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Paper 4
Published in Amanda Rabone, Benedict Thomson, Nicky Dineen, Vincent Helyar, Aidan Shaw, The Final FRCR, 2020
Amanda Rabone, Benedict Thomson, Nicky Dineen, Vincent Helyar, Aidan Shaw
The consultant looking after a 41 year old female outpatient with normal renal function and urine dip comes to ask you for advice. The patient had an ultrasound abdomen for query gallstones due to intermittent epigastric and right upper quadrant pain. The ultrasound confirmed gallstones but the report also mentioned bilateral echogenic renal pyramids with otherwise normal kidneys. A CT urinary tract from an emergency department attendance 1 month previously also demonstrated hyperdense medullary pyramids with no hydronephrosis. A CT urogram confirmed a striated nephrogram.
The Urinary System and Its Disorders
Published in Walter F. Stanaszek, Mary J. Stanaszek, Robert J. Holt, Steven Strauss, Understanding Medical Terms, 2020
Walter F. Stanaszek, Mary J. Stanaszek, Robert J. Holt, Steven Strauss
The glandular portion of the kidney that surrounds the structures of the renal sinus is divided into the medulla and the cortex [Figure 11.1(B)], The medullary portion consists of a series of conical structures called renal pyramids with their blunted points facing in toward the renal sinus. The blunted end of each renal pyramid is perforated by the openings of ducts and projects into a minor calyx. The cortex lies between the bases of these pyramids and the capsule or surface of the kidney and projects between the pyramids in the renal columns.
Familial Wilms Tumor and Related Syndromes
Published in Dongyou Liu, Handbook of Tumor Syndromes, 2020
The kidneys are a pair of bean-shaped organs (of 10–12 cm in length, 5–7 cm in width, 2–3 cm in thickness, and 135–150 g in weight) that are located along the posterior muscular wall of the abdominal cavity. Covered by a thin layer of fibrous connective tissue (the renal capsule), the kidneys comprise an outlayer of soft, dense, vascular renal cortex, and an inner renal medulla, the latter of which is composed of seven cone-shaped renal pyramids separated by the cortical tissue (called renal columns of Bertin). Each kidney contains around 1 million individual nephrons (the functional units), which are made of renal corpuscle and renal tubule. The renal corpuscle comprises the capillaries of the glomerulus that is surrounded by the glomerular capsule (or Bowman's capsule, a cup-shaped double layer of simple squamous epithelium with a hollow space between the layers). The glomerulus consists of podocytes and a basement membrane allowing water and certain solutes to be filtered across. Podocytes form a thin filter with the endothelium of the capillaries to separate urine from blood passing through the glomerulus. The outer layer of the glomerular capsule keeps the urine separated from the blood within the capsule. At the far end of the glomerular capsule is the mouth of the renal tubule, which carries urine from the glomerular capsule to the renal pelvis.
Curcumin modulates gut microbiota and improves renal function in rats with uric acid nephropathy
Published in Renal Failure, 2021
Xueling Xu, Huifang Wang, Dandan Guo, Xiaofei Man, Jun Liu, Junying Li, Congjuan Luo, Ming Zhang, Li Zhen, Xuemei Liu
There is accumulating evidence that hyperuricemia is an independent risk factor for the development and progression of chronic kidney disease [29]. As is well known, sustained high serum concentrations of urate can result in the accumulation of urate crystals in the interstitial of the renal pulp and renal pyramids [30], and stimulates a series of inflammatory reactions to further develop kidney disease [31]. The mechanisms of uric acid-induced renal injury may involve inflammation, endothelial dysfunction, oxidative stress, mitochondrial dysfunction and activation of renin-angiotensin system [32–34]. However, the exact mechanism remains unidentified and there are few safe and effective therapeutic interventions for nephropathy induced by hyperuricemia. In the present study, a uric acid nephropathy rat model was established using adenine and potassium oxonate to investigate renoprotective effects of curcumin. This rodent animal model induced by adenine and potassium oxonate has been reported in the literature [35,36], and had been optimized in our laboratory.
Contrast enhanced ultrasound characterization of surgically resected renal masses in patients on dialysis
Published in Scandinavian Journal of Urology, 2019
Amanda E. Kahn, Andrew K. Ostrowski, Melanie P. Caserta, Isabella J. Galler, David D. Thiel
Due to high blood flow to the kidneys, the kidneys demonstrate rapid and intense uptake of UCA. The typical contrast enhancement pattern of the kidneys shows enhancement of the arteries followed by rapid fill in of the cortex and gradual fill of the renal pyramids. Ultrasound has excellent sensitivity for detection of UCA and is more sensitive than CECT in detecting blood flow to hypovascular masses [3,4]. CEUS is an excellent modality for evaluating indeterminate renal masses identified on computed tomography (CT) and MRI and it excels at characterizing indeterminate lesions as cystic or solid. Assessment of cystic renal lesions is another frequent application of CEUS. CEUS characterization of complex cystic masses is more sensitive than CT in detecting enhancement of internal septa, cyst wall enhancement, and enhancing solid components within the cyst [3,5,6]. There is an overlap between the enhancement features of benign and malignant solid renal lesions with ultrasound; however, there are some features suggestive of malignancy. Clear cell renal cell carcinoma typically demonstrates heterogeneous avid early enhancement, a peripheral rim of enhancement, and early washout. Conversely, papillary renal cell carcinoma is typically hypoenhancing to the renal cortex on all phases [6].
Renal papillary necrosis, an endoscopic vision
Published in Scandinavian Journal of Urology, 2019
Jorge Panach-Navarrete, María Medina-González, Lorena Alarcón-Molero, Eduardo Sánchez-Cano, Francisco Pastor-Hernández, José María Martínez-Jabaloyas
Renal papillary necrosis is an infrequent pathology, which has been etiologically related to an infection of the renal pyramids associated with renal vasculopathy or obstruction of the upper urinary tract. Patients with diabetes, sickle cell anemia, chronic alcoholism and vascular disease are especially susceptible to this complication [2]. Even though tests such as urinary sediment (where papillary fragments can be observed) or culture (to check for the presence of infection) are important for the diagnosis, its basis will be made with imaging tests.