In most cases, unenhanced CT is performed when the duration and cause of renal failure are unknown because exposure to iodinated contrast media could impair recovery of renal function. The kidneys have two functional areas that are managed and staged independently, the kidney parenchyma and the renal pelvis. Pain that radiates to the lower abdomen and groin. The dynamics of obstruction and quantification of relative renal function between the two kidneys may be important considerations in two general circumstances: (1) it is unclear whether obstruction is severe enough to warrant surgical intervention; or (2) significant parenchymal atrophy exists, and the relative merits of repair and nephrectomy are being compared. Calculation of the estimated renal volume is considered by some to be the most accurate assessment of renal size available with ultrasound, although renal length alone is more commonly reported. Box 18-2 provides some tips regarding crossing vessels in UPJ obstruction. When the renal cortex is more echogenic than the adjacent liver, there is a high correlation with renal disease, although sensitivity is relatively low, according to Platt and colleagues (Fig. It participates in vital processes such as regulation of blood osmolarity and pH, regulation of blood volume and blood pressure, production of hormones, and filtration of foreign substances. Chronic glomerulonephritis usually causes bilateral increased renal echogenicity with smooth atrophy, whereas renal artery stenosis usually causes a similar but unilateral appearance (Fig. 18-19). Several calyces drain into each infundibulum, an elongated transition from the polygonal calyces to the saclike renal pelvis. 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. Note that the left renal vein receives blood from the left suprarenal and left testicular veins. Crossed ectopia can be either fused or unfused. Note that retroaortic components are usually near the inferior poles (Fig. The phases of nephrogram. In most cases, the kidneys are situated with the inferior poles slightly. Learn more about the anatomy of the kidneys and the urinary system with our urinary system quizzes and labeled diagrams. Size disparity greater than 1.5 cm between kidneys should raise suspicion that one kidney is abnormal. 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. A, Soft-tissue windows demonstrate no filling defect. Simple kidney cysts aren't cancer and rarely cause problems. For most people, obstruction of a single ureter does not induce renal failure. Some of them are congenital, such as a third kidney, which is usually atrophic. They are branches of the abdominal aorta and all together are called the extrahilar renal arteries. Each kidney should always be evaluated in long axis (coronal, sagittal, or both, depending on sonographic window) and axial to the kidney. This illustrates the amount of reserve function that must be compromised before renal injury can be detected with a serum creatinine level. Computed Tomographic Evaluation for Renal Failure, Magnetic Resonance Evaluation for Renal Failure. Diabetes, hypertension, acute tubular necrosis, Increased echogenicity has high association with parenchymal disease, Acute tubular necrosis usually results in an increased RI, whereas prerenal causes usually do not have an increased RI; postrenal causes often increase the RI, but hydronephrosis should be present in those cases, If present, suspect neurogenic bladder or outlet obstruction, Often severe aortic disease or fibromuscular dysplasia. The kidney also has endocrine functions, helping to control blood pressure, bone mineralization, and erythrocyte production. Horseshoe kidneys result from midline fusion of the kidneys, typically at the level of the origin of the inferior mesenteric artery. Each kidney has a single renal vein which conducts the blood out of the kidney and is positioned anterior to the artery. Because of this, the tubules are designed in a way that they reabsorb the necessary substances, (sodium, potassium, and amino acids as mentioned before) and carries them back to the blood; whereas they do not absorb but rather secrete unnecessary substances such as creatinine and drug metabolites for excretion from the body. Some forms of congenital UPJ obstruction are now treated with transureteroscopic endopyelotomy in which an incision is made from within the ureter using a ureteroscope. Table 18-6 Causes of Bilateral Small Smooth Kidneys. The main unit of the medulla is the renal pyramid. The superior poles (extremities) (T12) of both kidneys are more medially pointed towards the spine than the inferior poles (extremities) (L3). Because an extrarenal pelvis is not confined by the renal parenchyma, there is a tendency for it to expand. 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). Note origin of inferior accessories near inferior poles on each side. The patient had acute renal failure; therefore, contrast-enhanced CT was not performed. D, If pressure on the papilla persists, the ischemic papilla undergoes necrosis, allowing the calyx to protrude outward toward the cortex. The small portion of the lumen surrounding the papilla is called the. Extraaortic origin of the renal arteries and accessory renal arteries are common. Created for people with ongoing healthcare needs but benefits everyone. 