By Gauri Kulkani Kasturba medical college

1. 60 year old male came with
complains of painless hematuria
and a palpable abdominal lump

2. ANATOMY
- Retroperitoneal organ
- Right kidney L1-L3
- Left kidney T12-L2
Left kidney is little nearer to median plane than right
The kidneys are mobile organs that move vertically within
the retroperitoneum during normal respiration
external features
Shape:bean shaped
2 poles: upper & lower
2 Border: medial & lateral
2 Surface: anterior & posterior
Size: approx. 11–14 cm in length, 6 cm wide and 3cm thick
Weight: around 150 gm. in males & 135 gm. in females

3. RELATIONS
Anterior posterior

4. Coverings and Hilum of the kidney

5. Blood Supply
• Arterial supply by the renal arteries which are direct branches from abdominal aorta
• Entire arterial system is composed of end artries hence prone for infarction
• Venous drainage through the renal veins which drains into the inferior vena cava.
• veins anastomose freely
• Lymph Drainage
• The right kidney drains predominantly into the paracaval and interaortocaval lymph nodes
• left kidney drains exclusively to the para-aortic lymph nodes
• Nerve Supply:
• Through renal sympathetic plexus (T10 – L1) fibres, mainly vasomotor.
• Afferent nerves T10 to T12 thoracic nerves.
• Functions
• Excretion of wastes,
• Acid-base homeostasis,
• Osmolality regulation, Blood pressure regulation and Hormone secretion

6. INTERNAL STRUCTURES

7. DIFFERENTIAL DIAGNOSIS OF HEMATURIA
KEY POINT
-painless hematuria (papilloma and
carcinoma)
-Age –elederly (RCC)
-abdominal lump (polycyctic kidney ,
wilms tumor,
Renal cell carcinoma)

8. NEOPLAMS OF THE KIDNEY
• Benign
• Adenoma
• Papilloma arising from pelvis
• Hemangioma
• Malignant
• Renal Cell Carcinoma (Adenocarcinoma of Kidney)-MOST COMMON
• Transistional cell carcinoma
• Squamous cell carcinoma –EXTREMELY RARE

9. RENAL CELL CARCINOMA
• It is also called Hypernephroma or Grawitz tumor
• Commonly found in age group of 40 to 60 years
• Predominantly seen in males
• Aetiology :specific oncogenes are associated with different variants of
RCC
Clear cell
75%
Type
Incidence
Associated
mutations VHL
Papillary type 1
5%
c-Met
Papillary type 2
10%
FH
Chromophobe
5%
BHD
Oncocytoma
5%
BHD

10. Risk Factors
• Tobacco smoking
contributes to 24-30% of RCC cases
Tobacco results in a 2-fold increased risk
Environmental:
Cadmium, thorium-di-oxide,
petroleum
aresenic
phenacetin analgesics.
Occupational:
Leather workers
Asbestos workers
10

11. PATHOLOGY
• Nearly all renal cancers In adults are adenocarcinomas
• They arise from the proximal tubular epithelium
• Starts in one of the poles and usually ruptures outside
the capsule hence the reniform shape of the kidney is
maintained unlike wilms tumor.
• On the outer surface it is homogenous and yellow in
color
• Microscopically alternate clear cells and dark cells are
seen
• Tumor cells line the blood vessels which are
responsible for early blood spread.

12. THANK YOU
• Gauri Kulkarni