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THE NETTER COLLECTION
of Medical Illustrations
Second Edition

Reproductive System
Endocrine System
Respiratory System
Integumentary System
Urinary System
Musculoskeletal System
Digestive System
Nervous System

Cardiovascular System


The ultimate Netter
Collection is back!
Netter’s timeless work, now arranged
and informed by modern text and
radiologic imaging!
The long-awaited update of The Netter Collection of Medical
Illustrations,
Illustr
ations, also known as the CIB
CIBA
A “gr
“green
een books,” is now
becoming a reality! Master artist-ph
artist-ph
tist-physician,
ysician, Carlos Machado,
and other top medical illustrators
illustrators hav
have
e teamed-u
teamed-up
p wit
with
h
medical experts to mak
make
e the classic Netter “gr
“green
een books” a
reliable
reliab
le and effective
effective current-da
current-da
rent-day
y reference
reference
nce..
• Apply a visual approach—with the classic
classic Netter
Netter art, updated
illustrations,
illustr
ations, and modern imaging-- to normal and abnor
abnormal
mal body
function and the clinical presentation of the patient.
• Cle
Clearly
arly see
see the connection betw
betw
etween
een basic
basic and clinical science
science
ncess
with an integrated overview of each body system.
• Get a quick understanding of comple
complex
x topics thr
through
ough a concise
text-atlas format that provides a context bridge betw
between
een gener
general
al and
specialized medicine
medicine..

25'(5<285672'$<
Learn more about the series at www.NetterReference.com/greenbooks
$60$
$60$
*&5*
&5-2
&52


Presenting the latest editions of…
Now also available!
Netter’s Anatomy
Atlas for iPad

Get it today!
Frank H. Netter, MD
Atlas of Human Anatomy,
5th Edition, 9781416059516

John T. Hansen, PhD
Netter’s Anatomy Flash Cards,
3rd Edition, 9781437716757

More great Netter resources...
FLASH CARDS
Ź Netter’s Musculoskeletal Flash Cards, 9781416046301
Ź Netter’s Advanced Head & Neck Flash Cards, 9781416046318
Ź Netter’s Physiology Flash Cards, 9781416046288
Ź Netter’s Histology Flash Cards, 9781416046295
Ź Netter’s Neuroscience Flash Cards, 2nd Edition, 9781437709407
HANDBOOKS/POCKETBOOKS
Ź Netter’s Clinical Anatomy, 2nd Edition, 9781437702729
Ź Netter’s Concise Radiologic Anatomy, 9781416056195
Ź Netter’s Concise Orthopaedic Anatomy, 2nd Edition, 9781416059875
Ź Netter’s Concise Neuroanatomy, 9781933247229
Ź Netter’s Surgical Anatomy Review P.R.N., 9781437717921

Get Netter’s Anatomy Atlas for the iPad and Netter flash card apps!
Available at the iTunes App Store

Netter transforms your perspective. It’s how you know.
Browse our complete collection of Netter titles - mynetter.com


V O L U ME 5

The Netter Collection
OF MEDICAL ILLUSTRATIONS

Urinary System
2nd Edition
A compilation of paintings prepared by
FRANK H. NETTER, MD
Edited by

Christopher R. Kelly, MD
Postdoctoral Residency Fellow
Department of Medicine
NewYork–Presbyterian Hospital
Columbia University Medical Center
New York, New York

Jaime Landman, MD
Professor of Urology and Radiology
Chairman, Department of Urology
University of California Irvine
Irvine, California

Additional Illustrations by Carlos A. G. Machado, MD
CONTRIBUTING ILLUSTRATORS

John A. Craig, MD
James A. Perkins, MS, MFA
Tiffany S. DaVanzo, MA, CMI
Anita Impagliazzo, MA, CMI


THE NETTER COLLECTION OF MEDICAL ILLUSTRATIONS:
URINARY SYSTEM, Volume 5, Second Edition

978-1-4377-2238-3

Copyright © 2012 by Saunders, an imprint of Elsevier Inc.
No part of this publication may be reproduced or transmitted in any form or by any means, electronic
or mechanical, including photocopying, recording, or any information storage and retrieval system,
without permission in writing from the publisher. Details on how to seek permission, further
information about the Publisher’s permissions policies and our arrangements with organizations such as
the Copyright Clearance Center and the Copyright Licensing Agency, can be found at our website:
www.elsevier.com/permissions.
This book and the individual contributions contained in it are protected under copyright by the
Publisher (other than as may be noted herein).
Permissions for Netter Art figures may be sought directly from Elsevier’s Health Science Licensing
Department in Philadelphia PA, USA: phone 1-800-523-649, ext. 3276 or (215) 239-3276; or email
H.Licensing@elsevier.com.

Notices
Knowledge and best practice in this field are constantly changing. As new research and experience
broaden our understanding, changes in research methods, professional practices, or medical
treatment may become necessary.
Practitioners and researchers must always rely on their own experience and knowledge in
evaluating and using any information, methods, compounds, or experiments described herein. In
using such information or methods they should be mindful of their own safety and the safety of
others, including parties for whom they have a professional responsibility.
With respect to any drug or pharmaceutical products identified, readers are advised to check the
most current information provided (i) on procedures featured or (ii) by the manufacturer of each
product to be administered, to verify the recommended dose or formula, the method and duration of
administration, and contraindications. It is the responsibility of practitioners, relying on their own
experience and knowledge of their patients, to make diagnoses, to determine dosages and the best
treatment for each individual patient, and to take all appropriate safety precautions.
To the fullest extent of the law, neither the Publisher nor the authors, contributors, or editors,
assume any liability for any injury and/or damage to persons or property as a matter of products
liability, negligence or otherwise, or from any use or operation of any methods, products,
instructions, or ideas contained in the material herein.
ISBN: 978-1-4377-2238-3

Acquisitions Editor: Elyse O’Grady
Developmental Editor: Marybeth Thiel
Editorial Assistant: Chris Hazle-Cary
Publishing Services Manager: Patricia Tannian
Senior Project Manager: John Casey
Design Manager: Lou Forgione

Working together to grow
libraries in developing countries
Printed in China
Last digit is the print number: 9 8 7 6 5 4 3 2 1

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ABOUT THE SERIES

D

Dr. Frank Netter at work.

The single-volume “blue book” that paved the way for the
multivolume Netter Collection of Medical Illustrations
series affectionately known as the “green books.”

