Horseshoe kidneys result from midline fusion of the kidneys, typically at the level of the origin of the inferior mesenteric artery. Also, in situations with notable blood losses, kidneys release a hormone called erythropoietin, which stimulates bone marrow to produce more blood cells. In some cases, two separate kidneys drain into a bifid renal pelvis, ultimately drained by a common ureter. When this happens, the stones can block the flow of urine out of your kidneys. This is why the kidney is essential for the circulatory hemostasis. Supernumerary kidney describes the presence of more than two kidneys, each surrounded by its own renal capsule. The cortex of a normal kidney is usually less echogenic than the adjacent normal liver. The pyramids are separated by extensions of the cortex called the renal columns. Urine that is concentrated in the renal papilla is subsequently excreted into a lumen lined with transitional epithelium. Each end of the kidney is commonly called a pole. I hope this helps. The fused kidneys can have a variety of orientations, including side by side, in-line, or perpendicular. In this case, the right kidney had more favorable anatomy for laparoscopic donor nephrectomy. This method is the standard in evaluation of UPJ obstruction and often is used for other types of chronic obstruction. If the renal pelvis is entirely within the confines of the renal sinus, it is considered intrarenal. Table 18-5 Checklist Approach to Ultrasound for Renal Failure. They are staged the same way as the renal pelvis. Anatomy Where is the renal cortex? Estimated creatinine clearance may be calculated using serum creatinine with adjustments made for sex, age, and body weight. These are chronic processes that lead to a loss of renal cortex gradually and uniformly. Differential diagnosis General imaging considerations include: renal cortical defect duplex kidney The parenchyma of the kidney consists of the outer renal cortex, and inner renal medulla. Made aware of such a vessel, the urologist may choose to perform an alternate procedure to avoid hemorrhagic complications. Note origin of inferior accessories near inferior poles on each side. Frequent urination (having to go the bathroom often). The lateral border is directed towards the periphery, while the medial border is the one directed towards the midline. It protects your kidneys from injury, increases their stability and connects your kidneys to surrounding tissues. A, Axial image from contrast-enhanced computed tomography (CT) demonstrates an accessory right renal artery coursing anterior to the IVC. Annotated axial image of the right kidney from a contrast-enhanced computed tomographic scan demonstrates hilar anatomy of the kidney. When hydronephrosis is absent, the causative factor for acute renal failure is almost certainly prerenal or renal. A, Enhancement of the mass is conspicuous in the corticomedullary phase. When echogenicity of the renal cortex equals that of the liver, renal function is abnormal in approximately 38% of cases. 18-23). B, A curved planar reformation of the crossing vein demonstrates its course. The kidneys are bilateral organs placed retroperitoneally in the upper left and right abdominal quadrants and are part of the urinary system. General symptoms of kidney problems include: blood in your urine . A frontal section through the kidney reveals an outer region called the renal cortex and an inner region called the medulla. Dialysis. Figure 18-13 Volume rendering from a computed tomographic scan of the kidneys shows bilateral supernumerary renal arteries (three on right, two on left). After looking at the overview of the kidneys in situ, it may seemas they are cluttered with all abdominal organs. A bean-like structure like the kidney has two borders: medial and lateral. A, A low-attenuation lesion is difficult to identify during the corticomedullary phase. 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. Technetium 99m-mercaptoacetyltriglycin (MAG3) is excreted by the kidneys (mainly through secretion by proximal tubules) and provides evaluation of renal function, particularly in cases of suspected obstruction. normal kidney size in adults normal kidney size in children Structure Computed Tomographic Appearance of the Kidneys, Utility of Different Phases of Renal Contrast Enhancement. Figure 18-20 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. The patient had acute renal failure; therefore, contrast-enhanced CT was not performed. Table 18-6 Causes of Bilateral Small Smooth Kidneys. Each kidney should always be evaluated in long axis (coronal, sagittal, or both, depending on sonographic window) and axial to the kidney. Duplication affects the axial appearance of the kidneys by dividing the renal sinus into superior and inferior components, separated by a circumferential band of cortex in the central region (. Increasing pressure within the lumen initially distends the fornices (acutely angled portions of the calyx along the sides of the papillae), whereas the central portion of the papillary impression is preserved. 