FACTS & HINTS
High-Yield Facts
Anatomic Points
Vascular supply to the kidney
Variation in the vascular supply to the kidney is fairly common.
Embryologically, the kidneys develop in the pelvis and ascend to their abdominal position.
In doing so, they acquire successively more superior vessels from the aorta and IVC, whereas inferior vessels degenerate.
Failure of degeneration of any of these vessels may result either in branches to the poles of the kidney, or in accessory vessels at the hilum.
Furthermore, the renal arteries are not infrequently divided prior to their arrival at the hilum.Clinical Points
Nephrolithiasis (kidney stones)
Renal caliculi (stones) may be found anywhere between the renal calices and urinary bladder
A stone in the ureter can cause significant distension
This results in colicky pain radiating from loin to groin as ureteric contractions try to 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 may have an allergic response to the dye
used in the urogram.
Management is usually conservative (waiting for the stone to pass), but may be surgical or involve lithotripsy (sonic disruption of the stone).Renal cysts
Cysts are a common finding in the kidney.
They may be solitary or multiple.
Solitary cysts are usually of no clinical consequence.
Multiple cysts may cause gross distortion and enlargement of the kidneys, culminating in renal failure.
Multiple cysts may be caused by adult polycystic kidney disease, because of an autosomal dominant gene.