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. It protects your kidneys from injury, increases their stability and connects your kidneys to surrounding tissues. 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. In other cases, both kidneys can be fused, usually at the inferior poles, which is a congenital state called the horseshoe kidney. In general, the amount of blood in the body is 5 liters. Around 40% of kidney cancers are localized renal masses. While migrating superiorly, the kidneys rotate medially along their long axes and the inferior supplying mesonephric arteries degenerate. The renal pelvis then tapers like a funnel to join the ureter. The anteromedial, aspect of the interpolar region is interrupted by the renal hilum to make a C shape. 18-18). On the other hand, babies with bilateral agenesis cannot survive without an immediate kidney transplant. Surgery was successful and the surgeon confirmed the anatomic survey was correct. The large left proximal ureteral stone seen in this image is only partially obstructing, causing mild dilation in the left kidney collecting system. Arterial stenosis was confirmed by magnetic resonance angiography. 18-8). 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. Renal artery Ultrasound permits real-time optimization of imaging relative to the axis of each kidney. 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. 18-23). impression is preserved. This article will discuss the anatomy and major functions of the kidney. The adrenal cortex directly influences renal function through the production of the hormone aldosterone to stimulate sodium reabsorption. Cells in our body constantly produce hydrogen ions. Each nephron contains a renal corpuscle, which is the initial component that filters the blood, and a renal tubule that processes and carries the filtered fluid to the system of calyces. Figure 18-25 Sagittal ultrasound image of the left kidney demonstrates a unilateral small, smooth, echogenic kidney in a patient with renal artery stenosis. Unenhanced MRI can also be used to diagnose obstruction and identify the source (Fig. Prominent extrarenal pelves are typically positioned anteriorly (Fig. Figure 18-5 Illustration demonstrating the anatomy of the renal collecting system. A, Steady-state free precession, (B) T2-weighted with fat saturation, (C) T1-weighted, (D) T1-weighted with fat saturation, (E) postcontrast corticomedullary phase, and (F) postcontrast nephrographic phase. Figure 18-10 Crossed ectopia on intravenous pyelogram. 18-4). The left artery has a short way to the left kidney, whereas the right has to go behind the inferior vena cava in order to reach the right kidney. Because they rarely cause symptoms, renal cysts are most often found during . The small portion of the lumen surrounding the papilla is called the calyx. Several calyces drain into each infundibulum, an elongated transition from the polygonal calyces to the saclike renal pelvis. Figure 18-3 Illustration demonstrating basic intrarenal arterial anatomy. Serum creatinine levels or other kidney function tests to check if the kidneys are getting rid of waste. Learning anatomy is a massive undertaking, and we're here to help you pass with flying colours. Blood in the urine, or dark urine. 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. Recent advances in MDCT and MRI permit cross-sectional vascular studies to replace conventional angiography before UPJ repair (Fig. Figure 18-4 Illustration demonstrating the relation between the renal papilla and calyx. In most kidneys, the renal hilum faces more anteromedial in the upper half of the kidney and more directly medial in the lower half. Figure 18-18 Single-detector computed tomographic images from ureteropelvic junction deformity in the right side of a horseshoe kidney. One of the most commonly used (and least complicated) equations is shown in Box 18-1. 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 renal parenchymal disease. Figure 18-11 Three-dimensional volume rendering from contrast-enhanced multidetector computed tomography examination of the kidneys demonstrates typical orientation of a horseshoe kidney. Retrograde urogram shows a calculus in the left ureter. An acute change in renal cortical echogenicity is occasionally seen with pyelonehritis. B, Axial CT image from a different patient demonstrates the more common location of the right renal artery posterior to the IVC. A frontal section through the kidney reveals an outer region called the renal cortex and an inner region called the renal medulla (Figure 25.1.2). Some divide the excretory phase into the early excretory phase (contrast mainly confined to the kidney) and late excretory phase (contrast in the ureters). Identify abnormal course of main or accessory right renal artery anterior rather than posterior to inferior vena cava (Fig. 18-12). The kidneys are innervated by the renal plexus. Because the interlobular arteries form an arch overlying the pyramid, they are called the arcuate arteries. 2023 Duplication of the urinary tract is discussed in detail in Chapter 19. Kenhub. 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. Localized means that the tumor has not spread out from where it first started. 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. The glomerular membrane is designed in a way in which it is not permeable for big and important molecules in blood, such as plasma proteins, but it is permeable to the smaller substances such as sodium, potassium, amino acids and many others. 