Gross Anatomy of the Kidney

[...]... solearis —5) of the hoof; whereas, its modified digital pad, the sole (solea ungulae) and the frog (cuneus ungulae) of the hoof, depending on the character of the ground-surface, bear only a small part of the body weight This is in contrast to the claw (see Atlas of Bovine Anatomy) Within the hoof, the body weight of a horse is transferred from the coffin bone (os ungulare) to the hoof plate by the suspensory... transfer part of the weight upon the limb to the inside of the wall through the following structures: distal phalanx, to the dermal lamellae, by interdigitation to the horny lamellae of the wall, and through the sole border of the wall to the ground IV The slightly concave sole segment (Solea) occupies the space between the sole border of the wall and the grog/bulb segment The dermis of the sole (4)... obturator in the trochanteric fossa The pectineus (and long adductor; 14) takes origin from the contralateral iliopubic eminence so that its tendon of origin crosses the median plane The tendon of origin, and that of the pectineus of the other side, thus form the bulk of the prepubic tendon The spindle-shaped belly of the pectineus ends at the middle of the medial border of the femur The adductor (magnus... suspensory apparatus of the coffin bone (apparatus suspensorius ossis ungulae) and by this to the solear border of this hoof plate I DEFINITION OF THE SUSPENSORY APPARATUS OF THE COFFIN BONE The suspensory apparatus of the coffin bone is a constituent of the equine hoof The concept, suspensory apparatus of the coffin bone, comprises all connective tissue and epithelial structures in the wall segment as... fills the space between the wall and frog; its parts between quarters and bars are its angles The triangular frog (27, 28) projects into the sole from behind and closes the gap between the heels Its two curar at the back of the hoof, thicken, spread upwards, an overhang the heels as the bulbs of the heels (26) The bulbs of the heels together with the frog are the homologue of the digital pad 5 6 The. .. digital artery at the level of the proximal border of the ungular cartilage It gives off a branch peripherally into the bulb of the heel and an axial branch to the crus of the frog The coronal artery (7) arises from the abaxial wall of the plantar digital artery closely above the proximal border of the hoof capsule It gives off dorsal branches and branches for the quarter region Shortly before the plantar... cartilages These lie against the concave deep surface of the hoof but project with their dorsal borders above the coronary border of the wall Several ligaments attach the Gross Anatomy of the Kidney Gross Anatomy of the Kidney Bởi: OpenStaxCollege The kidneys lie on either side of the spine in the retroperitoneal space between the parietal peritoneum and the posterior abdominal wall, well protected by muscle, fat, and ribs They are roughly the size of your fist, and the male kidney is typically a bit larger than the female kidney The kidneys are well vascularized, receiving about 25 percent of the cardiac output at rest There have never been sufficient kidney donations to provide a kidney to each person needing one Watch this video to learn about the TED (Technology, Entertainment, Design) Conference held in March 2011 In this video, Dr Anthony Atala discusses a cutting-edge technique in which a new kidney is “printed.” The successful utilization of this technology is still several years in the future, but imagine a time when you can print a replacement organ or tissue on demand External Anatomy The left kidney is located at about the T12 to L3 vertebrae, whereas the right is lower due to slight displacement by the liver Upper portions of the kidneys are somewhat protected by the eleventh and twelfth ribs ([link]) Each kidney weighs about 125–175 g in males and 115–155 g in females They are about 11–14 cm in length, cm wide, and cm thick, and are directly covered by a fibrous capsule composed of dense, irregular connective tissue that helps to hold their shape and protect them This capsule is covered by a shock-absorbing layer of adipose tissue called the renal fat pad, which in turn is encompassed by a tough renal fascia The fascia and, to a lesser extent, the overlying 1/7 Gross Anatomy of the Kidney peritoneum serve to firmly anchor the kidneys to the posterior abdominal wall in a retroperitoneal position Kidneys The kidneys are