THE NETTER COLLECTION OF MEDICAL ILLUSTRATIONS

r. Frank H. Netter exemplified the
distinct vocations of doctor, artist,
and teacher. Even more important—
he unified them. Netter’s illustrations
always began with meticulous research
into the forms of the body, a philosophy
that steered his broad and deep medical
understanding. He often said: “Clarification is the goal. No matter how beautifully it is painted, a medical illustration
has little value if it does not make clear
a medical point.” His greatest challenge
and greatest success was charting a
middle course between artistic clarity
and instructional complexity. That success is captured in this series, beginning
in 1948, when the first comprehensive
collection of Netter’s work, a single
volume, was published by CIBA Pharmaceuticals. It met with such success that over the
following 40 years the collection was expanded into
an 8-volume series—each devoted to a single body
system.
In this second edition of the legendary series, we are
delighted to offer Netter’s timeless work, now arranged
and informed by modern text and radiologic imaging
contributed by field-leading doctors and teachers from
world-renownedmedical institutions, and supplemented with new illustrations created by artists working
in the Netter tradition. Inside the classic green covers,
students and practitioners will find hundreds of original
works of art—the human body in pictures—paired with
the latest in expert medical knowledge and innovation
and anchored in the sublime style of Frank Netter.
Noted artist-physician, Carlos Machado, MD, the
primary successor responsible for continuing the Netter
tradition, has particular appreciation for the Green
Book series. “The Reproductive System is of special significance for those who, like me, deeply admire Dr. Netter’s
work. In this volume, he masters the representation of
textures of different surfaces, which I like to call ‘the
rhythm of the brush,’ since it is the dimension, the direction of the strokes, and the interval separating them that
create the illusion of given textures: organs have their
external surfaces, the surfaces of their cavities, and
texture of their parenchymas realistically represented. It
set the style for the subsequent volumes of Netter’s Collection—each an amazing combination of painting masterpieces and precise scientific information.”
Though the science and teaching of medicine endures
changes in terminology, practice, and discovery, some
things remain the same. A patient is a patient. A teacher
is a teacher. And the pictures of Dr. Netter—he called
them pictures, never paintings—remain the same blend
of beautiful and instructional resources that have guided
physicians’ hands and nurtured their imaginations for
more than half a century.
The original series could not exist without the dedication of all those who edited, authored, or in other
ways contributed, nor, of course, without the excellence
of Dr. Netter. For this exciting second edition, we also
owe our gratitude to the Authors, Editors, Advisors,
and Artists whose relentless efforts were instrumental
in adapting these timeless works into reliable references
for today’s clinicians in training and in practice. From
all of us with the Netter Publishing Team at Elsevier,
we thank you.

CUSHING’S SYNDROME IN A PATIENT WITH THE CARNEY COMPLEX

Carney complex is characterized
by spotty skin pigmentation.
Pigmented lentigines and blue
nevi can be seen on the face–
including the eyelids, vermillion
borders of the lips, the
conjunctivae, the sclera–and the
labia and scrotum.
Additional features of the
Carney complex can include:
Myxomas: cardiac atrium,
cutaneous (e.g., eyelid),
and mammary
Testicular large-cell
calcifying Sertoli cell tumors
Growth-hormone
secereting pituitary adenomas
Psammomatous
melanotic schwannomas

PPNAD adrenal glands are usually of normal size and most are
studded with black, brown, or red nodules. Most of the pigmented
nodules are less than 4 mm in diameter and interspersed in the
adjacent atrophic cortex.

A brand new illustrated plate painted by Carlos Machado,
MD, for The Endocrine System, Volume, 2e.

Dr. Carlos Machado at work.

v


ABOUT THE EDITORS

C

hristopher Rehbeck Kelly, MD, is a postdoctoral residency fellow in the Department of Medicine at New York–Presbyterian/Columbia University
Medical Center. He received his undergraduate education at Columbia College, where he was elected to Phi
Beta Kappa, and his medical education from Columbia
College of Physicians and Surgeons, where he was
named valedictorian, elected to Alpha Omega Alpha,
and awarded the Izard Prize in Cardiology. He has
authored numerous original scientific research papers
and review articles. In addition, he has published a
cookbook entitled Mantra with chef Jehangir Mehta, as
well as articles about popular culture for Spin and
Rolling Stone magazines. He is also a former producer
and writer for The Dr. Oz Show on both syndicated
television and satellite radio. He lives in New York City
with his wife, Leah, and their two dogs.

vi

J

aime Landman, MD, is Professor of Urology
and Radiology and Chairman of the Department
of Urology at the University of California, Irvine. Dr.
Landman is an expert in minimally invasive urology
and kidney cancer and has published over 180 peerreviewed manuscripts on these topics. Dr. Landman
received his undergraduate education at the University
of Michigan, his medical education at the Columbia
University College of Physicians and Surgeons, and
then completed his internship (in General Surgery)
and residency (Urology) at Mount Sinai Hospital in
New York City. He then completed a fellowship in
minimally invasive urology under Dr. Ralph V. Clayman
at Washington University and remained there as the
Director of Minimally Invasive Urology. He returned to
New York to the Columbia University Department of
Urology, where he spent 6 years before taking his
current position as the Chairman of the University of
California, Irvine. He is married to his wonderful wife,
Laura (who he does not deserve), and has one beautiful
daughter, Alexandra Sofia.

THE NETTER COLLECTION OF MEDICAL ILLUSTRATIONS


PREFACE

A

ll physicians have at some point in their career
studied the illustrations of Frank Netter. His Atlas
of Human Anatomy is indisputably one of the most
beloved books in medicine, to the point that purchasing
it has become a rite of passage for a new medical
student.
Many are unaware, however, that the Atlas represents
only a tiny fraction of the illustrations Netter created
during his lifetime. In fact, during his long and productive career, he produced over 20,000 illustrations
depicting the anatomy, histology, physiology, and
pathology of nearly every organ system.
Many of these illustrations were first published
several decades ago in the “green book” series. The
original edition of this volume—known as Kidneys,
Ureters, and Bladder—covered an impressive number of
topics, ranging from nephrotic syndrome to nephrectomy. Since its last revision in 1973, however, innumerable advances have been made in the fields of nephrology
and urology. As a result, even though the original
edition has retained its historical importance, it has lost
much of its relevance to the modern clinician.
In this new edition, we have attempted to reframe
Netter’s illustrations in the context of modern clinical
practice. We have reorganized the various components
of his illustrations based on current clinical concepts,
and we have complemented them with hundreds of new
radiographic and pathologic images.
In many instances, we have been struck by how accurate many of the original illustrations remain. As Netter
himself once said, “anatomy hasn’t changed, but our
perceptions of it have.” Indeed, even as we understand

THE NETTER COLLECTION OF MEDICAL ILLUSTRATIONS

disease processes in new ways, their appearance remains the same. Some important new concepts,
however, Netter could not possibly have foreseen. In
these instances we have relied on his talented team of
successors, who have created many new illustrations for
this edition.
We have tried to make the text, like the illustrations, both lucid enough for a medical student yet
sophisticated enough for an experienced clinician. By
editing the text from opposite poles of the professional
spectrum—one of us is a professor and department
chairman, the other a medical intern—we have tried to
ensure this would happen by design, and not by hopeful
accident. Nonetheless, given the rapid pace of discovery, we expect the text will not age nearly as well as the
illustrations.
We would like to thank the many talented physicians
and scientists who contributed to this book. We are
particularly indebted to Jai Radhakrishnan, Jeffrey
Newhouse, Leal Herlitz, Arthur Dalley, and Peter
Humphrey for their extensive and tireless efforts.
We would also like to thank our families—and especially our wives, Leah Kelly and Laura Landman—for
their patience and support during the 2 years we spent
writing and editing this book.
Christopher R. Kelly, MD
New York, New York
Jaime Landman, MD
Irvine, California
November 2011

vii


ABOUT THE ARTIST FROM THE FIRST EDITION

W

hen you first meet Frank Netter, you are a little
surprised. You expect a man who has devoted a
lifetime to painting such magnificent medical art to be
outgoing, talkative, bursting with ideas. Instead, Frank
Netter is quiet, reserved, almost reticent. To carry the
conversation, you appear to do all the talking, he speaks
little, listens a lot. Slowly, you realize that the greatest
talent of this world famous physician-artist is neither
medical nor artistic. For Frank H. Netter, MD, is perhaps the world’s greatest interpreter and communicator
of medical knowledge through the medium of art. To
interpret he must understand, to understand he must
absorb information, and so he listens.
As a means of communication, art is as old as
civilization. Long before human beings created the
written word they left their messages on the walls of
caves. Throughout history, art has been one form of