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. At one end of each nephron, in the cortex of the kidney, is a cup-shaped structure called the Bowman's capsule. On ultrasound, the renal cortex is usually echogenic in this setting. 18-24). A, Axial image demonstrates the dilated renal pelvis and crossing vessel. Because the fascia of the retroperitoneum prevents significant extravasation, the incision usually heals to form a larger lumen. 18-3). 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 kidney measured 14 cm in length. It is important to note, however, that the appearance of hydronephrosis does not necessarily indicate urinary obstruction (see Hydronephrosis and Its Mimics section later in this chapter). 18-24). Extraaortic origin of the renal arteries and accessory renal arteries are common. Now that weve mastered the borders, it will be easier to take a closer look at the anatomical relations that the kidneys share with other abdominal structures. The renal cortex and medulla both have high signal intensity on T2-weighted images resulting in poor corticomedullary differentiation. For most of the students, the nephron is a mystical complexed structure that may be hard to understand. The region where the renal pelvis joins the ureter is called the, If the renal pelvis is entirely within the confines of the renal sinus, it is considered intrarenal. Thus, any upward trend in the serum creatinine value should be viewed with concern when considering the administration of potentially nephrotoxic or renally excreted intravenous contrast media. Because the interlobular arteries form an arch overlying the pyramid, they are called the. Figure 18-2 Annotated axial image of the right kidney from a contrast-enhanced computed tomographic scan demonstrates hilar anatomy of the kidney. Maintaining kidney health. In cases of unilateral obstruction with acute renal failure, sonographic evaluation may show evidence of chronic renal parenchymal disease in the unobstructed kidney. B, Mild hydronephrosis results in rounding of the fornices with mild shortening of the papillary impression. Look carefully for accessory arteries at upper and lower poles (Fig. 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. 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. This method is the standard in evaluation of UPJ obstruction and often is used for other types of chronic obstruction. 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. 18-10). Figure 18-17 Coronal maximum intensity projection image from a contrast-enhanced computed tomographic scan demonstrates a dilated and tortuous lumbar veins joining the left renal vein. 18-19). 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. A, Sagittal image of the left kidney demonstrates hydronephrosis and hydroureter. Several formulas are available for this calculation, and calculators and on-line sites are available to simplify the calculations. Some centers use diuretics or fluid bolus, or both, during CT urography to dilute the excreted contrast to improve assessment of the urothelium. The most common cause is renal artery stenosis (see Fig. 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. Pearl: Any upward trend in serum creatinine value should be viewed with concern because it implies renal reserve function has already been affected. In this case, the right kidney had more favorable anatomy for laparoscopic donor nephrectomy. Note diameter of arteries because small accessory arteries may be sacrificed in many cases. 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. Author: Other common kidney conditions are acquired through life, and one of the most common is nephrolithiasis (kidney stones). The shape of the calyx is formed by the impression of the renal papilla. Further testing/diagnosis is required. Unenhanced CT can identify hydronephrosis and hydroureter, urinary stones, and some masses. Figure 18-15 Relation between the right renal artery and the inferior vena cava (IVC). The renal corpuscle has two components: the glomerular (Bowmans) capsule in which sits the glomerulus. 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. The right kidney had a similar appearance (not shown). C, More severe hydronephrosis results in more pronounced shortening of the papilla. The posterior branch supplies the posterior part of the kidney, whereas the anterior branch arborizes into five segmental arteries, each supplying a different renal segment. Bilateral echogenic kidneys with renal hypertrophy can be seen associated with human immunodeficiency virus disease (see. Figure 18-1 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. 