slightly protected by the ribs and are surrounded by fat for protection (not shown) On the superior aspect of each kidney is the adrenal gland The adrenal cortex directly influences renal function through the production of the hormone aldosterone to stimulate sodium reabsorption Internal Anatomy A frontal section through the kidney reveals an outer region called the renal cortex and an inner region called the medulla ([link]) The renal columns are connective tissue extensions that radiate downward from the cortex through the medulla to separate the most characteristic features of the medulla, the renal pyramids and renal papillae The papillae are bundles of collecting ducts that transport urine made by nephrons to the calyces of the kidney for excretion The renal columns also serve to divide the kidney into 6–8 lobes and provide a supportive framework for vessels that enter and exit the cortex The pyramids and renal columns taken together constitute the kidney lobes 2/7 Gross Anatomy of the Kidney Left Kidney Renal Hilum The renal hilum is the entry and exit site for structures servicing the kidneys: vessels, nerves, lymphatics, and ureters The medial-facing hila are tucked into the sweeping convex outline of the cortex Emerging from the hilum is the renal pelvis, which is formed from the major and minor calyxes in the kidney The smooth muscle in the renal pelvis funnels urine via peristalsis into the ureter The renal arteries form directly from the descending aorta, whereas the renal veins return cleansed blood directly to the inferior vena cava The artery, vein, and renal pelvis are arranged in an anterior-toposterior order Nephrons and Vessels The renal artery first divides into segmental arteries, followed by further branching to form interlobar arteries that pass through the renal columns to reach the cortex ([link]) The interlobar arteries, in turn, branch into arcuate arteries, cortical radiate arteries, and then into afferent arterioles The afferent arterioles service about 1.3 million nephrons in each kidney 3/7 Gross Anatomy of the Kidney Blood Flow in the Kidney Nephrons are the “functional units” of the kidney; they cleanse the blood and balance the constituents of the circulation The afferent arterioles form a tuft of high-pressure capillaries about 200 µm in diameter, the glomerulus The rest of the nephron consists of a continuous sophisticated tubule whose proximal end surrounds the glomerulus in an intimate embrace—this is Bowman’s capsule The glomerulus and Bowman’s capsule together form the renal corpuscle As mentioned earlier, these glomerular capillaries filter the blood based on particle size After passing through the renal corpuscle, the capillaries form a second arteriole, the efferent arteriole ([link]) These will next form a capillary network around the more distal portions of the nephron tubule, the peritubular capillaries and vasa recta, before returning to the venous system As the glomerular filtrate progresses through the nephron, these capillary networks recover most of the solutes and water, and return them to the circulation Since a capillary bed (the glomerulus) drains into a vessel that in turn forms a second ...Anatomy of the Human Body Henry Gray CONTENTS I. Embryology 1. The Animal Cell 2. The Ovum 3. The Spermatozoön 4. Fertilization of the Ovum 5. Segmentation of the Fertilized Ovum 6. The Neural Groove and Tube 7. The Notochord 8. The Primitive Segments 9. Separation of the Embryo 10. The Yolk-sac 11. Development of the Fetal Membranes and Placenta 12. The Branchial Region 13. Development of the Body Cavities 14. The Form of the Embryo at Different Stages of Its Growth Bibliography II. Osteology 1. Introduction 2. Bone 3. The Vertebral Column a. General Characteristics of a Vertebra 1. The Cervical Vertebræ 2. The Thoracic Vertebræ 3. The Lumbar Vertebræ 4. The Sacral and Coccygeal Vertebræ b. The Vertebral Column as a Whole 4. The Thorax a. The Sternum b. The Ribs c. The Costal Cartilages 5. The Skull a. The Cranial Bones 1. The Occipital Bone 2. The Parietal Bone 3. The Frontal Bone 4. The Temporal Bone 5. The Sphenoid Bone 6. Ethmoid bone b. The Facial Bones 1. The Nasal Bones 2. The Maxillæ (Upper Jaw) 3. The Lacrimal Bone 4. The Zygomatic Bone 5. The Palatine Bone 6. The Inferior Nasal Concha 7. The Vomer 8. The Mandible (Lower Jaw) 9. The Hyoid Bone c. The Exterior of the Skull d. The Interior of the Skull 6. The Extremities a. The Bones of