Kidney – Wikipedia
Vertebrate organ that filters blood and produces urine
The kidneys are two reddish-brown bean-shaped organs present in vertebrates. They’re situated on the left and proper within the retroperitoneal house, and in grownup people are about 12 centimetres (4 1⁄2 inches) in size. They obtain blood from the paired renal arteries; blood exits into the paired renal veins. Every kidney is connected to a ureter, a tube that carries excreted urine to the bladder.
The nephron is the structural and purposeful unit of the kidney. Every human grownup kidney incorporates round 1 million nephrons, whereas a mouse kidney incorporates solely about 12,500 nephrons. The kidney participates within the management of the amount of assorted physique fluids, fluid osmolality, acid-base stability, varied electrolyte concentrations, and removing of poisons. Filtration happens within the glomerulus: one-fifth of the blood quantity that enters the kidneys is filtered. Examples of gear reabsorbed are solute-free water, sodium, bicarbonate, glucose, and amino acids. Examples of gear secreted are hydrogen, ammonium, potassium and uric acid. The kidneys additionally perform capabilities impartial of the nephron. For instance, they convert a precursor of vitamin D to its energetic type, calcitriol; and synthesize the hormones erythropoietin and renin.
Renal physiology is the research of kidney perform. Nephrology is the medical specialty which addresses illnesses of kidney perform: these embody continual kidney illness, nephritic and nephrotic syndromes, acute kidney harm, and pyelonephritis. Urology addresses illnesses of kidney (and urinary tract) anatomy: these embody most cancers, renal cysts, kidney stones and ureteral stones, and urinary tract obstruction.
Procedures used within the administration of kidney illness embody chemical and microscopic examination of the urine (urinalysis), measurement of kidney perform by calculating the estimated glomerular filtration price (eGFR) utilizing the serum creatinine; and kidney biopsy and CT scan to judge for irregular anatomy. Dialysis and kidney transplantation are used to deal with kidney failure; one (or each sequentially) of those are virtually at all times used when renal perform drops beneath 15%. Nephrectomy is often used to treatment renal cell carcinoma.
In people, the kidneys are situated excessive within the stomach cavity, one on all sides of the backbone, and lie in a retroperitoneal place at a barely indirect angle. The asymmetry throughout the stomach cavity, brought on by the place of the liver, sometimes ends in the correct kidney being barely decrease and smaller than the left, and being positioned barely extra to the center than the left kidney. The left kidney is roughly on the vertebral stage T12 to L3, and the correct is barely decrease. The suitable kidney sits slightly below the diaphragm and posterior to the liver. The left kidney sits beneath the diaphragm and posterior to the spleen. On high of every kidney is an adrenal gland. The higher components of the kidneys are partially protected by the eleventh and twelfth ribs. Every kidney, with its adrenal gland is surrounded by two layers of fats: the perirenal fats current between renal fascia and renal capsule and pararenal fats superior to the renal fascia.
The kidney is a bean-shaped construction with a convex and a concave border. A recessed space on the concave border is the renal hilum, the place the renal artery enters the kidney and the renal vein and ureter depart. The kidney is surrounded by powerful fibrous tissue, the renal capsule, which is itself surrounded by perirenal fats, renal fascia, and pararenal fats. The anterior (entrance) floor of those tissues is the peritoneum, whereas the posterior (rear) floor is the transversalis fascia.
The superior pole of the correct kidney is adjoining to the liver. For the left kidney, it’s subsequent to the spleen. Each, due to this fact, transfer down upon inhalation.
|Intercourse||Weight, normal reference vary|
|Proper kidney||Left kidney|
|Males||80–160 g (2 3⁄4–5 3⁄4 oz)||80–175 g (2 3⁄4–6 1⁄4 oz)|
|Girls||40–175 g (1 1⁄2–6 1⁄4 oz)||35–190 g (1 1⁄4–6 3⁄4 oz)|
A Danish research measured the median renal size to be 11.2 cm (4 7⁄16 in) on the left aspect and 10.9 cm (4 5⁄16 in) on the correct aspect in adults. Median renal volumes had been 146 cm3 (8 15⁄16 cu in) on the left and 134 cm3 (8 3⁄16 cu in) on the correct.
The purposeful substance, or parenchyma, of the kidney is split into two main constructions: the outer renal cortex and the internal renal medulla. Grossly, these constructions take the form of eight to 18 cone-shaped renal lobes, every containing renal cortex surrounding a portion of medulla referred to as a renal pyramid. Between the renal pyramids are projections of cortex referred to as renal columns. Nephrons, the urine-producing purposeful constructions of the kidney, span the cortex and medulla. The preliminary filtering portion of a nephron is the renal corpuscle, which is situated within the cortex. That is adopted by a renal tubule that passes from the cortex deep into the medullary pyramids. A part of the renal cortex, a medullary ray is a group of renal tubules that drain right into a single gathering duct.
The tip, or papilla, of every pyramid empties urine right into a minor calyx; minor calyces empty into main calyces, and main calyces empty into the renal pelvis. This turns into the ureter. On the hilum, the ureter and renal vein exit the kidney and the renal artery enters. Hilar fats and lymphatic tissue with lymph nodes encompass these constructions. The hilar fats is contiguous with a fat-filled cavity referred to as the renal sinus. The renal sinus collectively incorporates the renal pelvis and calyces and separates these constructions from the renal medullary tissue.