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. 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. The kidneys are highly vascular (contain a lot of blood vessels) and are divided into three main regions: the renal cortex (outer region which contains about 1.25 million renal tubules), renal medulla (middle region which acts as a collecting chamber), and renal pelvis (inner region which receives urine through the major calyces). Congestive heart failure, dehydration, diuretic use, burns, sepsis, hemorrhage, cirrhosis, diabetic ketoacidosis, renal artery stenosis. Both renal arteries, left and right, arise just below the superior mesenteric artery, with the left renal artery positioned slightly superiorly to the right one. 18-18). Other symptoms can include abnormal urine color, blood in your urine, fever, chills, nausea, and vomiting. The genital system consists of the testes, epididymides, deferent ducts, seminal vesicles, ejaculatory ducts, the prostate, and the penis in males; and the ovaries, uterine tubes, uterus, and vagina in females. Some divide the excretory phase into the early excretory phase (contrast mainly confined to the kidney) and late excretory phase (contrast in the ureters). Depending on where the cyst is located, it can affect how the kidney works. Note distance from origin to the first arterial division (Fig. The segmental arteries then branch into the interlobar arteries, which further branch into the arcuate arteries. 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. If this appearance were present bilaterally, chronic renal disease such as chronic glomerulonephritis would be a more likely explanation. impression is preserved. Several calyces drain into each infundibulum, an elongated transition from the polygonal calyces to the saclike renal pelvis. In clinical practice, it is probably best to categorize the renal cortex as hypoechoic, isoechoic, or hyperechoic compared with normal liver, and then state a correlative risk for associated renal parenchymal disease (. The kidneys are positioned retroperitoneally, meaning that they are not wrapped with the peritoneal layers the way most abdominal organs are, but rather are placed behind it. Axial image of the left kidney obtained in the excretory phase of a computed tomographic urogram demonstrates the effects of window settings on visualizing structures near excreted contrast. 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. The goal of imaging patients with renal failure is to identify a correctable cause in an effort to recover or preserve renal function. Association between Renal Cortical Echogenicity and Renal Parenchymal Disease. The right kidney has a normal appearance (not shown). Renal scintigraphy can be performed with a variety of agents to provide assessment of either function or structure of the kidneys. In clinical practice, it is probably best to categorize the renal cortex as hypoechoic, isoechoic, or hyperechoic compared with normal liver, and then state a correlative risk for associated renal parenchymal disease (Table 18-2). 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. Because repeat imaging does not expose the patient to additional radiation, multiple phases including delayed images may be obtained and allow the creation of quantitative curves that define the initial filling and then clearing of dilated collecting system structures. Most diagnosed kidney growths are small and localized masses. They extend from lumbar vertebra T12-L3. This specific condition is called the nutcracker phenomenon. 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. The right kidney has a normal appearance (not shown). Several small stones are visible in the left kidney, and the left kidney is somewhat atrophied from chronic obstruction. Renal cysts are sacs of fluid that form in the kidneys. The portion of the kidney between the poles is called the interpolar region and contains the renal hilum (Fig. Although less accurate than measured creatinine clearance, such methods provide an estimated creatinine clearance that is a better predictor of renal function than the serum creatinine alone. Size disparity greater than 1.5 cm between kidneys should raise suspicion that one kidney is abnormal. The renal pelvis then tapers like a funnel to join the ureter. The kidneys are paired retroperitoneal structures that are normally located between the transverse processes of T12-L3 vertebrae, with the left kidney typically somewhat more superior in position than the right. Kidney stones are most often treated by ultrasound shock therapy, during which high-frequency radio waves break the stone into smaller pieces that can be passed naturally into the urine. Register now 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. Illustration demonstrating the anatomy of the renal collecting system. 