the Upper Extremity 1. The Clavicle 2. The Scapula 3. The Humerus 4. The Ulna 5. The Radius b. The Hand 1. The Carpus 2. The Metacarpus 3. The Phalanges of the Hand c. The Bones of the Lower Extremity 1. The Hip Bone 2. The Pelvis 3. The Femur 4. The Patella 5. The Tibia 6. The Fibula d. The Foot 1. The Tarsus 2. The Metatarsus 3. The Phalanges of the Foot 4. Comparison of the Bones of the Hand and Foot 5. The Sesamoid Bones III. Syndesmology 1. Introduction 2. Development of the Joints 3. Classification of Joints 4. The Kind of Movement Admitted in Joints 1. Introduction 2. Development of the Joints 3. Classification of Joints 4. The Kind of Movement Admitted in Joints 5. Articulations of the Trunk a. Articulations of the Vertebral Column b. Articulation of the Atlas with the Epistropheus or Axis c. Articulations of the Vertebral Column with the Cranium d. Articulation of the Mandible e. Costovertebral Articulations f. Sternocostal Articulations g. Articulation of the Manubrium and Body of the Sternum h. Articulation of the Vertebral Column with the Pelvis i. Articulations of the Pelvis 6. Articulations of the Upper Extremity a. Sternoclavicular Articulation b. Acromioclavicular Articulation c. Humeral Articulation or Shoulder-joint d. Elbow-joint e. Radioulnar Articulation f. Radiocarpal Articulation or Wrist-joint g. Intercarpal Articulations h. Carpometacarpal Articulations i. Intermetacarpal Articulations j. Metacarpophalangeal Articulations k. Articulations of the Digits 7. Articulations of the Lower Extremity a. Coxal Articulation or Hip-joint b. The Knee-joint c. Articulations between the Tibia and Fibula d. Talocrural Articulation or Ankle-joint e. Intertarsal Articulations RESEARC H Open Access Measurement invariance of the kidney disease and quality of life instrument (KDQOL-SF) across Veterans and non-Veterans Karen L Saban 1,2* , Fred B Bryant 3 , Domenic J Reda 4 , Kevin T Stroupe 1,5,6 , Denise M Hynes 1,5,7 Abstract Background: Studies have demonstrated that perceived health-related quality of life (HRQOL) of patients receiving hemodialysis is significantly impaired. Since HRQOL outcome data are often used to compare groups to determine health care effectiveness it is imperative that measures of HRQOL are valid. However, valid HRQOL comparisons between groups can only be made if instrument invariance is demonstrated. The Kidney Disease Quality of Life- Short Form (KDQOL-SF) is a widely used HRQOL measure for patients with chronic kidney disease (CKD) however, it has not been validated in the Veteran population. Therefore, the purpose of this study was to examine the measurement invariance of the KDQOL-SF across Veterans and non-Veterans with CKD. Methods: Data for this study were from two large pros pective observational studies of patients receiving hemodialysis: 1) Veteran End-Stage Renal Disease Study (VETERAN) (N = 314) and 2) Dialysis Outcomes and Practice Patterns Study (DOPPS) (N = 3,300). Health-related quality of life was measured with the KDQOL-SF, which consists of the SF-36 and the Kidney Disease Component Summary (KDCS). Single-group confirmatory factor analysis was used to evaluate the goodness-of-fit of the hypothesized measurement model for responses to the subscales of the KDCS and SF-36 instruments when analyzed together; and given acceptable goodness-of-fit in each group, multigroup CFA was used to compare the structure of this factor model in the two samples. Pattern of factor loadings (configural invariance), the mag nitude of factor loadings (metric invariance), and the magnitude of item intercepts (scalar in variance) were assessed as well as the degree to which factors have the same variances, covariances, and means across groups (structural invariance). Results: CFA demonstrated that the hypothesized two-factor model (KDCS and SF-36) fit the data of both the Veteran and DOPPS samples well, supporting configural invariance. Multigroup CFA results concerning metric and scalar invariance suggested partial strict invariance for the SF-36, but only weak invariance for the KDCS. Structural invariance was not supported. Conclusions: Results suggest that Veterans may interpret the KDQOL-SF differently than non-Veterans. Further evaluation of measurement invariance of the KDQOL-SF between Veterans and non-Veterans is needed using large, randomly selected samples before comparisons between these two groups using the KDQOL-SF can be done reliably. Background