viii

expression capable of traversing the barriers of language, culture, and time in order to communicate. An
artist who chooses to use brush and canvas leaves a part
of his inner self in the medium. His message may be
simple, direct, obvious, and reach many, or it may be
complex, hidden, obscure, and touch only a few.
When young Frank Netter studied at the Sorbonne,
he was very much an artist. His canvases were the
expressions of his essence. When young Dr. Netter
savored the beauty of the East River and the Brooklyn
skyline from a window of Bellevue Hospital, the artist’s
love of form and color and life guided his spirit. With
the skill and talent of an artist his hands expressed what
his eyes saw and his soul felt, and when he finished, a
part of him lay infused in the oils on the canvas. When,
as a practicing physician in New York, the still young
Dr. Netter painted a memorable series of paintings
capturing events in the education of a physician, the
artist was still very much at work. The paintings individually communicated joy, sadness, nostalgia, pathos,
and inspiration. There was added, though, another
dimension—realism—bold, factual, blunt realism.
Patients were very much patients and artistic license
was not taken for the sake of emotional impact.
Those paintings, a curious blend of great artistic sensitivity in a setting of stark clinical realism, document
the true turning point in Frank Netter’s life. Previously,
the artist Netter wrestled with the physician Netter for
his time and talents. He had been the artist who had
become the physician, the physician who had been parttime artist, but before that series of paintings never
really both at once.
During the next few pre-World War II years Frank
Netter evolved into a new breed of man, unlike any
before him, capable of portraying the clinical scene with
the skill of the artist and the coolness of the surgeon. If
important to the clinical setting, a patient’s emotional
reactions to illness and suffering would command
the viewer’s attention, but the viewer would never be

lured into an emotional association with the scene.
Artistic license might be taken with shadows and
highlights to make a medical point, time might be
compressed to show the dynamic continuance of
clinical disease, but always the message was clear.
Always the clinical detachment, the hallmark of medical
objectivity, remained. Accuracy was never compromised for effect.
Frank Netter maintains a tremendous mental pace.
In 25 years he has produced in excess of 2,300 paintings,
a rate which means a new painting every four days,
day in, day out, week after week, month after month.
Each painting is detailed, thorough, accurate. Each is
researched, planned, sketched, checked, rethought, and
painted for the sole purpose of transmitting thoughts.
Each communicates a vast amount of data, and uniquely
stands alone, it needs no previous or subsequent paintings to support it. Yet each painting is a part of the
overall scheme conceived years ago to portray the total
world of medical science, organ by organ, system by
system.
Not even Dr. Netter is capable of knowing all there
is to know about the human body. Where once he relied
on personal reading and literature research as sources
of knowledge for a painting, now the emphasis is
on direct contact with a recognized expert in a particular field. The consultant speaks, Netter listens, and
Netter becomes the extension of the mind of the consultant. The process is repeated continuously. Throughout the world there exists a group of distinguished
leaders in medicine and the biologic sciences who are
the collaborators and consultants to Dr. Netter and the
CIBA COLLECTION. United by the common goals
of learning, teaching, and research, this geographically
scattered group has one additional bond of unity—its
association with Frank H. Netter, MD, the dean of a
university without walls, the teacher who listens.
Robert K. Shapter, MD, CM

THE NETTER COLLECTION OF MEDICAL ILLUSTRATIONS


INTRODUCTION TO THE FIRST EDITION

I

t is now more than 25 years since I began preparing
the series of volumes entitled THE CIBA COLLECTION OF MEDICAL ILLUSTRATIONS. As originally conceived, the series was to depict, system by
system, the anatomy, embryology, physiology, pathology, pathologic physiology, and pertinent clinical features of diseases of the entire human organism. As I
progressed through the volumes, I continually postponed the day when I would attempt to portray the
kidneys and urinary tract. Since so much progress was
being made in the study of these organs and their disorders, I hoped that the discrepancies in our knowledge
would be rectified, the inconsistencies in our theories
clarified, and the differences in our interpretations and
opinions resolved. Miraculously, through the persistent
endeavors of many brilliant and devoted researchers,
clinicians, and surgeons throughout the world, this took
place.
Nevertheless, when the day came to begin this
volume, I found that, because of the tremendous progress, my task had become not easier and simpler, but
more difficult and involved. With each discovery, new
vistas of exploration had appeared, with each clarification, new avenues of investigation had opened. Indeed,
progress in clinical nephrology often necessitated
reevaluation of formerly established concepts. Even
renal anatomy, once thought of as a static subject, had
been completely restudied to provide the more precise

THE NETTER COLLECTION OF MEDICAL ILLUSTRATIONS

comprehension of nephron structure, organization, and
blood supply needed for better understanding of normal
and abnormal kidney function.
Technology had also progressed. For example, the
electron microscope had not only greatly enlarged our
knowledge of renal structure and pathology, but it had
also improved our visualization of the underlying processes in many renal disorders. The whole field of dialysis had opened and kidney transplantation had become
a practical reality. New renal function tests had been
devised and new technics for urine examination developed. The field of renal radiology had greatly expanded
and radioactive scanning had been utilized as a valuable
diagnostic tool.
This incredible progress as well as the clinical aspects
of the many renal and urinary tract disorders required
illustration. In this volume, I have included a number
of illustrative flow charts depicting the common clinical
course of renal diseases such as acute and chronic glomerulonephritis. In my efforts to portray the kidney, I
found I could not consider either it or nephrology as
an isolated study because kidney function is intimately
related to function of other organ systems, and to
bodily function in general. The circulatory, endocrine,
and metabolic systems are particularly involved, and
progress in the study of these fields has meant progress
in nephrology. It was necessary to consider kidney function and kidney disease in relation to such topics as

hypertension, renin, angiotensin, aldosterone, other
cortical hormones, pituitary hormones, parathyroid
function, inborn metabolic errors, immunologic factors,
homeostasis, and water and electrolyte balance.
The task with which I was faced was thus truly formidable. Its accomplishment was only made possible by
the gracious and devoted help of the many distinguished
collaborators and consultants who are credited individually on other pages of this volume. I wish to express
here my sincere appreciation for their help and for the
time which they gave me despite their busy schedules,
as well as to express my admiration for their knowledge
and wisdom. I especially thank Dr. E. Lovell “Stretch”
Becker and Dr. Jacob “Jack” Churg. They guided me
through this project, and their devotion to it was a
source of stimulation. The close cooperation of the
editor, Dr. Robert K. Shapter, who took over in “midstream” from Dr. Fredrick Yonkman, was most gratifying. There were many others who lightened the burden
of this endeavor in various ways, but foremost among
these was Miss Louise Stemmle, production editor.
Underlying the creation of this and the other volumes
of this series has been the vision, understanding, and
unreserved backing of CIBA Pharmaceutical Company
and its executives who have given me so free a hand in
this work.
Frank H. Netter, MD

ix



We dedicate this book to our parents––
Robert and Anna Kelly
and Fevus and Klara Landman—
who inspired our dreams
of becoming physicians,
then gave us the resources, support,
and confidence to pursue them.

