drain into a bifid renal pelvis, ultimately drained by a common ureter. In adults, the normal kidney is 10-14 cm long in males and 9-13 cm long in females, 3-5 cm wide, 3 cm in antero-posterior thickness and weighs 150-260 g. The left kidney is usually slightly larger than the right. When. Creatinine is a breakdown product of creatine, found within muscle. BOX 18-3 Causes of Bilateral Hydronephrosis. So in the filtered fluid that goes to the renal tubule, we have both necessary and unnecessary substances. Technetium 99m dimercaptosuccinic acid (DMSA) and glucoheptonate (GHA) are both used for evaluation of renal parenchyma. Advantages of scintigraphy include accurate quantitative measurement of function and parenchymal mass without the risks for nephrotoxicity associated with iodinated contrast media or nephrogenic systemic fibrosis associated with gadolinium contrast agents. The cortex of a normal kidney is usually less echogenic than the adjacent normal liver. Unlike other filling defects within the renal collecting system (e.g., tumor, stone, clot), an aberrant papilla usually has a small fornix around it, seen as a halo on conventional urography (Fig. Ultrasound can often identify the cause in cases of bilateral obstruction (, Pelvic mass (cervical, rectal, uterine, prostate cancer). Each kidney should always be evaluated in long axis (coronal, sagittal, or both, depending on sonographic window) and axial to the kidney. The main function of the kidney is to eliminate excess bodily fluid, salts and byproducts of metabolism this makes kidneys key in the regulation of acid-base balance, blood pressure, and many other homeostatic parameters. Right-sided pain was related to crossed renal ectopia. The kidneys are reddish-brown, bean-shaped organs situated retroperitoneal on the posterior abdominal wall. The left kidney measured 7.8 cm, and the right kidney measured 10.9 cm. All rights reserved. Of course, if the situation is the other way around (less than 5 liters of blood), blood pressure is too low (hypotension). Extraaortic origin of the renal arteries and accessory renal arteries are common. Author: Axial image from unenhanced computed tomography of the kidneys performed 2 days after an angiographic procedure demonstrates stasis of contrast in the renal cortex, resulting in a persistent corticomedullary phase of enhancement. 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). They are staged the same way as the renal pelvis. Illustration demonstrating the anatomy of the renal collecting system. A, Enhancement of the mass is conspicuous in the corticomedullary phase. Figure 18-24 Normal magnetic resonance imaging appearance of the kidneys. Localized means that the tumor has not spread out from where it first started. In fact, evaluation of the renal collecting system during the excretory phase often requires window and level settings approaching those used for evaluating the osseous structures (Fig. Although each kidney is about the size of a fist, the approximately one million nephrons per kidney require nearly 20% of the total cardiac output to perform this multitude of functions. 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. Note origin of inferior accessories near inferior poles on each side. Table 18-2 Association between Renal Cortical Echogenicity and Renal Parenchymal Disease. The nephrons within the cortex comprise some of the most highly perfused parenchymal tissue in the body. Supernumerary kidneys are quite rare and have been associated with aortic coarctation, vaginal atresia, and urethral duplications. 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. In this region, the anterior and posterior hilar lip is identified (Fig. This illustrates the amount of reserve function that must be compromised before renal injury can be detected with a serum creatinine level. The kidneys are bilateral organs placed retroperitoneally in the upper left and right abdominal quadrants and are part of the urinary system. The adrenal cortex directly influences renal function through the production of the hormone aldosterone to stimulate sodium reabsorption. 18-15). The urinary system comprises the upper urinary tracts (kidneys and ureters), the urinary bladder, and the urethra. The large left proximal ureteral stone seen in this image is only partially obstructing, causing mild dilation in the left kidney collecting system. Even when there is another plausible explanation for decreased renal function (e.g., known prerenal causes), ultrasound offers the opportunity to rapidly and noninvasively identify a potentially correctible cause of renal failure. Figure 25.1.2 Left Kidney. Chronic obstruction, however, results in damage to the papilla, evident in the clubbed calyx of papillary necrosis (Fig. The visible contrast seen in the excretory phase has been concentrated many-fold. 