Theprevalenceofchronickidneydisease(CKD)con- tinues to grow each year with the incidence of patients receiving hemodialysis in the United States reaching 310 per m illion in 2004 [1]. H emodialysi s, while not a cure for CKD, helps prolong and improve patients’ quality of life [2]. However, hemodialysis is often a burden for patients requiring them to be essentially immobile while they are connected to a dialysis machine several hours a day at least three times a week. Social activities, CAS E REP O R T Open Access Metastatic collecting duct carcinoma of the kidney treated with sunitinib El Mehdi Tazi 1* , Ismail Essadi 1 , Mohamed Fadl Tazi 2 , Youness Ahellal 2 , Hind M’rabti 1 and Hassan Errihani 1 Abstract Collecting duct carcinoma (CDC) of the kidney is a rare and aggressive malignant tumor arising from the distal collecting tubules which has been shown to have a poor response to several kinds of systemic therapy. We present a case of metastatic CDC that responded favorably to a multiple tyrosine kinase inhibitor, sunitinib, achieving a partial response in both lung and skeletal metastases. To our knowledge, this is the first report showing therapeutic activity of sunitinib against CDC. Considering these findings, it would be worthwhile prospectively investigating the role of multiple tyrosine kinase inhibitors, particularly sunitinib, in the management of metastatic CDC. Keywords: Collecting duct carcinoma, Sunitinib, Metastasis Introduction Collecting duct carcinoma (CDC) of the kidney, also known as Bellini duct carcinoma, is a rare variant of renal cell carcinoma (RCC) arising from the epithelium of the distal collecting ducts; it accounts for 2% of all RCCs [1]. Clinically, CDC is characterized by an extremely aggressive phenotype, accompanying metastatic diseases at presenta- tion in most reported cases; the prognosis ofCDC is there- fore po or, with approxim ately 70% o f p atients dy ing of disease progression within 2 years after diagnosis. In fact, several systemic therapies, including cytokine therapy and cytotoxic chemotherapy, have failed to achieve favorable response to metastatic CDC except for very limited cases [2-7]. Sunitinib is an orally available inhibitor of multiple receptor tyrosine kinases, inc luding vascular en dothelial growth factor receptor, platelet-derived growth factor receptor, and others, with direct antitumor and antiangio- genic activity. Based on impressive outcomes in several clinical trials, sunitinib has been approved worldwide for treatment of RCC patients with clear cell histology [8]. Furthermore, significant therapeutic activities of sunitinib against non-clear cell RCCs, for example papillary and chromophobe carcinomas, have also been reported in recent studies [8,9]; however, it remains unknown whether sunitinib has a therapeutic impact on CDC of the kidney. Here, we report the first case of a patient with metastatic CDC of the kidney who had a favorable response to suniti- nib treatment. Case report A 47-year-old man with a 14.1 cm left renal mass extending into the renal vein and metastases involving the bilateral lungs and retroperitoneal lymph nodes were referred to our institution. * Correspondence: moulay.elmehdi@yahoo.fr 1 Department of Medical Oncology, National Institute of Oncology, Rabat, Morocco Full list of author information is available at the end of the article Figure 1 Hematoxylin and eosin staining of tissue sections from the nephrectomy specimens demonstrating collecting duct carcinoma (× 400). Tazi et al. World Journal of Surgical Oncology 2011, 9:73 http://www.wjso.com/content/9/1/73 WORLD JOURNAL OF SURGICAL ONCOLOGY © 2011 Tazi et al; licensee BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2 .0), which permits unrestricted u se, distribution, and reproduction in any medium, provided the original work i s properly cited. Radical left nephrectomy combined with lymphadenect- omy was performed. Pathological examination resulted in diagnosis of this case as CDC with tubulopapillary archi- tecture consisting of tumor cells with eosinophilic cyto- plasm and high-grade nuclei (Figure 1). In addition, immunohistochemical staining was characteristic of CDC; that is, tumor ce lls were positive for Ulex Europaeus agglutinin (Figure 2), cytokeratin 19, 34bE12, epithelial membrane antigen and focally positive with vimentin [1]. CAS E REP O R T Open Access Inflammatory pseudotumor of the kidney: a case report Abdelhak