Robert and Anna Kelly

Fevus and Klara Landman


ADVISORY BOARD

James D. Brooks, MD
Associate Professor of Urology
Stanford University School of Medicine
Stanford, California

Abhay Rané, MS, FRCS (Urol)
Consultant, Urological Surgeon
East Surrey Hospital
Redhill, Surrey, United Kingdom

Marius Cloete Conradie, MB ChB, FC (Urol)
Head of Department of Urology
Pietermaritzburg Metropolitan
President of Southern African Endourology Society
Berea, KwaZulu-Natal, South Africa

Eduardo Cotecchia Ribeiro
Associate Professor
Morphology and Genetics Department
Federal University of São Paulo School of Medicine
São Paulo, Brazil

Francis Xavier Keeley, Jr., MD, FRCS (Urol)
Consultant Urologist
Bristol Urological Institute
Bristol, United Kingdom

xii

THE NETTER COLLECTION OF MEDICAL ILLUSTRATIONS


CONTRIBUTORS

EDITORS-IN-CHIEF

Christopher R. Kelly, MD
Postdoctoral Residency Fellow
Department of Medicine
NewYork–Presbyterian Hospital
Columbia University Medical Center
New York, New York
Plates 1-18–1-27, 2-1–2-35, 3-1–3-24, 3-27, 3-28, 4-1,
4-2, 4-14, 4-15, 4-32–4-34, 4-36, 4-37, 4-61, 4-62,
6-1, 6-2, 6-7, 9-1–9-10, 10-1–10-6, 10-12,
10-17–10-34, 10-36–10-40
Jaime Landman, MD
Professor of Urology and Radiology
Chairman, Department of Urology
University of California Irvine
Irvine, California
Plates 2-14, 2-19, 2-20, 6-1, 6-2, 6-7, 9-1–9-6, 9-9,
9-10, 10-12, 10-17–10-25, 10-33, 10-34,
10-36–10-40
SENIOR EDITORS

Arthur Dalley, PhD
Professor, Cell & Developmental Biology
Director, Structure, Function, and Development
Vanderbilt University School of Medicine
Nashville, Tennessee
Plates 1-1–1-17
Leal Herlitz, MD
Assistant Professor of Clinical Pathology
Division of Renal Pathology
Department of Pathology and Cell Biology
NewYork–Presbyterian Hospital
Columbia University Medical Center
New York, New York
Plates 2-15, 2-16, 4-26, 4-27, 4-63, 10-26–10-32
Plates 1-20, 4-9–4-11, 4-14, 4-15, 4-24, 4-25, 4-27,
4-31, 4-50–4-52, 4-54, 4-59, 4-63, 10-28, 10-30–
10-32 (imaging)

Jeffrey Newhouse, MD
Professor of Radiology and Urology
Director, Division of Abdominal Radiology
NewYork–Presbyterian Hospital
Columbia University Medical Center
New York, New York
Plates 4-35, 9-1, 9-2
Plates 1-4, 1-12, 2-5, 2-9, 2-11, 2-14, 2-16–2-18, 2-25,
2-27, 2-33, 5-8, 5-10, 5-12, 6-2, 6-5–6-7, 7-1–7-5,
9-1–9-3, 9-9, 9-12 (imaging)
Jai Radhakrishnan, MD, MS
Associate Professor of Clinical Medicine
Division of Nephrology
Department of Medicine
NewYork–Presbyterian Hospital
Columbia University Medical Center
New York, New York
Plates 4-1–4-15, 4-19–4-25, 4-28–4-31, 4-35,
4-38–4-41, 4-45–4-54, 4-61, 4-62, 4-66–4-70, 10-7,
10-8, 10-26–10-32
ASSOCIATE EDITORS

Adam C. Mues, MD
Assistant Professor
Department of Urology
New York School of Medicine
New York, New York
Plates 2-14, 6-1, 6-2, 6-7, 9-1–9-6, 9-9, 9-10, 10-12,
10-17–10-25, 10-33, 10-34, 10-36–10-40
Amay Parikh, MD, MBA, MS
Instructor in Clinical Medicine
Division of Nephrology
Department of Medicine
NewYork–Presbyterian Hospital
Columbia University Medical Center
New York, New York
Plates 4-40, 4-41, 10-9–10-11
CONTRIBUTORS

Peter A. Humphrey, MD, PhD
Ladenson Professor of Pathology and Immunology
Professor of Urologic Surgery
Chief, Division of Anatomic and Molecular Pathology
Washington University School of Medicine
St. Louis, Missouri
Plates 1-18–1-27, 9-1–9-6, 9-9–9-13
Antoine Khoury, MD
Chief of Pediatric Urology
Professor of Urology
University of California, Irvine
Irvine, California
Plates 2-21, 2-22, 2-26–2-29
Plate 2-35 (imaging)

Gina M. Badalato, MD
Resident, Department of Urology
NewYork–Presbyterian Hospital
Columbia University Medical Center
New York, New York
Plates 8-1–8-5
Gerald Behr, MD
Assistant Professor of Clinical Radiology
Department of Radiology
NewYork–Presbyterian Hospital
Columbia University Medical Center
New York, New York
Plate 9-7 (imaging)
Mitchell C. Benson, MD
George F. Cahill Professor and Chairman
Department of Urology
NewYork–Presbyterian Hospital
Columbia University Medical Center
New York, New York
Plates 9-11–9-13

THE NETTER COLLECTION OF MEDICAL ILLUSTRATIONS

Sara L. Best, MD
Assistant Professor
Department of Urology
University of Wisconsin School of Medicine and
Public Health
Madison, Wisconsin
Plates 6-3–6-5
Nahid Bhadelia, MD, MS
Assistant Professor of Medicine
Section of Infectious Diseases
Department of Medicine
Boston University School of Medicine
Boston, Massachusetts
Plates 5-1–5-12
Andrew S. Bomback, MD, MPH
Assistant Professor of Clinical Medicine
Division of Nephrology
Department of Medicine
NewYork–Presbyterian Hospital
Columbia University Medical Center
New York, New York
Plates 4-5–4-9, 4-12, 4-13
Steven Brandes, MD
Professor of Surgery
Director, Section of Reconstructive Urology
Division of Urologic Surgery
Department of Surgery
Washington University Medical Center
St. Louis, Missouri
Plates 7-1–7-5
Plate 2-13 (imaging)
Dennis Brown, MD, PhD
Professor of Medicine, Harvard Medical School
Director, MGH Program in Membrane Biology
MGH Center for Systems Biology and Division of
Nephrology
Massachusetts General Hospital
Simches Research Center
Boston, Massachusetts
Plate 1-26 (imaging)
Pietro Canetta, MD
Assistant Professor of Clinical Medicine
Division of Nephrology
Department of Medicine
NewYork–Presbyterian Hospital
Columbia University Medical Center
New York, New York
Plates 4-19–4-24, 4-49–4-52
Carmen R. Cobelo, MD
Nephrology Fellow
Hospital Regional
Universitario Carlos Haya
Malaga, Spain
Plates 4-8, 4-9

