Examination of the Kidney

Ruthashini R Selvasingam 0902005207 The methods and detail for the investigation of the urogenital organs depends on the gender of the patient. There are two main techniques in examining the kidney which are the external and internal examination. An adult kidney measures approximately 11 6 3cm. The kidney of an adult men weighs around 150g, which is slightly lesser than the women. It would be difficult to recognise chronic disease of an atrophic kidney. A detail attention to the anatomical area with histology of the dominant soft tissue would help in identifying at least some residual parenchyma. Fats surrounding the kidney should be cleared away before weighing. On the internal examination, a longitudinal, sagittal slice is done with a largebladed knife, via the kidney from the convex area towards the hilum .The kidney must be held firmly, placing it on the flat dissecting board and anchored with a sponge using the non cutting hand as the blade is drawn across the kidney. Alternatively, the kidney can be held between the arms of large pair of forceps where the hilar surface faces down towards the dissection table or board with the peripheral surface facing the uppermost. The blade of the knife should be carefully positioned on the angle of the forceps and is moved downwards towards the hilum and dissecting board. Parenchyma would be easily demonstrated via this technique. This technique would allow assessment of the boundaries of cortical and medullary areas. As the slice is extended towards the pelvis, the hilar vessels can then be inspected. Any mass or material within the kidney and pelvis can be easily recognised. Stones should be removed and their size and quality must be noted. The kidney capsule should be held with toothed forceps where the incision has been made previously. The capsule should be lifted off the outer cortex and opened back to reveal the sub capsular surface. The appearance of the normal sub capsular surface will be smooth. The usual dissection of the kidney is concluded as follow where first remove the surrounding fat. Then slice through the convexity in a sagital direction followed by stripping of the capsule. Inspect the cortex and medulla subsequently. If required, blocks for histology can be taken. Special techniques can be used in examining kidneys containing tumours. Renal tumours can be visualized with the techniques described earlier unless the mass is extremely large and particularly if it invades perinephric tissue. The renal vein is inspected to identify vascular invasion which is a common feature of these tumours. It is suggested that renal vein should be assessed

histologically in cases of renal cell carcinoma. Examining the transplanted kidneys are slightly different as they are localed within the pelvis, " plumbed into" the iliac arterial and venous vessels. The kidney have to be removed in continuity with its vascular connections by dissecting it free and reflecting it medially while posterior adhesions are divided. Following this, the vessels are open to check sites of anastomoses if there is any intraluminal obstructions.