Khallouk 1 , Youness Ahallal 1* , Mohammed Fadl Tazi 1 , Hinde Elfatemi 2 , Elmehdi Tazi 3 , Jalaleddine Elammari 1 , Mohammed Jamal Elfassi 1 and Moulay Hassan Farih 1 Abstract Introduction: Inflammatory pseudotumors, also known as inflammatory myofibroblastic tumors, are uncommon benign tumors of unknown etiology which may develop at several anatomical sites. In the urogenital tract, inflammatory pseudotumor usually affects the urinary bladder or the prostate. Inflammatory pseudotumor of the kidney is very rare. It is considered as a reactive inflammatory lesion that features very good prognosis. Case presentation: We present the case of a 57-year-old Moroccan man who presented with a two-month history of gross hematuria and left lumbar pain. Imaging investigations revealed a left kidney mass and pathological examination of the nephrectomy specim en showed an inflammatory pseudotumor. Conclusion: As the preoperative definitive diagnosis of such a tumor is not possible, surgery is advised because only pathological examination of the nephrectomy specimen can establish the diagnosis with certainty. From one case report and literature review, the authors suggest a diagnostic and therapeutic strategy for the management of this rare tumor. Introduction Inflammatory pseudotumor is a rare benign condition of unknown cause. As far as we know, less than 20 cases have been reported in the English literature. It is impor- tant to report such rare benign renal tumors in order to determine their reliable c haracteristics and avoid per- forming unnecessary ne phrectomies that increase the risk of chronic kidney disease. It can be seen in various organs. Originally described in the lungs, a ren al loca- tion is extremely rare [1]. As inflammatory pseudotumor of the kidney usually mimics renal cell carcinoma, the preoperative diagnosis remains difficult and it is only made through pathological e xamination of the tumor. We report a case of inflammatory pseudotumor of the kidney; our patient presented with a renal mass and was treated with radical nephrectomy. Case presentation A 57-year-old Moroccan man presented with a two- month history of gross hematuria and left lumbar pain. There was no past history of calculous disease or flank pain. He had been smoking 40 cigarettes a day for the past 35 years. The physical and basic paraclinical exami- nations were normal. Ultrasonography revealed an 8 cm size he terogeneous mass of his left kidney. A contrast- enhanced computed tomography (CT) scan revealed a huge cystic tumor on the left kidney (9.0 × 6.5 × 5.0 cm in size). It was slightly enhanced with contrast, suggest- ing a malignant tumor such as renal cell carcinoma (Fig- ure 1). Radical nephrectomy was therefore performed under the diagnosis of renal cell carcinoma. Histopatho - logical examination resulted in the lesion being diag- nosed as an inflammatory myofibroblastic tumor, in which spindle cells were admixed with variable amounts of extracellular collagen, lymphocytes, p lasma cells and siderophages (Figure 2 and 3). Immunostaining was positive for vimentin and HHF-35 and focally positive for smooth muscle actin. The postoperative course was uneventful and our patient is disease-free after a follow-up of 14 months. Discussion Renal inflammatory pseudotumor (RIP) is very rare. It affects individuals of both sexes and is seen in a wide range of age groups [2]. First described in the lung * Correspondence: dryouness@gmail.com 1 Department of Urology, Hassan II Teaching Hospital, Fes, Morocco Full list of author information is available at the end of the article Khallouk et al. Journal of Medical Case Reports 2011, 5:411 http://www.jmedicalcasereports.com/content/5/1/411 JOURNAL OF MEDICAL CASE REPORTS © 2011 Khallouk et al; licensee BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative Commons Attribution ... each kidney 3/7 Gross Anatomy of the Kidney Blood Flow in the Kidney Nephrons are the “functional units” of the kidney; they cleanse the blood and balance the constituents of the circulation The. .. columns taken together constitute the kidney lobes 2/7 Gross Anatomy of the Kidney Left Kidney Renal Hilum The renal hilum is the entry and exit site for structures servicing the kidneys: vessels,... tutorial of the flow of blood through the kidney Cortex In a dissected kidney, it is easy to identify the cortex; it appears lighter in color compared to the rest of the kidney All of the renal