The cortex contains specialized capillaries called glomeruli, which, together with a series of tubules, make up the nephrons, the filtering units of the kidney. The nephrons filter blood under pressure and then selectively reabsorb water and certain other substances back into the blood. Urine is formed from substances that are not reabsorbed. The urine is conducted through tubules to the renal pelvis (the central collecting area of the kidney) and then through tubes called ureters to the bladder.
The kidneys also regulate the body’s fluid balance.
To do this, the kidneys excrete excess water, and when water is lost from the body (for example as a result of sweating), they conserve it (see ADH).
In addition, the kidneys control the body’s acid–base balance by adjusting urine acidity.
The kidneys are also involved in hormonal regulation of red blood cell production and blood pressure.... kidney
Adult kidneys have a smooth exterior, enveloped by a tough ?brous coat that is bound to the kidney only by loose ?brous tissue and by a few blood vessels that pass between it and the kidney. The outer margin of the kidney is convex; the inner is concave with a deep depression, known as the hilum, where the vessels enter. The URETER, which conveys URINE to the URINARY BLADDER, is also joined at this point. The ureter is spread out into an expanded, funnel-like end, known as the pelvis, which further divides up into little funnels known as the calyces. A vertical section through a kidney (see diagram) shows two distinct layers: an outer one, about 4 mm thick, known as the cortex; and an inner one, the medulla, lying closer to the hilum. The medulla consists of around a dozen pyramids arranged side by side, with their base on the cortex and their apex projecting into the calyces of the ureter. The apex of each pyramid is studded with tiny holes, which are the openings of the microscopic uriniferous tubes.
In e?ect, each pyramid, taken together with the portion of cortex lying along its base, is an independent mini-kidney. About 20 small tubes are on the surface of each pyramid; these, if traced up into its substance, repeatedly subdivide so as to form bundles of convoluted tubules, known as medullary rays, passing up towards the cortex. One of these may be traced further back, ending, after a tortuous course, in a small rounded body: the Malpighian corpuscle or glomerulus (see diagram). Each glomerulus and its convoluted tubule is known as a nephron, which constitutes the functional unit of the kidney. Each kidney contains around a million nephrons.
After entering the kidney, the renal artery divides into branches, forming arches where the cortex and medulla join. Small vessels come o? these arches and run up through the cortex, giving o? small branches in each direction. These end in a tuft of capillaries, enclosed in Bowman’s capsule, which forms the end of the uriniferous tubules just described; capillaries with capsule constitute a glomerulus.
After circulating in the glomerulus, the blood leaves by a small vein, which again divides into capillaries on the walls of the uriniferous tubules. From these it is ?nally collected into the renal veins and then leaves the kidney. This double circulation (?rst through the glomerulus and then around the tubule) allows a large volume of ?uid to be removed from the blood in the glomerulus, the concentrated blood passing on to the uriniferous tubule for removal of parts of its solid contents. Other arteries come straight from the arches and supply the medulla direct; the blood from these passes through another set of capillaries and ?nally into the renal veins. This circulation is con?ned purely to the kidney, although small connections by both arteries and veins exist which pass through the capsule and, joining the lumbar vessels, communicate directly with the aorta.
Function The kidneys work to separate ?uid and certain solids from the blood. The glomeruli ?lter from the blood the non-protein portion of the plasma – around 150–200 litres in 24 hours, 99 per cent of which is reabsorbed on passing through the convoluted tubules.
Three main groups of substances are classi?ed according to their extent of uptake by the tubules:
(1) SUBSTANCES ACTIVELY REABSORBED These include amino acids, glucose, sodium, potassium, calcium, magnesium and chlorine (for more information, see under separate entries).
(2) SUBSTANCES DIFFUSING THROUGH THE TUBULAR EPITHELIUM when their concentration in the ?ltrate exceeds that in the PLASMA, such as UREA, URIC ACID and phosphates.
(3) SUBSTANCES NOT RETURNED TO THE BLOOD from the tubular ?uid, such as CREATINE, accumulate in kidney failure, resulting in general ‘poisoning’ known as URAEMIA.... structure each kidney is about 10 cm long,
Kidney biopsy is performed to investigate and diagnose serious kidney disorders, such as glomerulonephritis, proteinuria, nephrotic syndrome, and acute kidney failure, or to assess the kidneys’ response to treatment.
