Download cross-sectional-anatomy

 Retroperitoneal
 Left
higher than the right (Liver on the rt)
 Ascends during embryology from the
lower abdomen.
 Pelvic kidney?
 Back pain? Could be your kidney!
 ADULT
• 9.0 to 12.0 cm in length.
• 4.0 to 5.0 cm in width.
• 2.5 to 3.0 cm in height.
• Minimum of 1 cm in cortical thickness.
 CHILD
• 7.0 to 8.0 cm in length.
 INFANT
• 5.0 to 6.0 cm in length.
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Increase in creatinine or BUN levels.
Urinary tract infection.
Flank pain.
Hematuria.
Hypertension.
Decrease in urine output.
Trauma.
Evaluate mass from previous medical
imaging study (i.e., CT, MRI, IVP)
LABORATORY VALUES
 CREATININE
Normal 0.6 to 1.2 mg/dL.
A waste product produced from meat protein and
normal wear and tear on the muscles in the body.
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More specific in determining renal dysfunction than
BUN levels.
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Elevated in renal failure, chronic nephritis or urinary
obstruction.
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BLOOD UREA NITROGEN
Normal 11 to 23 mg/dL.
Produced from the breakdown of food proteins.
Elevated in urinary obstruction, renal dysfunction, or
dehydration.
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Decreased levels associated with over hydration,
pregnancy, liver failure, decrease in protein intake, and
smoking.
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 HEMATURIA
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Visible or microscopic
red blood cells in
the urine.
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Associated with early renal disease.
 PROTEINURIA
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Abnormal amount of proteins in the
urine.
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Associated with nephritis,
nephrolithiasis, carcinoma, polycystic
disease, hypertension, and diabetes
mellitus.
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Increases risk of developing progressive
renal dysfunction.
 Dromedary
hump cortical bulge on
the lateral aspect of the kidney.
 fascia fibrous connective membrane
of the body that may be separate from
other structures.
 Fetal lobulation immaturity of renal
development resulting in a lobulated
renal contour.
 Gerota’s fascia protective covering of
tissue surrounding each kidney.
 Renal
parenchyma the functional
tissue of the kidney consisting of the
nephrons.
 Renin renal enzyme that affects
blood pressure.
FUNCTIONS OF THE URINARY SYSTEM
Produces urine and erythroprotein.
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Influences blood pressure, blood
volume, and intake or excretion of salt
and water through the renin–angiotensin
system.
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Regulates serum electrolytes.
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Regulates acid–base balance.
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TECHNIQUE
PREPARATION
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Kidneys—patient should be hydrated.
Renal vessels—nothing by mouth for 6 to 8
hours before the examination.
Bladder—drink 8 to 16 ounces of water 1
hour before the examination.
 Use
the highest-frequency abdominal
transducer possible to obtain optimal
resolution for penetration depth.
 Place gain settings to display the normal
adult renal cortex as moderate or lowlevel echogenicity and the renal sinus as
the most echogenic with adjustments to
reduce echoes within the vessels.
 Position
the focal zone(s) at or below the
region of interest.
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Sufficient imaging depth to visualize
structures posterior to the region of interest.
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Harmonic imaging and decreasing the
compression (dynamic range) can be used
to reduce artifactual echoes within anechoic
structures and improve prominence of
posterior acoustic shadowing.
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Evaluation and documentation of the
superior, inferior, medial, and lateral
aspects of each kidney in the coronal or
sagittal plane.
 Evaluation
and documentation of the
superior pole, renal hilum, and inferior
pole of each kidney in the transverse
plane.
 Measurements
of maximum length,
thickness, and width of each kidney.
 Measurement of the cortical thickness of
each kidney.
 Evaluation
and documentation of the
bladder wall.
 Prevoid and postvoid bladder volumes
may be included.
 Kidneys are best evaluated with an
empty urinary bladder.
 Documentation and measurement of any
abnormality in two scanning planes
should be included.
 Supine
 Right
superior pole with intercostal
approach
 Right inferior pole with subcostal
approach
 Left
posterior oblique (LPO)
 Allows bowel to move away from right
kidney
 Subcostal or intercostal approach
Left lateral decubitus
 Liver and kidney “fall” from the rib cage
 Aids in obese or gassy patients
Right posterior oblique (RPO)
 Left superior pole with intercostal
approach
 Posterior subcostal approach for left
inferior pole
Right lateral decubitus
 Left posterior approach with deep
inspiration
Prone
 Demonstrates mid and inferior poles of
both kidneys
PHYSIOLOGY
The nephron is the basic functional unit of
the kidney.
• Each kidney contains over one million
nephrons.
•
 ANATOMY
 Renal
capsule
 Fibrous capsule (true capsule)
surrounding the cortex
 Renal
cortex
 Outer portion of the kidney
Medulla
 Inner portion of the renal parenchyma
 Within the medulla lie the renal pyramids
 Renal pyramids contain tubules and the
loops of Henle
Column of Bertin
 Inward extension of the renal cortex
between the renal pyramids
 Renal sinus
 Central portion of the kidney
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Contains the major and minor calyces,
peripelvic fat, fibrous tissues, arteries, veins,
lymphatics, and part of the renal pelvis
 Renal hilum
 Contains the renal artery, renal vein, and
ureter
 Paired
bean-shaped structures lying in a
sagittal oblique plane in the
retroperitoneal cavity.
 Located between the first and third
lumbar vertebrae.
 Superior poles lie more posterior and
medial.
 Inferior poles lie more anterior and
lateral.
 Left kidney lies superior to the right
 Each
Kidney Is Located
 Anterior to the psoas and quadratus
lumborum muscles.
 Medial to the transverse abdominus
muscle and liver or spleen.
 Lateral to the quadratus lumborum
muscle.
 Renal
Anatomical Variants
 Dromedary
hump
 Cortical bulge on the lateral aspect of
the kidney
 Demonstrated most often on the left
 Asymptomatic
Lateral outward cortical
bulge