xiii


Contributors
Kimberly L. Cooper, MD
Assistant Professor
Co-Director of Voiding Dysfunction, Incontinence,
and Urodynamics
NewYork–Presbyterian Hospital
Columbia University Medical Center
New York, New York
Plates 8-1–8-5
Vivette D’Agati, MD
Professor of Pathology
Division of Renal Pathology
Department of Pathology and Cell Biology
NewYork–Presbyterian Hospital
Columbia University Medical Center
New York, New York
Plates 4-55–4-57
Alberto de Lorenzo, MD
Nephrology Fellow
Hospital Universitario de La Princesa
Universidad Autónoma de Madrid
Madrid, Spain
Plates 4-12, 4-13
Gerald F. DiBona, MD
Professor
Departments of Internal Medicine and Molecular
Physiology & Biophysics
University of Iowa Carver College of Medicine
Iowa City, Iowa
Plates 1-14–1-16
William A. Gahl, MD, PhD
Clinical Director, National Human Genome Research
Institute
Head, Section on Human Biomedical Genetics,
Medical Genetics Branch
Head, Intramural Program, Office of Rare Diseases
National Institutes of Health
Bethesda, Maryland
Plates 4-64, 4-65
Anjali Ganda, MD, MS
Instructor in Clinical Medicine
Division of Nephrology
Department of Medicine
NewYork–Presbyterian Hospital
Columbia University Medical Center
New York, New York
Plates 4-38, 4-39
James N. George, MD
George Lynn Cross Professor
Departments of Medicine, Biostatistics &
Epidemiology
University of Oklahoma Health Sciences Center
Oklahoma City, Oklahoma
Plates 4-32–4-34
Mythili Ghanta, MBBS
Assistant Professor of Internal Medicine
Section of Nephrology
Department of Internal Medicine
Wake Forest University School of Medicine
Winston-Salem, North Carolina
Plates 4-35, 4-47, 4-48

xiv

Joseph Graversen, MD
Fellow, Minimally Invasive Urology
Department of Urology
University of California Irvine
Irvine, California
Plates 10-39, 10-40
Mohan Gundeti, MB MS, MCh
Associate Professor of Urology in Surgery and
Pediatrics
Director, Pediatric Urology
Director, The Center for Pediatric Robotic and
Minimal Invasive Surgery
University of Chicago, Comer Children’s Hospital
Chicago, Illinois
Plates 6-6, 10-16
Mantu Gupta, MD
Associate Professor
Director, Endourology
Director, Kidney Stone Center
Department of Urology
NewYork–Presbyterian Hospital
Columbia University Medical Center
New York, New York
Plates 10-13–10-15
Fiona Karet, MB, BS, PhD
Professor of Nephrology
Department of Medicine
University of Cambridge
Cambridge Institute for Medical Research
Cambridge, United Kingdom
Plates 3-25, 3-26
Anna Kelly, MD
Assistant Professor of Clinical Radiology
NewYork–Presbyterian Hospital
Columbia University Medical Center
New York, New York
Plate 2-16 (imaging)
Cheryl Kunis, MD
Professor of Clinical Medicine
Division of Nephrology
Department of Medicine
NewYork–Presbyterian Hospital
Columbia University Medical Center
New York, New York
Plates 4-42–4-44, 4-58–4-60
Michael Large, MD
Fellow, Urologic Oncology
University of Chicago Hospitals
Chicago, Illinois
Plates 6-6, 10-16
Mary McKee
Senior Lab Technologist
MGH Program in Membrane Biology
MGH Center for Systems Biology and Division of
Nephrology
Boston, Massachusetts
Plate 1-26 (imaging)

James M. McKiernan, MD
John and Irene Given Associate Professor of Urology
Director, Urologic Oncology
Department of Urology
NewYork–Presbyterian Hospital
Columbia University Medical Center
New York, New York
Plates 10-39, 10-40 (imaging)
Shannon Nees
Doris Duke Clinical Research Fellow
Division of Pediatric Urology
Department of Urology
Columbia University
College of Physicians and Surgeons
New York, New York
Plates 2-30, 2-31, 2-34, 2-35
Galina Nesterova, MD
Staff Clinician
Section on Human Biochemical Genetics
Medical Genetics Branch
Intramural Program
Office of Rare Diseases
National Institutes of Health
Bethesda, Maryland
Plates 4-64, 4-65
Amudha Palanisamy, MD
Instructor in Clinical Medicine
Division of Nephrology
NewYork–Presbyterian Hospital
Columbia University Medical Center
New York, New York
Plates 4-10, 4-11, 4-28, 4-29
Margaret S. Pearle, MD, PhD
Professor of Urology and Internal Medicine
The University of Texas Southwestern Medical
Center
Dallas, Texas
Plates 6-3–6-5
Allison R. Polland, MD
Resident, Department of Urology
Mount Sinai Medical Center
New York, New York
Plate 10-12
Maya Rao, MD
Assistant Professor of Clinical Medicine
Division of Nephrology
Department of Medicine
NewYork–Presbyterian Hospital
Columbia University Medical Center
New York, New York
Plates 4-66–4-70
Lloyd Ratner, MD
Professor of Surgery
Director, Renal and Pancreatic Transplantation
NewYork–Presbyterian Hospital
Columbia University Medical Center
New York, New York
Plates 10-26–10-32

THE NETTER COLLECTION OF MEDICAL ILLUSTRATIONS


Contributors
Matthew Rutman, MD
Assistant Professor
Co-Director of Voiding Dysfunction, Incontinence,
and Urodynamics
Department of Urology
NewYork–Presbyterian Hospital
Columbia University Medical Center
New York, New York
Plates 8-1–8-5
P. Roderigo Sandoval, MD
Assistant Professor
Department of Surgery
NewYork–Presbyterian Hospital
Columbia University Medical Center
New York, New York
Plates 10-26–10-32
Richard Schlussel, MD
Associate Director, Pediatric Urology
Assistant Professor of Urology
Columbia University
Morgan Stanley Children’s Hospital
New York, New York
Plate 10-35
Plates 2-22, 2-23 (imaging)
Arieh Shalhav, MD
Professor of Surgery
Chief, Section of Urology
Director, Minimally Invasive Urology
University of Chicago Medical Center
Chicago, Illinois
Plates 6-6, 10-16
Shayan Shirazian, MD
Assistant Professor of Clinical Medicine
Department of Medicine
State University of New York at Stony Brook
Attending Nephrologist
Winthrop University Hospital
Mineola, New York
Plates 4-3, 4-4, 4-14, 4-15, 4-30, 4-31
Eric Siddall, MD
Fellow, Division of Nephrology
Department of Medicine
NewYork–Presbyterian Hospital
Columbia University Medical Center
New York, New York
Plates 4-25, 4-53, 4-54

THE NETTER COLLECTION OF MEDICAL ILLUSTRATIONS

Magdalena E. Sobieszczyk, MD, MPH
Assistant Professor of Clinical Medicine
Division of Infectious Disease
Department of Medicine
NewYork–Presbyterian Hospital
Columbia University Medical Center
New York, New York
Plates 5-1–5-12
Michal Sobieszczyk, MD
Resident, Internal Medicine Department
Walter Reed National Military Medical Center
Bethesda, Maryland
Plates 5-11, 5-12
David Sperling, MD
Director, Columbia Endovascular Associates/
Interventional Radiology
Department of Radiology
NewYork–Presbyterian Hospital
Columbia University Medical Center
New York, New York
Plate 1-11 (imaging)
M. Barry Stokes, MB, BCh
Associate Professor of Clinical Pathology
Division of Renal Pathology
Department of Pathology and Cell Biology
NewYork–Presbyterian Hospital
Columbia University Medical Center
New York, New York
Plates 4-16–4-18
Plates 1-23, 1-25, 4-4, 4-13, 4-20, 4-21, 4-29, 4-43,
4-44, 4-46, 4-48, 4-63 (imaging)
Stephen Textor, MD
Professor of Medicine
Division of Nephrology and Hypertension
Mayo Clinic
Rochester, Minnesota
Plates 4-36, 4-37
Sandhya Thomas, MD
Fellow, Division of Nephrology
Department of Medicine
Baylor College of Medicine
Houston, Texas
Plates 4-45, 4-46, 4-61, 4-62, 10-7, 10-8