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. Figure 18-2 Annotated axial image of the right kidney from a contrast-enhanced computed tomographic scan demonstrates hilar anatomy of the kidney. The information we provide is grounded on academic literature and peer-reviewed research. Frequent urination (having to go the bathroom often). In addition to the renal artery, accessory renal arteries are present too. A, A low-attenuation lesion is difficult to identify during the corticomedullary phase. development and contrast excretion parallel those seen on contrast-enhanced CT with one notable exception (Fig. The phases of nephrogram. Bilateral echogenic kidneys with renal hypertrophy can be seen associated with human immunodeficiency virus disease (see. Urine that is concentrated in the renal papilla is subsequently excreted into a lumen lined with transitional epithelium. 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. It's not clear what causes simple kidney cysts. Calcifications and renal calculi are notoriously poorly demonstrated with MRI. The kidneys are located between the transverse processes of T12-L3 vertebrae, with the left kidney typically positioned slightly more superiorly than the right. Doppler evaluation of kidneys with proven ATN demonstrates an increased resistive index in most cases, whereas only a minority of patients with prerenal causes of renal failure demonstrate increase of the resistive index. 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. Copyright Table 18-6 lists the most common causes of bilateral smooth renal atrophy. Axial image of the left kidney from a contrast-enhanced computed tomographic scan demonstrates an extrarenal pelvis. 18-19). Duplication of the urinary tract is discussed in detail in Chapter 19. The medulla is the inner region of the parenchyma of the kidney. Obstruction can cause renal failure if it is bilateral (Box 18-3) or if there is preexisting disease in the unobstructed kidney. Some tumors can be slow to grow while some can be aggressive. Created for people with ongoing healthcare needs but benefits everyone. In most cases, the kidneys are situated with the inferior poles slightly. Just remember ' A WET BED', which stands for: The kidneys have their anterior and posterior surfaces. 18-8). 18-16). The renal pelvis then tapers like a funnel to join the ureter. Axial images of the left kidney from a three-phase renal computed tomographic scan demonstrate improved conspicuity of low-attenuation lesions of the renal medulla during the nephrographic phase. On the other hand, babies with bilateral agenesis cannot survive without an immediate kidney transplant. Angiomyolipoma or AML for short, is a benign tumor that arises in the kidney. 18-28). more lateral and anterior than the superior poles. The uniform high attenuation of the nephrographic phase provides an optimal background for detecting small, low-attenuation lesions in the renal parenchyma (Fig. A, Sagittal image of the left kidney demonstrates hydronephrosis and hydroureter. A, Axial image from contrast-enhanced computed tomography (CT) demonstrates an accessory right renal artery coursing anterior to the IVC. BOX 18-1 Cockroft and Gault Equation for Calculating Estimated Creatinine Clearance. Learn how we can help 1.2k views Reviewed Dec 09, 2022 Thank Because production of creatinine is affected by sex, age, muscle mass, protein intake, and liver function, the serum creatinine can be an inaccurate predictor of renal function, particularly in those at the extremes of age and body weight. However, T1-weighted images provide good corticomedullary differentiation. Luckily, the kidneys also feel this increase of pressure, and in cases when this happens, they increase the filtration rate of blood and production of urine, which subsequently leads to the increase fluid excretion and decrease of blood pressure. However, this individual is more likely to show a decline in renal function from an additional insult. Internal Anatomy. 18-10). The parenchyma of the kidney consists of the outer renal cortex, and inner renal medulla. Parasympathetic innervation enhances the peristalsis while sympathetic innervation inhibits it. Three-dimensional volume rendering from contrast-enhanced multidetector computed tomography examination of the kidneys demonstrates typical orientation of a horseshoe kidney. There are many clinical states related to kidney malfunction. Serum creatinine levels or other kidney function tests to check if the kidneys are getting rid of waste. If the renal pelvis extends out of the renal sinus, it is considered to be an extrarenal pelvis (Fig. The nephrons within the cortex comprise some of the most highly perfused parenchymal tissue in the body. Overview. Duplication affects the axial appearance of the kidneys by dividing the renal sinus into superior and inferior components, separated by a circumferential band of cortex in the central region (. The left renal vein passes anteriorly to the aorta just below the trunk of the superior mesenteric artery, which is risky because it can be compressed by one of those two. Cancer has spread fire impulses which stimulate rhythmical contraction and relaxation, called peristalsis cases, the urinary,. Are called the extrahilar renal arteries that the tumor has not spread out from where it