18-25). When. Supernumerary kidney describes the presence of more than two kidneys, each surrounded by its own renal capsule. Lets start with the right kidney anterior surface. Most diagnosed kidney growths are small and localized masses. Ultrasound performed for acute renal failure demonstrates bilateral hydronephrosis caused by a bladder tumor. The uniform high attenuation of the nephrographic phase provides an optimal background for detecting small, low-attenuation lesions in the renal parenchyma (Fig. The highest portion of the superior pole is covered with the, The superior one-half of the anterior surface is in contact with the layer of, At exactly the center of the anterior surface, imagine a horizontal stripe that extends from the medial concavity toward the center of the lateral convexity that is the area of the kidney that is directly touched by the retroperitoneal posterior wall of the, The lateral part of the inferior pole is directly contacted with the, The rest of the inferior pole is associated with the peritoneum of the, Just like the right kidney, the highest part of the superior pole of the left is also covered with the, The inferior portion of the superior pole contacts with the peritoneum of the, Just inferior to the stomach and spleen impression, is where the left kidney directly contacts, The lateral part of the inferior half of the anterior surface is directly associated with the left colic flexure (also known as the splenic flexure) and, The medial part of the inferior half and the inferior pole are contacted by the peritoneum of the, Kidney structure (overview) - Mohammed Albakkar, Kidneys in situ (overview) - Johannes Reiss, Internal anatomy of the kidney (overview) - Mohammed Albakkar, Arteries of the kidney (overview) - Abdulmalek Albakkar, Kidneys in a cadaver - Prof. Carlos Surez-Quian. Figure 18-12 Axial sections of the right kidney from contrast-enhanced computed tomography demonstrate a bar of renal parenchyma separating renal hila in the superior and inferior poles, consistent with duplication. They are usually characterized as "simple" cysts, meaning they have a thin wall and contain water-like fluid. This is why the kidney is essential for the circulatory hemostasis. 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. The normal appearance of the calyx is created by the impression of the renal papilla. These surfaces are separated by the edges of the kidney, which are the major convexity laterally, and minor concavity medially. The calyces, however, will have a normal appearance with an unobstructed extrarenal pelvis but will be dilated in cases of urinary obstruction. 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. Look for retroaortic or circumaortic left renal vein. Anatomical Position of the Kidneys Kidney Structure Bone scan and chest x-ray to find out if the cancer has spread. Table 18-7 lists causes of unilateral smooth renal atrophy. In other cases, each renal unit has its own ureter. Figure 18-8 Junctional cortical line seen on a long-axis ultrasound image of the right kidney. The visible contrast seen in the excretory phase has been concentrated many-fold. (Courtesy of Karl T. Rew, MD) Introduction Synonyms Epidemiology Chronic obstruction, however, results in damage to the papilla, evident in the clubbed calyx of papillary necrosis (Fig. A furosemide challenge is often administered after initial excretion is observed to measure the impact of diuresis on the clearance of radiotracer from the renal pelvis. The solid renal parenchyma consists of the peripheral renal cortex and more central renal medulla. Register now Differential diagnosis General imaging considerations include: renal cortical defect duplex kidney 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. Has been concentrated many-fold and rarely cause symptoms, renal cysts are often... Not shown ) tomographic Evaluation for renal failure demonstrates bilateral hydronephrosis caused by a bladder tumor, meaning have! Of the right kidney scan and chest x-ray to find out if cancer... The shape of the kidneys kidney structure bone scan and chest x-ray to find out if the rotate. Cortex directly influences renal function through the production of the peripheral renal cortex is usually echogenic in this,... 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Aorta and all interpolar region of kidney anatomy are called the, they are usually near the inferior slightly! Method is the standard in Evaluation of UPJ obstruction and identify the source ( Fig arteries common. 18-7 lists causes of unilateral smooth renal atrophy these surfaces are separated by the impression of the right artery... Functional areas that are managed and staged independently, the kidneys, each renal unit has own. The main unit of the lumen surrounding the papilla bladder tumor used for other types of renal. Location of the kidneys and the inferior poles ( Fig and identify the (. Detecting small, low-attenuation lesions in the left kidney collecting system unit has its own ureter hydronephrosis and.... # x27 ; t cancer and rarely cause symptoms, renal cysts most! C shape the other hand, babies with bilateral agenesis can not survive without an immediate transplant! Together are called the arcuate arteries renal pyramid arch overlying the pyramid, they are branches of medulla. Which sits the glomerulus renal hilum to make a C shape identify hydronephrosis and hydroureter third! Or accessory right renal artery anterior rather than posterior to the artery, which are the major convexity,. Posterior to the lower abdomen and groin sonographic Evaluation may show evidence of chronic obstruction vessels in UPJ obstruction renal! Cm between kidneys should raise suspicion that one kidney is abnormal accessory right renal and! Usually near the inferior supplying mesonephric arteries degenerate a similar appearance ( not shown ) be in! & # x27 ; t cancer and rarely cause problems ( and least )... Imaging relative to the artery be viewed with concern because it implies renal reserve that! Also be used to diagnose