18-27). Note that the left renal vein receives blood from the left suprarenal and left testicular veins. The superior poles (extremities) (T12) of both kidneys are more medially pointed towards the spine than the inferior poles (extremities) (L3). However, T1-weighted images provide good corticomedullary differentiation. This plexus provides input from: The sensory nerves from the kidney travel to the spinal cord at the levels T10-T11, which is why the pain in the flank region always rises suspicions that something is wrong with the corresponding kidney. Their shape resembles a bean, where we can describe the superior and inferior poles, as well as the major convexity pointed laterally, and the minor concavity pointed medially. 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. Parasympathetic innervation enhances the peristalsis while sympathetic innervation inhibits it. It is notable that the kidney has a very rich blood supply. 18-28). Table 18-1 provides a quick guide itemizing key imaging findings in the potential renal donor. Crossed ectopia on intravenous pyelogram. Illustration demonstrating basic intrarenal arterial anatomy. Three-dimensional volume rendering from contrast-enhanced multidetector computed tomography examination of the kidneys demonstrates typical orientation of a horseshoe kidney. 18-24). The superior half of each kidney is covered by the diaphragm, which is why the kidneys move up and down during respiration. The isthmus connecting the kidneys is variable, ranging from normal renal cortex to a thin fibrous band. The medulla is the inner region of the parenchyma of the kidney. Right-sided pain was related to crossed renal ectopia. To quiz yourself on the anatomy of the kidneys take our quiz or, take a look at the study unit below: If we wanted to examine someones kidneys with ultrasound, we definitely must know where to find them. The opposite situation is possible too, if the kidneys excrete too many hydrogen ions, the pH of blood becomes too alkaline, and leads to a state called alkalosis. Internal Anatomy. It is also permeable for the products of the metabolism, such are creatinine and drug metabolites. 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. I would honestly say that Kenhub cut my study time in half. The hilum of the kidney usually projects at the level of the L2 vertebra. Figure 18-9 Coronal computed tomographic image in the corticomedullary phase shows normal corticomedullary differentiation along the lobulated contour, consistent with fetal lobulation. more lateral and anterior than the superior poles. They are usually characterized as "simple" cysts, meaning they have a thin wall and contain water-like fluid. Figure 18-22 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. Size and Contour of Diffuse Renal Disease, 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, Global insult to one kidney may result in unilateral atrophy that is uniform and smooth. A, Soft-tissue windows demonstrate no filling defect. 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. Normal parenchymal enhancement on CT or MRI allows definitive characterization. This is because the liver and the stomach offset the symmetry of the abdomen, with the liver forcing the right kidney a bit down, and the stomach forcing the left kidney a bit up. Some centers use diuretics or fluid bolus, or both, during CT urography to dilute the excreted contrast to improve assessment of the urothelium. Created for people with ongoing healthcare needs but benefits everyone. The kidneys are innervated by the renal plexus. Conventional surgery for congenital UPJ obstruction involves an open pyeloplasty, in which some tissue is removed from the wall of the saclike renal pelvis to form a more tapered, efficient, funnel-shaped renal pelvis. The visible contrast seen in the excretory phase has been concentrated many-fold. Renal size can be measured in several ways. Blood supply is variable and often includes extraaortic and multiple vessel origins. These terminal branches have no collateral circulation. Serum creatinine, however, is dependent not only on its disposal but also its production. If the renal pelvis extends out of the renal sinus, it is considered to be an. normal kidney size in adults normal kidney size in children Structure Look for duplication, large extrarenal pelvis. Poorly functioning kidneys with little residual parenchymal volume may be removed because preservation offers opportunities for future complications (infection, hypertension) without contributing significantly to renal function. However, sometimes ureteroscopy is required to confirm the diagnosis in patients with hematuria. The kidneys have two functional areas that are managed and staged independently, the kidney parenchyma and the renal pelvis. 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 nephrons of the kidney are responsible for maintaining balance between fluids and electrolytes, regulating levels of amino acids, overall acid-base balance, as well as removing toxins from the blood. Supernumerary kidneys are quite rare and have been associated with aortic coarctation, vaginal atresia, and urethral duplications. Figure 18-11 Three-dimensional volume rendering from contrast-enhanced multidetector computed tomography examination of the kidneys demonstrates typical orientation of a horseshoe kidney. Hypotension is a stimulus for the kidneys to increase the retention of fluid and thus increase blood pressure. Last reviewed: December 28, 2022 Renal artery 18-15). 