FACTS & HINTS

High-Yield Facts

Anatomic Points

Vascular supplyto the kidney

Variation in the vascular supplyto the kidneyis fairlycommon.

Embryologically, the kidneys develop in the pelvis and ascend to their abdominal position.

In doing so, theyacquire successivelymore superior vessels from the aorta and IVC, whereas inferior vessels degenerate.

Failure of degeneration of anyof these vessels mayresult either in branches to the poles of the kidney, or in accessoryvessels at the hilum. Furthermore, the renal arteries are not infrequentlydivided prior to their arrival at the hilum.

Clinical Points

Nephrolithiasis (kidneystones)

Renal caliculi (stones) maybe found anywhere between the renal calices and urinarybladder Astone in the ureter can cause significant distension

This results in colickypain radiating from loin to groin as ureteric contractions tryto move the stone distally

In the past, an intravenous urogram (pyelogram) was the imaging tool to determine a filling defect in the ureter

More recently, a computed tomography(CT) scan has become the tool of choice, because patients mayhave an allergic response to the dye used in the urogram.

Management is usuallyconservative (waiting for the stone to pass), but maybe surgical or involve lithotripsy(sonic disruption of the stone).

Renal cysts

Cysts are a common finding in the kidney.

Theymaybe solitaryor multiple.

Solitarycysts are usuallyof no clinical consequence.

Multiple cysts maycause gross distortion and enlargement of the kidneys, culminating in renal failure.

Multiple cysts maybe caused byadult polycystic kidneydisease, because of an autosomal dominant gene.

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