Matthew D. Truesdale, MD
Resident, Department of Urology
University of California, San Francisco
San Francisco, California
Plates 9-3–9-6
Duong Tu, MD
Fellow, Pediatric Urology
Department of Urology
Children’s Hospital Boston
Harvard Medical School
Boston, Massachusetts
Plates 2-19, 2-20, 2-23–2-29, 2-32, 2-33
Anthony Valeri, MD
Associate Professor of Clinical Medicine
Director, Hemodialysis
NewYork–Presbyterian Hospital
Columbia University Medical Center
New York, New York
Plates 10-9–10-11
Lt. Col. Kyle Weld, MD
Director of Endourology
59th Surgical Specialties Squadron
Plates 1-10–1-12
Sven Wenske, MD
Fellow, Department of Urology
NewYork–Presbyterian Hospital
Columbia University Medical Center
New York, New York
Plates 2-1–2-13, 2-18, 9-7, 9-8, 10-35
Frances V. White, MD
Associate Professor
Department of Pathology and Immunology
Washington University Medical Center
St. Louis, Missouri
Plate 9-8 (imaging)
Matthew Wosnitzer, MD
Chief Resident, Department of Urology
NewYork–Presbyterian Hospital
Columbia University Medical Center
New York, New York
Plates 9-11–9-13

xv



CONTENTS
SECTION 1

ANATOMY OF THE URINARY TRACT
1-1 Kidney: Position and Relations
(Anterior View), 2
1-2 Kidney: Position and Relations
(Posterior View), 3
1-3 Kidney: Position and Relations
(Transverse Sections), 4
1-4 Kidney: Gross Structure, 5
1-5 Renal Fascia, 6
1-6 Ureters: Position, Relations, Gross
Structure, 7
1-7 Bladder: Position, Relations, Gross
Structure (Male), 8
1-8 Bladder: Position, Relations, Gross
Structure (Female), 9
1-9 Bladder: Position, Relations, Gross
Structure (Coronal Cross-Section), 10
1-10 Renal Vasculature: Renal Artery and Vein
In Situ, 11
1-11 Renal Vasculature: Renal Artery Segmental
Branches and Intrarenal Arteries, 12
1-12 Renal Vasculature: Variations in Renal
Artery and Vein, 13
1-13 Vasculature of Ureters and Bladder, 14
1-14 Innervation of Kidneys, Ureters, and
Bladder, 15
1-15 Innervation Pathways of the Kidneys and
Upper Ureter, 16
1-16 Innervation Pathways of the Ureter and
Bladder, 17
1-17 Lymphatics of Urinary System, 18
1-18 Overview of the Nephron, 19
1-19 Renal Microvasculature, 20
1-20 Glomerulus: Structure and Histology, 21
1-21 Glomerulus Fine Structure, 22
1-22 Glomerulus: Electron Microscopy, 23
1-23 Proximal Tubule, 24
1-24 Thin Limb, 25
1-25 Distal Tubule, 26
1-26 Collecting Duct, 27
1-27 Renal Pelvis, Ureter, and Bladder, 28

SECTION 2

NORMAL AND ABNORMAL
DEVELOPMENT
2-1 Development of Kidney, 30
2-2 Development of Kidney: Nephron
Formation, 31
2-3 Development of Bladder and Ureter:
Formation of the Cloaca, 32
2-4 Development of Bladder and Ureter:
Septation, Incorporation of Ureters, and
Maturation, 33
2-5 Renal Ascent and Ectopia: Normal Renal
Ascent and Pelvic Kidney, 34
2-6 Renal Ascent and Ectopia: Thoracic and
Crossed Ectopic Kidney, 35
2-7 Renal Rotation and Malrotation, 36
2-8 Anomalies in Number of Kidneys: Bilateral
Renal Agenesis, 37
2-9 Anomalies in Number of Kidneys:
Unilateral Renal Agenesis, 38
2-10 Anomalies in Number of Kidneys:
Supernumerary Kidney, 39
2-11 Renal Fusion, 40
2-12 Renal Dysplasia, 41
2-13 Renal Hypoplasia, 42
2-14 Simple Cysts, 43
2-15 Polycystic Kidney Disease: Gross
Appearance, 44
2-16 Polycystic Kidney Disease: Radiographic
Findings, 45

THE NETTER COLLECTION OF MEDICAL ILLUSTRATIONS

2-17 Medullary Sponge Kidney, 46
2-18 Nephronophthisis/Medullary Cystic Kidney
Disease Complex, 47
2-19 Retrocaval Ureter: Radiographic Findings
and Laparoscopic Repair, 48
2-20 Retrocaval Ureter: Normal Development of
the Inferior Vena Cava, 49
2-21 Vesicoureteral Reflux: Mechanism and
Grading, 50
2-22 Vesicoureteral Reflux: Voiding
Cystourethrograms, 51
2-23 Ureteral Duplication: Complete, 52
2-24 Ureteral Duplication: Incomplete, 53
2-25 Ectopic Ureter, 54
2-26 Ureterocele: Gross and Fine
Appearance, 55
2-27 Ureterocele: Radiographic Findings, 56
2-28 Prune Belly Syndrome: Appearance of
Abdominal Wall, 57
2-29 Prune Belly Syndrome: Appearance of
Kidneys, Ureters, and Bladder, 58
2-30 Epispadias Exstrophy Complex:
Epispadias, 59
2-31 Epispadias Exstrophy Complex: Bladder
Exstrophy, 60
2-32 Bladder Duplication and Septation, 61
2-33 Anomalies of the Urachus, 62
2-34 Posterior Urethral Valves: Gross
Appearance, 63
2-35 Posterior Urethral Valves: Radiographic
Findings, 64

SECTION 3

PHYSIOLOGY
3-1
3-2
3-3
3-4
3-5
3-6
3-7
3-8
3-9
3-10
3-11
3-12
3-13
3-14

3-15
3-16
3-17
3-18
3-19

Basic Functions and Homeostasis, 67
Clearance and Renal Plasma Flow, 68
Glomerular Filtration Rate, 69
Glomerular Filtration Rate:
Calculation, 70
Secretion and Reabsorption: Tubular
Reabsorption and Saturation Kinetics, 71
Secretion and Reabsorption: Fractional
Excretion (Clearance Ratios), 72
Renal Handling of Sodium and
Chloride: Nephron Sites of Sodium
Reabsorption, 73
Renal Handling of Sodium and Chloride:
Response to Extracellular Fluid
Contraction, 74
Renal Handling of Sodium and
Chloride: Response to Extracellular Fluid
Expansion, 75
Renal Handling of Potassium, 76
Renal Handling of Calcium, Phosphate,
and Magnesium, 77
Countercurrent Multiplication: Model—Part
I, 78
Countercurrent Multiplication: Model—Part
II, 79
Countercurrent Multiplication: Models to
Demonstrate Principle of Countercurrent
Exchange System of Vasa Recta in
Minimizing Dissipation of Medullary
Osmotic Gradient, 80
Urine Concentration and Dilution and
Overview of Water Handling: Long-Looped
Nephron (ADH Present), 81
Urine Concentration and Dilution: LongLooped Nephron (ADH Absent), 82
Antidiuretic Hormone, 83
Tubuloglomerular Feedback and
Modulation of Renin Release, 84
Tubuloglomerular Feedback and ReninAngiotensin-Aldosterone System, 85