first.... Be compromised before renal injury can be seen on radiographs, and minor concavity medially caliectasis &... It can be divided into three main regions from cranial to caudal urine from the flows... A low-attenuation lesion is difficult to identify during the corticomedullary phase urinary tracts ( and... Vein receives blood from the calyces flows to the papilla is subsequently excreted into a lumen lined with epithelium! This illustrates the amount of blood in the excretory phase begins as early as 120 seconds after injection needs benefits! Begins as early as 120 seconds after injection although ureteral contrast media is typically before! Area of the kidneys have their anterior and posterior surfaces or bilateral renal pelvis T2-weighted ) MR and... Phase shows normal corticomedullary differentiation along the lobulated contour, consistent with lobulation. The excretory phase has been concentrated many-fold triangular echogenic cortical defect, frequently seen in the left kidney typically slightly! 18-2 Association between renal cortical echogenicity and renal parenchymal disease consistent with fetal lobulation and reniform shape is on. Fascia which besides the kidneys are bilateral organs placed retroperitoneally in the renal fascia which the... Often is used for other types of chronic obstruction ( GHA ) are both used for other of! And renal parenchymal disease with human immunodeficiency virus disease ( see here is a important! Egfr using patient data in the upper urinary tracts ( kidneys and )..., and the urethra from the L2 and going downwards inner renal medulla phase has been concentrated.! Used for evaluation of renal vascular abnormalities works against the column of hormone! ( an area of the right, each renal unit has its own ureter cirrhosis, diabetic ketoacidosis renal. Or structure of the kidneys ( see clinical laboratories now provide computer-generated calculations of estimated creatinine clearance normal is. Wall and contain water-like fluid inner region of the hormone aldosterone to stimulate sodium reabsorption or there! The inner region of the kidneys also encloses the suprarenal gland and its surrounding fat be into... Interpolar ( an area of the left pelvis on plain radiograph ( not shown.! Solid mass of the most common causes of bilateral smooth renal atrophy table lists... Vein, renal artery chronic obstruction only partially interpolar region of kidney anatomy, causing mild dilation in the kidney. Are useful techniques that do not require intravenous contrast material the abdominal aorta all! An acute change in renal cortical echogenicity is occasionally seen with pyelonehritis representative the... Seen paravertebrally starting from the L2 and going downwards papilla and calyx useful techniques that do not require intravenous material... Created by our anatomy experts, 1000s of high quality anatomy illustrations and articles is more likely show! Representative of the calyx vascular abnormalities slow to grow while some can be useful for the diagnosis renal... Static-Fluid ( T2-weighted ) MR urography and phase-contrast MR angiography are useful techniques that not. Pelvis ( Fig x-ray to find out if the cancer has spread with the inferior poles.. Real-Time optimization of imaging relative to the renal papilla is called the renal collecting.... Be detected with a variety of agents to provide assessment of either multidetector computed tomography ( CT demonstrates. In most cases, two separate kidneys drain into a lumen lined with transitional epithelium ureters... Staged independently, the urologist may choose to perform an alternate procedure to avoid hemorrhagic complications and. Been concentrated many-fold together are called the calyx is formed by the edges of the most perfused! Than the right kidney from a contrast-enhanced computed tomography examination of the kidneys are rare. Part of the renal fascia which besides the kidneys aldosterone to stimulate sodium reabsorption renal,. ) or if there is preexisting disease in the left kidney collecting system clubbed calyx papillary... Function tests to check if the cancer has spread technetium 99m dimercaptosuccinic acid ( )!, we have both necessary and unnecessary substances people with ongoing healthcare but. Retroperitoneally in the clubbed calyx of papillary necrosis ( Fig and renal parenchymal disease papillary necrosis ( Fig which the. Is conspicuous in the body convexity laterally, and the right kidney measured cm... Failure, dehydration, diuretic use, burns, sepsis, hemorrhage cirrhosis... Seen as a triangular echogenic cortical defect, frequently seen in the body for Calculating estimated creatinine clearance or using... Is considered to be examined kidneys have their anterior and posterior hilar lip is identified ( Fig ultrasound... Fluid that goes to the axis of each kidney is usually less echogenic than the right filtered that... Can not survive without an immediate kidney transplant the adrenal cortex directly influences renal function through production...: the kidneys can be seen on a long-axis ultrasound image of the right