Anatomy – Vascular
Location and External Anatomy of Kidneys
Lateral to ……… vertebrae ?
T12 to L 3
– 12 cm tall, 6 cm wide, 3 cm
– On concave surface
– Vessels and nerves enter
• Renal capsule surrounds the
Anatomy of the kidneys
• Superficial outer cortex and inner medulla
– The medulla consists of 6-18 renal pyramids
– The cortex is composed of roughly 1.25 million nephrons
• Major and minor calyces along with the pelvis drain urine to
The kidneys are surrounded by three layers
The renal fascia is a thin, outer layer of
fibrous connective tissue that surrounds
each kidney (and the attached adrenal
gland) and fastens it to surrounding
The adipose capsule is a middle layer of
adipose (fat) tissue that cushions the
The renal capsule is an inner fibrous
membrane that prevents the entrance of
Functions of the urinary system
• Homeostatic regulation of blood plasma
Regulating blood volume and pressure
Regulating plasma ion concentrations
Stabilizing blood pH
• Filter many liters of fluid from blood
• Excretion - The removal of organic waste products
from body fluids
– Uric acid
• Elimination - The discharge of waste products into
The urinary system helps maintain
homeostasis by regulating water
balance and by removing harmful
substances from the blood.
The blood is filtered by two
kidneys, which produce urine, a
fluid containing toxic substances
and waste products.
From each kidney, the urine flows
through a tube, the ureter, to the
urinary bladder, where it is stored
until it is expelled from the body
through another tube, the
Ureters :Pair of narrow thick muscular tube.
Kidney to the urinary bladder.
They lie deep of peritonium.
Length – 25 cm , 3 mm diameter.
Urinary bladder:Muscular reservoir , lies anterior part of
Capacity of bladder is ……… ?
Urethra :It is the passage through which urine is
expelled out from the urinary bladder.
Mechanisms of Urine Production
• Filtration - filtrate of
blood leaves kidney
• Reabsorption – most
nutrients, water, and
essential ions reclaimed
• Secretion - active process
of removing undesirable
Disease of Kidney Conditions
Kidney stones :(nephrolithiasis): Minerals in urine form crystals (stones), which may grow large
enough to block urine flow. It's considered one of the most painful conditions.
Most kidney stones pass on their own but some are too large and need to be
• Polycystic kidney
disease :- A genetic
condition resulting in
large cysts in both
kidneys that impair
• Kidney cancer:- Renal cell
carcinoma is the most
common cancer affecting
the kidney. Smoking is the
most common cause of
Acute renal failure (kidney failure): A sudden
worsening in kidney function. Dehydration, a
blockage in the urinary tract, or kidney damage
can cause acute renal failure, which is usually
Chronic renal failure:- A permanent partial loss
of kidney function. Diabetes and high blood
pressure are the most common causes.
Renal cyst :- A benign hollowed-out space in
the kidney. Isolated kidney cysts occur in many
normal people and almost never impair kidney
• Urinalysis :- A routine test of the urine by a machine
looking through a microscope. Urinalysis can help detect
infections, inflammation, microscopic bleeding, and kidney
An endoscope (flexible tube with a camera on
its end) is passed through the urethra into the
bladder and ureters.
X-Ray- KUB , IVP
CT and MRI
Antibiotics :- Treatment giving with antibiotic medicine
Lithotripsy :- …..?
kidney stones may be shattered into small pieces done by a machine
that projects ultrasound shock waves through the body.
Hemodialysis :- A person with complete kidney failure is connected to
a dialysis machine, which filters the blood and returns it to the body.
typically done three days per week in people with ESRD. ?
Kidney transplanting :- Transplanting a kidney into a person with ESRD
can restore kidney function. A kidney may be transplanted from a living
donor, or a recently deceased organ donor.
Contrast administration…. PATIENT PREPARATION Need C.T. SCAN
Blood urea and Creatinine … ?
History of allergies to drugs
Previous reactions to contrast
• Renal failure or cardiac problems
• Pregnancy or breast feeding
• Diabetes Patients:Stopping Metformin ….?
If the patient is diabetic it is
important to establish if they are
patients are at risk of lactic acidosis
following the administration of the
IV contrast media. Renal function
should be assessed prior to the
injection and the following steps
Time Calculating ……?
• Phase One is completed without contrast
and is the KUB portion of this exam
assessing for stone disease
• Phase Two is the arterial phase scanning
through the kidney with contrast,
identifying hypervascular lesions
• Phase Three is the portal venous phase,
allowing further characterization
of enhancement kinetics of any lesion
• Phase Four is a delayed scan through the
kidneys, ureter, and bladder when the
collecting systems and bladder will be
Bolus Tracking Protocol for C T Kidney
CTA Renal Arteries :23 sec – 4cc / sec
Locator – just above the kidney
ROI – Descending Aort
Tips to remember
lab pls request Bun and Creatinin
Diabetic patient give correct instruction
Time Calculating for contrast protocol
Educate the patient about Kidney awarness