Echogenicity equal to the cortex
Carcinoma?

Hematoma?
 Congenital
Anomalies
 Agenesis
 Absence
of the kidney(s)
 Unilateral
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or bilateral
Asymptomatic when unilateral
Fatal when bilateral
Associated with genital anomalies
Empty renal fossa(e)
Large, contralateral kidney
Pelvic kidney?
Surgical removal?
 Horseshoe
kidney
MAIN RENAL ARTERY
 The right renal artery arises from the
anterolateral aspect of the aorta. The
left renal artery arises from the
posterolateral aspect of the aorta.

May have multiple ipsilateral arteries
A
single ipsilateral artery may divide into
multiple renal arteries at the hilum
 Courses posterior to the renal vein
 Main renal artery arises 1.0-1.5 cm
inferior to the origin of the superior
mesenteric artery
 Right renal artery is longer than the left renal artery
 Demonstrates
low-resistance blood flow
 Supplies the kidney, ureter, and adrenal
gland
 Segmental artery
 After entering the renal hilum the
artery divides into 4-5 segmental
arteries
 Demonstrates low-resistance blood flow
 Interlobar
artery
 Branch of the segmental artery
 Course alongside the renal pyramids
 Demonstrates low-resistance blood flow
 Renal Vasculature—
 Arcuate
artery
 Boundary between the cortex and
medulla
 Branch of the interlobar artery located at
the base of the medulla
 Arcuate arteries give rise to the interlobular
arteries
 Demonstrates low-resistance blood flow

Interlobular artery
 Branch of the arcuate arteries entering
the renal glomeruli
 MAIN
RENAL VEIN
 Formed from the junction of
tributaries in the renal hilum
 Courses anterior to the renal artery
 Left renal vein receives the left
suprarenal and left gonadal vein
 Left renal vein is longer than the right renal vein
 Dilatation of the left renal vein due
mesenteric compression may be
demonstrated
to
 Ureter
Anatomy
 25 – 34 cm long tubular structure
connecting the renal pelvis to the urinary
bladder.
 Coarse vertically with retroperitoneum
along the psoas muscles.
 Insert posterior and inferiorly at the
Trigone of the bladder.
 Distal ureter at the trigone considered
extraperitoneal.
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Support Structure of the Kidneys
Psoas muscle
Major groin muscle
Primary flexor of the hip joint
Lies posterior to the inferior pole of each kidney
Quadratus lumborum muscle
Muscle of the posterior abdominal wall
Lies posterior and medial to each kidney
Transversus abdominus muscle
Deepest layer of flat muscles of the anterolateral wall
Lies lateral to each kidney
Gerota’s fascia
Fibrous covering of tissue surrounding each kidney
Also known as Gerota’s capsule; renal fascia
Perinephric fat
Fatty tissue surrounding each kidney
Renal capsule
Protective connective tissue capsule surrounding each
kidney
Right Kidney
• Sagittal
Mid-Med and Lateral Borders
Measure upper pole to lower pole
• Doppler Right Renal artery-Nml is low resistant
Transverse
Mid pole-Measure side to side
Upper pole to lower pole
Doppler IVC to check for thrombus
 Left
Kidney
• Sagittal
• Mid-Med Lateral
 Measure Upper pole to lower pole
 Transverse
 Measure mid pole (Lateral side to Medial Side)
 Upper pole to lower pole
 OTHER
 Check bladder
 Locate
the following on a cartoon and an
ultrasound image:
• Renal Sinus
• Column of Bertin
• Psoas muscle
• Renal Hilum
• Perinephric fat
• Segmental artery
• Interlobar artery
• Main Renal Artery
• Main Renal Vein
 The
kidneys are retroperitoneal.
 Right
higher than the left.
 Descends
during embryology from the
upper abdomen.
 A. increase
in creatinine
 B. Decrease in BUN levels
 C. Flank Pain.
 D. Hematuria
 The
protective covering of tissue
surrounding each kidney is called:
 A. parenchyma
 B. Renal cortex
 C. Gerota’s fascia