There are 2 basic techniques: percutaneous needle biopsy, in which a hollow needle is passed through the skin into the kidney under local anaesthesia; and open surgery under general anaesthesia.... kidney biopsy
Formula. Corn Silk 3; Plantain (Plantago major L) 2; Golden Rod 1; Hydrangea 1; Valerian half. Dosage: thrice daily before meals. Liquid Extracts: 1 teaspoon. Tinctures: 2 teaspoons. Powders: two 00 capsules or one-third teaspoon. This may be used as a basic combination to be adapted to a changing clinical picture.
Treatment by a general medical practitioner or oncologist. ... cancer – kidney
Urinalysis is a simple test in which a urine sample is examined under a microscope for blood cells, pus cells, and casts (cells and mucous material that accumulate in the tubules of the kidneys and pass into the urine).
Urine may be tested for substances, such as proteins, that leak into the urine when the kidneys are damaged.
Kidney function can be assessed by measuring the concentration in the blood of substances, such as urea and creatinine, that the kidneys normally excrete.
Kidney function may also be assessed by kidney imaging techniques.... kidney function tests
Ultrasound scanning, CT scanning, and MRI are commonly used.
Radionuclide scanning may reveal cysts and tumours and show bile excretion.
X–ray techniques include cholangiography, cholecystography, and ERCP (endoscopic retrograde cholangiopancreatography).
In these procedures, a contrast medium, which is opaque to X-rays, is introduced to show abnormalities in the biliary system.
Angiography reveals the blood vessels in the liver.... liver imaging
Most lung disorders can be detected by chest X-ray.
CT scanning and MRI play an important role in detecting the presence and spread of lung tumours.
Ultrasound scanning is sometimes used to reveal pleural effusion.
Radioisotope scanning is used to detect evidence of pulmonary embolism.... lung imaging
cavities; it may be red or yellow. Red bone marrow is present in all bones at birth and is the factory for most of the blood cells. During the teens, red bone marrow is gradually replaced in some bones by less active yellow marrow. In adults, red marrow is confined chiefly to the spine, sternum, (breastbone), ribs, pelvis (hip-bones), scapulae (shoulderblades), clavicles (collarbones), and bones of the skull.
Stem cells within the red marrow are stimulated to form blood cells by the hormone erythropoietin.
Yellow marrow is composed mainly of connective tissue and fat.
If the body needs to increase its rate of blood formation, some of the yellow marrow will be replaced by red.
Sometimes marrow fails to produce sufficient numbers of normal blood cells, as occurs in aplastic anaemia (see anaemia, aplastic) or when marrow has been displaced by tumour cells.
In other cases, marrow may overproduce certain blood cells, as occurs in polycythaemia and leukaemia.... bone imaging
scanning gives images of the brain substance; it gives clear pictures of the ventricles (fluid-filled cavities) and can reveal tumours, blood clots, strokes, aneurysms, and abscesses. is especially helpful in showing tumours of the posterior fossa (back of the skull). and scanning are specialized forms of radionuclide scanning that use small amounts of radioactive material to give information about brain function as well as structure. They enable
blood flow and metabolic activity in the brain to be measured.
Ultrasound scanning is used only in premature or very young babies since ultrasound waves cannot penetrate the bones of a mature skull.... brain imaging
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Echocardiography is useful for investigating congenital heart defects and abnormalities of the valves or heart wall. An ultrasound technique using the Doppler effect allows measurement of blood flow through valves. Radionuclide scanning and CT scanning provide information about the efficiency of heart function. Angiography may be used to show the heart chambers and to assess the condition of the coronary arteries and valves. High-quality images of the heart can be obtained by MRI.... heart imaging
Polycystic kidney disease is distinguished from multiple simple kidney cysts, which occur commonly with age.
There are 2 types of polycystic disease.
The most common usually becomes apparent in middle age, producing abdominal swelling, pain, and blood in the urine.
As the disease progresses, hypertension and kidney failure may result.
The rare type causes enlargement of the kidneys and kidney failure in infants and young children.
There is no effective treatment for preserving kidney function in either type, but symptoms of kidney failure can be treated by dialysis and kidney transplant.... kidney, polycystic