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Kidney

The kidneys are the most important excretory organ in vertebrates. Medical terms related to the kidneys either involve renal or nephro-. Nephrology is the study of the kidneys.

Table of contents
1 Function
2 Basic anatomy
3 Diseases and disorders
4 Dialysis and kidney transplants
5 See also

Function

The major functions of the kidney are to filter wastes from the bloodstream and to regulate the pH, serum osmolality and blood pressure (and secondarily, the volume of the blood). The wastes are concentrated to form urine which is passed on to the bladder via the ureters.

The kidney also serves an endocrine function by secreting erythropoietin, a hormone that regulates red blood cell production in the bone marrow. Other hormones produced by the kidneys are renin, active form of vitamin D - 1,25-dihydroxycholecalciferol (calcitriol) and prostaglandins.

Basic anatomy

In humans the kidneys are the two organs that are located in the posterior part of the abdomen, on either side of the spine just below the liver and spleen on the right and left sides of the body respectively. Superior to each kidney is an adrenal gland (also called the suprarenal gland).

Kidneys viewed from behind with spine removed

The kidneys are retroperitoneal, which means they lie behind the peritoneum that surounds most of the other abdominal organs. They are approximately at the vertebral level T12 to L3, and the right kidney usually lies slightly lower than the left, due to the size of the liver.

The upper parts of the kidneys are protected somewhat by the eleventh and twelfth ribs, and each whole kidney is surrounded by two layers of fat, the perirenal fat and the pararenal fat, which help to cushion it.

Section of a kidney
In a normal human adult, each kidney is about 11 cm long and about 5 cm thick, weighing 150 grams. The kidneys are 'bean-shaped' organs, and have a concave side facing inwards (medially). On this medial aspect of each kidney is an opening, called the hilus, which admits the renal artery, the renal vein, nerves, and the ureter. A kidney is divided into a renal cortex, medulla and pelvis.

The basic functional unit of the kidney is the nephron, of which there are more than a million in each normal adult kidney. Nephrons regulate water and soluble substances (especially ions) in the body by filtering it all out first, reabsorbing what should be kept and excreting the rest. They use countercurrent exchange mechanisms. A nephron consists of a Bowman's capsule, a proximal convoluted tubule, a loop of Henle and a distal convoluted tubule which empties the urine into a collecting duct.

Terms

Diseases and disorders

Congenital diseases of the kidneys

Acquired diseases of the kidneys

Diagnosis

A simple means of estimating renal function is to measure serum
urea, creatinine and basic electrolytes (sodium and potassium). As the kidney is the most important organ in controlling these values, any derangement in these values would suggest renal impairment.

A more formal test of renal function would be to measure the glomerular filtration rate; usually a creatinine clearance test is performed.

Dialysis and kidney transplants

Generally, one can live fine with just one kidney. If both kidneys don't function properly, dialysis is performed, where the blood is filtered outside of the body. Kidney transplants are now also quite common. The first successful such transplant was announced on March 4, 1954 by Peter Bent Brigham Hospital in Boston.

See also