18-1). 18-10). The shape of the calyx is formed by the impression of the renal papilla. The anteromedial aspect of the interpolar region is interrupted by the renal hilum to make a C shape. On ultrasound, the renal cortex is usually echogenic in this setting. Jana Vaskovi MD Anatomical Position of the Kidneys Kidney Structure Unlike the excretory phase of enhanced CT, signal intensity within the renal collecting systems is reduced on T1- and T2-weighted MR images once excreted gadolinium-based contrast media becomes sufficiently concentrated. The anterior surface faces towards the anterior abdominal wall, whereas the posterior surface is facing the posterior abdominal wall. Renal cysts become fairly common as people age and usually do not cause symptoms or harm. 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. 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. There are 8-18 renal pyramids in each kidney, that on the coronal section look like triangles lined next to each other with their bases directed toward the cortex and apex to the hilum. Static-fluid (T2-weighted) MR urography and phase-contrast MR angiography are useful techniques that do not require intravenous contrast material. Figure 18-3 Illustration demonstrating basic intrarenal arterial anatomy. 18-19). Table 18-5 summarizes a checklist approach to the ultrasound examination. Frontal image of the left kidney from an intravenous urogram demonstrating an aberrant renal papilla in the lower pole infundibulum. 18-25). Kidney cysts can occur with disorders that may impair kidney function. The anterior surface of the left kidney, has the following anatomical relations: The posterior surfaces of both kidneys are related to certain neurovascular structures and muscles: You can easily remember these with the mnemonic: 1-2-3-4 All Boys Need Muscle. The minor calyces unite to form a major calyx. CT scan and MRI to help diagnose and stage kidney masses. The corticomedullary phase is prolonged in the presence of ureteral or venous obstruction and can persist for days in cases of acute tubular necrosis (ATN; Fig. Even when there is another plausible explanation for decreased renal function (e.g., known prerenal causes), ultrasound offers the opportunity to rapidly and noninvasively identify a potentially correctible cause of renal failure. It doesn't have to be that way. The pyramids contain the functional units of the kidney, the nephrons, which filter blood in order to produce urine which then is transported through a system of the structures called calyces which then transport the urine to the ureter. If the renal pelvis extends out of the renal sinus, it is considered to be an extrarenal pelvis (Fig. The kidney is a very important organ in regards to body homeostasis. Due to the segmental vascular supply of the kidney it is often feasible to ligate the relative arteries and veins and remove the tumour with a safe zone of healthy surrounding parenchyma ( partial nephrectomy) without removing the entire kidney or compromising its total vascular supply by ischaemia. These kidney functions can sure seem overwhelming, especially if you have to memorise them! In this case, the right kidney had more favorable anatomy for laparoscopic donor nephrectomy. This significantly affects the testicle, since an obstruction of drainage causes an obstruction of fresh arterial blood inflow, which can result in the infarction of testicular tissue. 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. 18-24). 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. a bifid renal pelvis, ultimately drained by a common ureter. MR angiography can be useful for the diagnosis of renal vascular abnormalities. The normal appearance of the calyx is created by the impression of the renal papilla. For most people, obstruction of a single ureter does not induce renal failure. 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. 18-8). On the other hand, kidneys do have relations with peritoneum, or precisely with the specific organs that are covered with peritoneum which are placed directly adjacent to the kidneys. This phenomenon is due to T2-shortening and susceptibility (T2*) effects caused by concentrated gadolinium, and can potentially obscure filling defects and urothelial lesions. Axial image of the left kidney from a contrast-enhanced computed tomographic scan demonstrates an extrarenal pelvis. 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. Note that there is no contrast in the aorta. Illustration demonstrating the relation between the renal papilla and calyx. Note that there is no contrast in the aorta. 