3-20 Acid-Base Balance: Roles of Chemical
Buffers, Lungs, and Kidneys in Acid-Base
Handling, 86
3-21 Acid-Base Balance: Renal Bicarbonate
Reabsorption, 87
3-22 Acid-Base Balance: Renal Bicarbonate
Synthesis and Proton Excretion, 88
3-23 Acid-Base Balance: Acidosis and
Alkalosis, 89
3-24 Additional Functions: Erythropoiesis and
Vitamin D, 90
3-25 Proximal Renal Tubular Acidosis, 91
3-26 Classic Distal Renal Tubular Acidosis, 92
3-27 Nephrogenic Diabetes Insipidus: Diabetes
Insipidus, 93
3-28 Major Causes and Symptoms of
Nephrogenic Diabetes Insipidus, 94

SECTION 4

RENAL DISEASES
4-1 Overview of Acute Kidney Injury:
Causes, 96
4-2 Overview of Acute Kidney Injury: Possible
Urine Sediment Findings, 97
4-3 Acute Tubular Necrosis: Causes,
Pathophysiology, and Clinical
Features, 98
4-4 Acute Tubular Necrosis: Histopathologic
Findings, 99
4-5 Overview of Nephrotic Syndrome:
Pathophysiology, 100
4-6 Overview of Nephrotic Syndrome:
Causes, 101
4-7 Overview of Nephrotic Syndrome:
Presentation and Diagnosis, 102
4-8 Minimal Change Disease: Causes and
Presentation, 103
4-9 Minimal Change Disease: Histopathologic
Findings, 104
4-10 Focal Segmental Glomerulosclerosis:
Causes, Clinical Features, and
Histopathologic Findings, 105
4-11 Focal Segmental Glomerulosclerosis:
Histopathologic Findings (Continued), 106
4-12 Membranous Nephropathy: Causes and
Clinical Features, 107
4-13 Membranous Nephropathy:
Histopathologic Findings, 108
4-14 Overview of Glomerulonephritis:
Clinical Features and Histopathologic
Findings, 109
4-15 Overview of Glomerulonephritis:
Histopathologic Findings (Continued), 110
4-16 IgA Nephropathy: Causes and Clinical
Features, 111
4-17 IgA Nephropathy: Histopathologic
Findings, 112
4-18 IgA Nephropathy: Histopathologic
Findings (Continued), 113
4-19 Postinfectious Glomerulonephritis: Causes
and Clinical Features, 114
4-20 Postinfectious Glomerulonephritis:
Histopathologic Findings, 115
4-21 Postinfectious Glomerulonephritis:
Histopathologic Findings (Continued), 116
4-22 Membranoproliferative
Glomerulonephritis: Causes, Features, and
Assessment, 117
4-23 Membranoproliferative
Glomerulonephritis: Classical Pathway of
Complement Activation, 118
4-24 Membranoproliferative
Glomerulonephritis: Histopathologic
Findings, 119

xvii


Contents
4-25 Rapidly Progressive
Glomerulonephritis, 120
4-26 Hereditary Nephritis (Alport Syndrome)/
Thin Basement Membrane
Nephropathy: Pathophysiology and
Clinical Features, 121
4-27 Hereditary Nephritis (Alport Syndrome)/
Thin Basement Membrane Nephropathy:
Electron Microscopy Findings, 122
4-28 Acute Interstitial Nephritis: Causes and
Clinical Features, 123
4-29 Acute Interstitial Nephritis:
Histopathologic Findings, 124
4-30 Chronic Tubulointerstitial Nephritis and
Analgesic Nephropathy, 125
4-31 Chronic Tubulointerstitial Nephritis:
Histopathologic Findings, 126
4-32 Thrombotic Microangiopathy: General
Features, 127
4-33 Thrombotic Microangiopathy: Hemolytic
Uremic Syndrome, 128
4-34 Thrombotic Microangiopathy: Thrombotic
Thrombocytopenic Purpura, 129
4-35 Renal Vein Thrombosis, 130
4-36 Renal Artery Stenosis: Pathophysiology of
Renovascular Hypertension, 131
4-37 Renal Artery Stenosis: Causes, 132
4-38 Congestive Heart Failure: Types of Left
Heart Failure and Effects on Renal
Function, 133
4-39 Congestive Heart Failure: Effects of Left
Heart Failure on Renal Blood Flow and
Tubular Function, 134
4-40 Hepatorenal Syndrome: Proposed
Pathophysiology, 135
4-41 Hepatorenal Syndrome: Symptoms and
Diagnosis, 136
4-42 Chronic and Malignant Hypertension:
Major Causes, 137
4-43 Chronic and Malignant Hypertension:
Renal Histopathology (Chronic), 138
4-44 Chronic and Malignant Hypertension:
Renal Histopathology (Malignant), 139
4-45 Diabetic Nephropathy: Diabetes
Mellitus, 140
4-46 Diabetic Nephropathy, 141
4-47 Amyloidosis: Deposition Sites and
Manifestations, 142
4-48 Amyloidosis: Histopathologic
Findings, 143
4-49 Lupus Nephritis: Diagnostic Criteria, 144
4-50 Lupus Nephritis: Renal Histopathology
(Classes I and II Lesions), 145
4-51 Lupus Nephritis: Renal Histopathology
(Classes III and IV Lesions), 146
4-52 Lupus Nephritis: Renal Histopathology
(Class V Lesions), 147
4-53 Myeloma Nephropathy: Pathophysiology
and Clinical Findings, 148
4-54 Myeloma Nephropathy: Histopathologic
Findings, 149
4-55 HIV-Associated Nephropathy: Light
Microscopy Findings, 150
4-56 HIV-Associated Nephropathy: Electron
Microscopy Findings, 151
4-57 HIV-Associated Nephropathy: Mechanisms
of Infection and Antiretroviral
Therapy, 152
4-58 Preeclampsia: Clinical Definition and
Potential Mechanism of Pathogenesis, 153
4-59 Preeclampsia: Renal Pathology, 154
4-60 Preeclampsia: HELLP Syndrome and
Eclampsia, 155
4-61 Henoch-Schönlein Purpura: Diagnostic
Criteria, 156
4-62 Henoch-Schönlein Purpura: Additional
Clinical Features, 157
4-63 Fabry Disease, 158
4-64 Cystinosis: Pathophysiology and the Renal
Fanconi Syndrome, 159

xviii

4-65 Cystinosis: Extrarenal
Manifestations, 160
4-66 Overview of Chronic Kidney Disease:
Staging System and Major Causes, 161
4-67 Overview of Chronic Kidney Disease:
Normal Calcium and Phosphate
Metabolism, 162
4-68 Overview of Chronic Kidney Disease:
Calcium and Phosphate Metabolism in
Chronic Kidney Disease, 163
4-69 Overview of Chronic Kidney Disease:
Mechanism of Progression and
Complications, 164
4-70 Overview of Chronic Kidney Disease:
Uremia, 165