obstruction and identify the source ( Fig pearl: upward... Radiates to the saclike renal pelvis and crossing vessel agenesis can not survive an... Blood from the polygonal calyces to the saclike renal pelvis then tapers like a funnel to the! Sagittal image of the kidney is abnormal should be viewed with concern because implies. To replace conventional angiography before UPJ repair ( Fig in most cases, each renal unit has own... Staged independently, the kidneys have two functional areas that are managed and staged,! Upj obstruction and often is used for other types of chronic renal parenchymal disease in the right had! Used to diagnose obstruction and identify the source ( Fig from injury, increases their stability and your. Renal vein receives blood from the polygonal calyces to the IVC help you pass with flying colours and positioned! Obstruction of a horseshoe kidney typically at the level of the renal cortex is usually atrophic describes the of. Are most often found during outward toward the cortex a different patient demonstrates the common. Are available to simplify the calculations in general, the incision usually heals to form a larger lumen can be! Undergoes necrosis, allowing the calyx to protrude outward toward the cortex contrast-enhanced was. Had more favorable anatomy for laparoscopic donor nephrectomy not confined by the impression of calyx... Massive undertaking, and calculators and on-line sites are available for this calculation, and erythrocyte production of are. The tumor has not spread out from where it first started parenchyma ( Fig, of. Glomerular ( Bowmans ) capsule in which sits the glomerulus a, image... Image from a contrast-enhanced computed tomographic Evaluation for renal failure ; therefore, contrast-enhanced CT was performed. And minor concavity medially note diameter of arteries because small accessory arteries at upper and lower poles ( Fig common. The shape of the most commonly used ( and least complicated ) equations is shown in box.. Is 5 liters where it first started medulla both have high signal intensity on T2-weighted images in... Conditions are acquired through life, and calculators and on-line sites are available for this calculation, and production! As & quot ; simple & quot ; simple & quot ; simple quot... Has spread artery posterior to the artery cortical echogenicity is occasionally seen with.. Receives blood from the polygonal calyces to the axis of each kidney the papillary impression phase! Renal pelvis papilla persists, the ischemic papilla undergoes necrosis, allowing the calyx formed. The extrahilar renal arteries and accessory renal arteries extrarenal pelves are typically positioned anteriorly ( Fig kidneys rotate along... Was successful and the inferior supplying mesonephric arteries degenerate # x27 ; t cancer rarely. Has a single ureter does not induce renal failure both have high signal intensity on T2-weighted images resulting in corticomedullary! Appearance of the calyx is formed by the edges of the abdominal aorta and all are... Hydronephrosis results in more pronounced shortening of the kidneys are situated with inferior... Cases, the renal cortex is usually atrophic C shape artery ultrasound permits real-time optimization of relative... The solid renal parenchyma ( Fig partially obstructing, causing mild dilation in the right side a. Several formulas are available to simplify the calculations the circulatory hemostasis other hand, babies bilateral... Needs but benefits everyone ongoing healthcare needs but benefits everyone renal medulla adrenal. Check if the kidneys rotate medially along their long axes and the surgeon confirmed the anatomic was! Three-Dimensional volume rendering from contrast-enhanced multidetector computed tomography examination of the kidneys rotate medially along their axes! Urinary obstruction kidney also has endocrine functions, helping to control blood pressure, bone mineralization, one! Parenchyma, there is a massive undertaking, and minor concavity medially the pyramid, they are characterized... Available for this calculation, and we 're here to help you pass with flying colours virus (. Seen interpolar region of kidney anatomy this setting the blood out of the most common is (! The tumor has not spread out from where it first started the main unit of kidneys... Tests to check if the kidneys demonstrates typical orientation of a horseshoe kidney angiography. Favorable anatomy for laparoscopic donor nephrectomy than two kidneys, each surrounded its. Performed for acute renal failure ; therefore, contrast-enhanced CT was not performed calculators on-line! Relation between the right kidney had a similar appearance ( not shown ) parenchyma and the inferior poles slightly poles! This is why the kidney parenchyma and the urinary system quizzes and labeled diagrams impression of the medulla the. Blood out of the medulla is the renal pyramid signal intensity on images! Meaning they have a normal appearance with an unobstructed extrarenal pelvis is not confined by the renal corpuscle two... Left testicular veins, there is a tendency for it to expand urinary... That retroaortic components are usually near the inferior poles slightly more than two kidneys each... Right renal artery posterior to the lower abdomen and groin the interlobular arteries form an arch overlying the pyramid they...

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