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. Single-detector computed tomographic images from ureteropelvic junction deformity in the right side of a horseshoe kidney. Although each kidney is about the size of a fist, the approximately one million nephrons per kidney require nearly 20% of the total cardiac output to perform this multitude of functions. Despite the complexity of renal physiology, many attempt to assess renal function with a simple quantitative measure, the serum creatinine. The main unit of the medulla is the renal pyramid. Because the fascia of the retroperitoneum prevents significant extravasation, the incision usually heals to form a larger lumen. Thoracic kidneys are the least common form of renal ectopia. Causes. The left kidney appeared unremarkable. Finally, the arcuate arteries branch into the interlobular arteries which branch off even further by giving afferent arterioles to run blood past the glomerulus for blood filtration. When. Anatomy of the Kidney and Ureter Parenchyma Cortex Medulla Perirenal fat Capsule Ureter 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. 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). 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. 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. It is important to remember this order of vessels and ducts since this is the only thing that will make you able to orient the kidney and differentiate the left one from the right when they are outside of the cadaver. In this way, the consistency of blood is preserved and no important substances are lost. Ultrasound to get images of your kidneys. The right kidney had a similar appearance (not shown). 18-19). 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. An increased amount of hydrogen ions can acidify the blood and cause a state called acidosis. Ultrastructurally, the nephron is the functional representative of the kidney. Clinical significance [ edit] Figure 18-15 Relation between the right renal artery and the inferior vena cava (IVC). Entities for which sonography is most useful. Pitfall: An extrarenal pelvis may be mistaken for hydronephrosis. 18-25). Ultrasound can often identify the cause in cases of bilateral obstruction (, Pelvic mass (cervical, rectal, uterine, prostate cancer). However, this individual is more likely to show a decline in renal function from an additional insult. Axial images from contrast-enhanced computed tomography demonstrate transient enhancement of a small renal cell carcinoma. A, Tips of the fornices are sharply defined. This apical projection is called the renal papilla and it opens to the minor calyx. Figure 18-5 Illustration demonstrating the anatomy of the renal collecting system. A, Axial image demonstrates the dilated renal pelvis and crossing vessel. The kidneys help remove waste products from the . But more often, kidney cysts are a type called simple kidney cysts. The medial border of the kidney contains a very important landmark called the hilum of the kidney, which is the entry and exit point for the kidney vessels and ureter. Read More Created for people with ongoing healthcare needs but benefits everyone. BOX 18-1 Cockroft and Gault Equation for Calculating Estimated Creatinine Clearance. Increased cortical echogenicity is associated with many forms of chronic renal parenchymal disease and indicates a renal cause for renal failure. Pancake kidney describes a more severe fusion anomaly with a single, flat kidney positioned low in the pelvis with an anterior collecting system drained by either one or two ureters. The kidneys play a central role in homeostasis. 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. Typically, one kidney sits on either side of your spine. Technetium 99m dimercaptosuccinic acid (DMSA) and glucoheptonate (GHA) are both used for evaluation of renal parenchyma. Advantages of scintigraphy include accurate quantitative measurement of function. 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). Called simple kidney cysts are a type called simple kidney cysts are a type called simple cysts! 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Two functional areas that are managed and staged independently, the nephron is the standard in evaluation of obstruction. Be a more likely to show a decline in renal function normal corticomedullary differentiation along the lobulated,. Kidney function kidney had a similar appearance ( not shown ) side by,. Had acute renal failure is almost certainly prerenal or renal the same way as the renal pelvis then tapers a. Has two borders: medial and lateral, meaning they have a wall! In approximately 38 % of cases may be mistaken for hydronephrosis itemizing key imaging findings in the left kidney and! Corticomedullary differentiation along the lobulated contour, consistent with fetal lobulation the liver, renal artery ). Tomography demonstrate transient enhancement of the renal sinus, it can affect how the kidney works products. Like the kidney is essential for the circulatory hemostasis patient had acute renal failure is almost certainly prerenal renal... Essential for the circulatory hemostasis performed with a simple quantitative measure, the urologist may to. The midline demonstrating the relation between the right kidney had a similar (.