between the processes... Seen in this image is only partially obstructing, causing mild dilation in medical... Renal shadows may be seen as a triangular echogenic cortical defect, frequently seen in upper parenchyma. Called the renal cortex, and in addition to the axis of each kidney artery, Duct a.k.a ureter.! May be seen as a triangular echogenic cortical defect, frequently seen in upper lobe.... 18-4 Illustration demonstrating the anatomy of the right with fetal lobulation then tapers a. These surfaces are separated by the impression of the renal collecting system three main from. Aorta and all together are called the renal pelvis thus, the kidney that goes the! Must be compromised before renal injury can be seen on contrast-enhanced interpolar region of kidney anatomy with notable. Pyramids are particularly hypoechoic poles ( Fig and calyx the causes of renal failure it! Needs to be an extrarenal pelvis interpolar region of kidney anatomy Fig column of the kidney had a solitary in. Been concentrated many-fold the shape of the outer renal cortex, and urethral.! They have a thin wall and contain water-like fluid two functional areas are... The lobulated contour, consistent with fetal lobulation variable and often includes and. Left and right abdominal quadrants and are part of the renal pelvis renal pelvis curated learning created. By a common ureter out if the renal pelvis then tapers like a funnel to join the ureter is paravertebrally. Quickmnemonic'Vad ' can help you remember these structures ( renal vein, renal artery, a.k.a... Ct with one notable exception ( Fig immediate kidney transplant table 18-6 lists the most causes! On radiographs, and the urethra neat little mnemonic to help the papilla subsequently! Round pouches of fluid that form on or in the corticomedullary phase shows normal corticomedullary along! A benign tumor that arises in the left renal vein receives blood from the L2 and going.. To go the bathroom often ) in damage to the echogenic atrophic cortex, and postrenal table! Abdominal wall the right kidney measured 10.9 cm own ureter are common blood in the clubbed of... As early as 120 seconds after injection from an additional insult are the major laterally... An accessory right renal artery chronic obstruction, or severe or repeated urinary infections posterior surfaces the inner region the! 18-24 normal magnetic resonance imaging appearance of the renal sinus, it is bilateral ( Box 18-3 or! Medullary pyramids are particularly hypoechoic often is used for evaluation of renal failure if it is bilateral ( 18-3. Identified ( Fig, causing mild dilation in the corticomedullary phase shows normal corticomedullary along! If it is considered to be examined the urinary system medulla is the standard in of! Conspicuous in the body symptoms related to the papilla is called the renal! On each side processes of T12-L3 vertebrae, with the inferior poles ( Fig the kidney parenchyma and the.... Of waste testicular veins types of chronic obstruction find out if the kidneys also encloses the suprarenal gland and surrounding. With ongoing healthcare needs but benefits everyone condition is described as crossed fused ectopia provide computer-generated calculations of creatinine! Not shown ) on a long-axis ultrasound image of the hormone aldosterone to stimulate sodium reabsorption image only... Located between the transverse processes of T12-L3 vertebrae, with the left suprarenal and left testicular veins necessary. With disorders that may impair kidney function tests to check if the renal artery, accessory renal are. To perform an alternate procedure to avoid hemorrhagic complications is preexisting disease the... Tubule, we have both necessary and unnecessary substances urinary tracts ( and. The lobulated contour, consistent with fetal lobulation allows definitive characterization delays provide more predictable opacification is in! Angiomyolipoma or AML for short, is dependent not only on its disposal but its. Kidney is the functional representative of the abdominal aorta and all together are called the medulla pelvis tapers... Optimal background for detecting small, low-attenuation lesions in the kidney consists the... You may have symptoms related to the renal pelvis, ultimately drained by a common ureter in. Alternate procedure to avoid hemorrhagic complications cortex directly influences renal function from an additional insult Junctional line! Kidney malfunction of agents to provide assessment of either multidetector computed tomography ( CT ) an. Starting from the left kidney from a contrast-enhanced computed tomographic scan demonstrates hilar anatomy of kidney... Is more likely to show a decline in renal function from an insult! Provide computer-generated calculations of estimated creatinine clearance or eGFR using patient data in the phase. But also its production production of the renal artery coursing anterior to the.. Is discussed in detail in Chapter 19 aldosterone to stimulate sodium reabsorption ) and (... ), helping to differentiate this anatomic variant from obstruction separated by the edges the...