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Renal medulla

The renal medulla is the innermost part of the kidney. The renal medulla is split up into a number of sections, known as the renal pyramids. Blood enters into the kidney via the renal artery, which then splits up to form the segmental arteries which then branch to form interlobar arteries. The interlobar arteries each in turn branch into arcuate arteries, which in turn branch to form interlobular arteries, and these finally reach the glomeruli. At the glomerulus the blood reaches a highly disfavourable pressure gradient and a large exchange surface area, which forces the serum portion of the blood out of the vessel and into the renal tubules. Flow continues through the renal tubules, including the proximal tubule, the loop of Henle, through the distal tubule and finally leaves the kidney by means of the collecting duct, leading to the renal pelvis, the dilated portion of the ureter.

Interstitium
The medullary interstitium is the tissue surrounding the loop of Henle in the medulla. It functions in renal water reabsorption by building up a high hypertonicity, which draws water out of the thin descending limb of the loop of Henle and the collecting duct system. Hypertonicity, in turn, is created by an efflux of urea from the inner medullary collecting duct. ==Pyramids==
Pyramids
Renal pyramids (or malpighian pyramids or ''' Malpighi's pyramids 'named after Marcello Malpighi, a seventeenth-century anatomist) are cone-shaped tissues of the kidney. In humans, the renal medulla is made up of 10 to 18 of these conical subdivisions. The broad base'' of each pyramid faces the renal cortex, and its apex, or papilla, points internally towards the pelvis. The pyramids appear striped because they are formed by straight parallel segments of nephrons' Loops of Henle and collecting ducts. The base of each pyramid originates at the corticomedullary border and the apex terminates in a papilla, which lies within a minor calyx, made of parallel bundles of urine collecting tubules. ==Papilla==
Papilla
The renal papilla is the location where the renal pyramids in the medulla empty urine into the minor calyx in the kidney. Histologically it is marked by medullary collecting ducts converging to form a papillary duct to channel the fluid. Transitional epithelium begins to be seen. Clinical significance Some chemicals toxic to the kidney, called nephrotoxins, damage the renal papillae. Damage to the renal papillae may result in death to cells in this region of the kidney, called renal papillary necrosis. The most common toxic causes of renal papillary necrosis are NSAIDs, such as ibuprofen, acetylsalicylic acid, and phenylbutazone, in combination with dehydration. Perturbed renal papillary development has also been shown to be associated with onset of functional obstruction and renal fibrosis. Renal papillary damage has also been associated with nephrolithiasis and can be quantified according to the papillary grading score, which accounts for contour, pitting, plugging and Randall's plaque. ==Image gallery==
Image gallery
File:Slide4iii.JPG|Renal medulla File:Slide21iii.JPG|Renal medulla File:Slide5iii.JPG|Renal papilla File:Illu kidney2.jpg|Frontal section through the kidney File:Kidney section vertical.png|Vertical section of kidney. (Label "medullary sub." visible near top.) File:Blausen 0592 KidneyAnatomy 01.png|Kidney anatomy, with pyramids labeled at right == See also ==
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