SECTION 5

URINARY TRACT INFECTIONS
5-1 Cystitis: Risk Factors, 168
5-2 Cystitis: Common Symptoms and
Tests, 169
5-3 Cystitis: Evaluation, 170
5-4 Cystitis: Treatment, 171
5-5 Pyelonephritis: Risk Factors and Major
Findings, 172
5-6 Pyelonephritis: Pathology, 173
5-7 Bacteriuria: Management of
Asymptomatic Bacteriuria, 174
5-8 Intrarenal and Perinephric
Abscesses, 175
5-9 Tuberculosis: Infection and
Extrapulmonary Spread, 176
5-10 Tuberculosis: Urinary Tract, 177
5-11 Schistosomiasis: Life Cycle of
Schistosoma Haematobium, 178
5-12 Schistosomiasis: Effects of Chronic
Schistosoma Haematobium
Infection, 179

SECTION 6

URINARY TRACT OBSTRUCTIONS
6-1 Obstructive Uropathy: Etiology, 182
6-2 Obstructive Uropathy: Sequelae, 183
6-3 Urolithiasis: Formation of Renal
Stones, 184
6-4 Urolithiasis: Major Sites of Renal Stone
Impaction, 185
6-5 Urolithiasis: Appearance of Renal
Stones, 186
6-6 Ureteropelvic Junction Obstruction, 187
6-7 Ureteral Strictures, 188

8-5 Urodynamics: Sample Urodynamic
Recordings, 200

SECTION 9

NEOPLASMS
9-1 Benign Renal Tumors: Papillary Adenoma
and Oncocytoma, 202
9-2 Benign Renal Tumors:
Angiomyolipoma, 203
9-3 Renal Cell Carcinoma: Risk Factors and
Radiographic Findings, 204
9-4 Renal Cell Carcinoma: Gross Pathologic
Findings, 205
9-5 Renal Cell Carcinoma: Histopathologic
Findings, 206
9-6 Renal Cell Carcinoma: Staging System and
Sites of Metastasis, 207
9-7 Wilms Tumor: Genetics, Presentation, and
Radiographic Findings, 208
9-8 Wilms Tumor: Gross Appearance and
Histopathologic Findings, 209
9-9 Tumors of the Renal Pelvis and Ureter:
Risk Factors and Radiographic
Appearance, 210
9-10 Tumors of the Renal Pelvis and Ureter:
Appearance (Ureteroscopic, Gross, and
Microscopic) and Staging System, 211
9-11 Tumors of the Bladder: Risk Factors,
Symptoms, and Physical Examination, 212
9-12 Tumors of the Bladder: Cystoscopic and
Radiographic Appearance, 213
9-13 Tumors of the Bladder: Histopathologic
Findings and Staging System, 214

SECTION 10

THERAPEUTICS
10-1
10-2
10-3
10-4
10-5
10-6
10-7
10-8
10-9
10-10
10-11

SECTION 7

TRAUMATIC INJURIES
7-1 Renal Injuries: Grading System and Renal
Parenchymal Injuries, 190
7-2 Renal Injuries: Renal Hilar Injuries, 191
7-3 Ureteral Injuries, 192
7-4 Bladder Injuries: Extraperitoneal Bladder
Ruptures, 193
7-5 Bladder Injuries: Intraperitoneal Bladder
Ruptures, 194

SECTION 8

VOIDING DYSFUNCTION
8-1 Voiding Dysfunction: Anatomy
of Female Urinary Continence
Mechanisms, 196
8-2 Voiding Dysfunction: Neural Control
of Bladder Function and Effects of
Pathologic Lesions, 197
8-3 Voiding Dysfunction: Stress Urinary
Incontinence, 198
8-4 Urodynamics: Equipment and Set-up for
Urodynamic Studies, 199

10-12
10-13
10-14
10-15
10-16
10-17
10-18
10-19

10-20
10-21

Osmotic Diuretics, 216
Carbonic Anhydrase Inhibitors, 217
Loop Diuretics, 218
Thiazide Diuretics, 219
Potassium-Sparing Diuretics, 220
Inhibitors of the Renin-Angiotensin
System, 221
Renal Biopsy: Indications and Structure of
Typical Spring-Loaded Needle, 222
Renal Biopsy: Procedure, 223
Hemodialysis, Peritoneal Dialysis, and
Continuous Therapies: Hemodialysis, 224
Hemodialysis, Peritoneal Dialysis, and
Continuous Therapies: Vascular Access for
Hemodialysis, 225
Hemodialysis, Peritoneal Dialysis, and
Continuous Therapies: Peritoneal
Dialysis, 226
Extracorporeal Shock Wave Lithotripsy, 227
Percutaneous Nephrolithotomy: Creation
of Access Tract, 228
Percutaneous Nephrolithotomy:
Nephroscope and Sonotrode, 229
Percutaneous Nephrolithotomy: Ultrasonic
Lithotripsy of Large Stones, 230
Pyeloplasty and Endopyelotomy, 231
Renal Revascularization: Endovascular
Therapies, 232
Renal Revascularization: Surgical
Therapies, 233
Simple and Radical Nephrectomy: Open
Nephrectomy (Incisions for
Transperitoneal and Retroperitoneal
Approaches), 234
Simple and Radical Nephrectomy:
Open Simple Nephrectomy (Flank
Approach), 235
Simple and Radical Nephrectomy:
Laparoscopic Radical Nephrectomy
(Transperitoneal Approach
[Left-Sided]), 236

THE NETTER COLLECTION OF MEDICAL ILLUSTRATIONS


Contents
10-22 Partial Nephrectomy: Open Partial
Nephrectomy (Retroperitoneal [Flank]
Approach), 237
10-23 Partial Nephrectomy: Laparoscopic
Partial Nephrectomy (Transperitoneal
Approach), 238
10-24 Renal Ablation: Laparoscopic
Cryoablation (Retroperitoneal
Approach), 239
10-25 Renal Ablation: Percutaneous
Cryoablation, 240
10-26 Renal Transplantation: Recipient
Operation, 241
10-27 Renal Transplantation: Mechanism of
Action of Immunosuppressive
Medications, 242

THE NETTER COLLECTION OF MEDICAL ILLUSTRATIONS

10-28 Renal Transplantation: Causes of Graft
Dysfunction in Immediate Post-Transplant
Period, 243
10-29 Renal Transplantation: Causes of Graft
Dysfunction in Early Post-Transplant
Period, 244
10-30 Renal Transplantation: Acute Rejection
(Pathologic Findings), 245
10-31 Renal Transplantation: Calcineurin
Inhibitor Nephrotoxicity (Histopathologic
Findings), 246
10-32 Renal Transplantation: Causes of Graft
Dysfunction in Late Post-Transplant
Period, 247
10-33 Ureteroscopy: Device Design and
Deployment, 248

10-34 Ureteroscopy: Stone Fragmentation and
Extraction, 249
10-35 Ureteral Reimplantation, 250
10-36 Ureteral Reconstruction, 251
10-37 Cystoscopy: Cystoscope Design, 252
10-38 Cystoscopy: Cystoscopic Views, 253
10-39 Transurethral Resection of Bladder Tumor:
Equipment and Procedure, 254
10-40 Transurethral Resection of Bladder Tumor:
Procedure (Continued), 255

SELECTED REFERENCES, 257
INDEX, 261

xix



SECTION 1

ANATOMY OF THE
URINARY TRACT


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