The kidneys possess no overtly transferring constructions.
A CT scan of the stomach exhibiting the place of the kidneys. The left cross-section within the higher stomach exhibits the liver on the left aspect of scan (proper aspect of physique). Middle: cross-section exhibiting the kidneys beneath the liver and spleen. Proper: additional cross-section via the left kidney.
Picture exhibiting the constructions that the kidney lies close to.
Cross-section via a cadaveric specimen exhibiting the place of the kidneys.
The kidneys obtain blood from the renal arteries, left and proper, which department straight from the stomach aorta. Regardless of their comparatively small dimension, the kidneys obtain roughly 20% of the cardiac output. Every renal artery branches into segmental arteries, dividing additional into interlobar arteries, which penetrate the renal capsule and lengthen via the renal columns between the renal pyramids. The interlobar arteries then provide blood to the arcuate arteries that run via the boundary of the cortex and the medulla. Every arcuate artery provides a number of interlobular arteries that feed into the afferent arterioles that offer the glomeruli.
Blood drains from the kidneys, in the end into the inferior vena cava. After filtration happens, the blood strikes via a small community of small veins (venules) that converge into interlobular veins. As with the arteriole distribution, the veins observe the identical sample: the interlobular present blood to the arcuate veins then again to the interlobar veins, which come to type the renal veins which exiting the kidney .
The kidney and nervous system talk through the renal plexus, whose fibers course alongside the renal arteries to achieve every kidney. Enter from the sympathetic nervous system triggers vasoconstriction within the kidney, thereby lowering renal blood stream. The kidney additionally receives enter from the parasympathetic nervous system, by the use of the renal branches of the vagus nerve; the perform of that is but unclear. Sensory enter from the kidney travels to the T10-11 ranges of the spinal wire and is sensed within the corresponding dermatome. Thus, ache within the flank area could also be referred from corresponding kidney.
Renal histology is the research of the microscopic construction of the kidney. Distinct cell sorts embody:
Gene and protein expression
About 20,000 protein coding genes are expressed in human cells and virtually 70% of those genes are expressed in regular, grownup kidneys. Simply over 300 genes are extra particularly expressed within the kidney, with just some 50 genes being extremely particular for the kidney. Lots of the corresponding kidney particular proteins are expressed within the cell membrane and performance as transporter proteins. The best expressed kidney particular protein is uromodulin, essentially the most considerable protein in urine with capabilities that stop calcification and development of micro organism. Particular proteins are expressed within the totally different compartments of the kidney with podocin and nephrin expressed in glomeruli, Solute provider household protein SLC22A8 expressed in proximal tubules, calbindin expressed in distal tubules and aquaporin 2 expressed within the gathering duct cells.
The mammalian kidney develops from intermediate mesoderm. Kidney growth, additionally referred to as nephrogenesis, proceeds via a collection of three successive developmental phases: the pronephros, mesonephros, and metanephros. The metanephros are primordia of the everlasting kidney.
The kidneys excrete quite a lot of waste merchandise produced by metabolism into the urine. The microscopic structural and purposeful unit of the kidney is the nephron. It processes the blood equipped to it through filtration, reabsorption, secretion and excretion; the consequence of these processes is the manufacturing of urine. These embody the nitrogenous wastes urea, from protein catabolism, and uric acid, from nucleic acid metabolism. The power of mammals and a few birds to pay attention wastes right into a quantity of urine a lot smaller than the amount of blood from which the wastes had been extracted relies on an elaborate countercurrent multiplication mechanism. This requires a number of impartial nephron traits to function: a decent hairpin configuration of the tubules, water and ion permeability within the descending limb of the loop, water impermeability within the ascending loop, and energetic ion transport out of a lot of the ascending limb. As well as, passive countercurrent change by the vessels carrying the blood provide to the nephron is important for enabling this perform.
The kidney participates in whole-body homeostasis, regulating acid-base stability, electrolyte concentrations, extracellular fluid quantity, and blood stress. The kidney accomplishes these homeostatic capabilities each independently and in live performance with different organs, notably these of the endocrine system. Numerous endocrine hormones coordinate these endocrine capabilities; these embody renin, angiotensin II, aldosterone, antidiuretic hormone, and atrial natriuretic peptide, amongst others.
Formation of urine
Filtration, which takes place on the renal corpuscle, is the method by which cells and enormous proteins are retained whereas supplies of smaller molecular weights are filtered from the blood to make an ultrafiltrate that ultimately turns into urine. The kidney generates 180 liters of filtrate a day. The method is also referred to as hydrostatic filtration as a result of hydrostatic stress exerted on the capillary partitions.
Reabsorption is the transport of molecules from this ultrafiltrate and into the peritubular capillary. It’s achieved through selective receptors on the luminal cell membrane. Water is 55% reabsorbed within the proximal tubule. Glucose at regular plasma ranges is totally reabsorbed within the proximal tubule. The mechanism for that is the Na+/glucose cotransporter. A plasma stage of 350 mg/dL will absolutely saturate the transporters and glucose shall be misplaced within the urine. A plasma glucose stage of roughly 160 is ample to permit glucosuria, which is a vital medical clue to diabetes mellitus.
Amino acids are reabsorbed by sodium dependent transporters within the proximal tubule. Hartnup illness is a deficiency of the tryptophan amino acid transporter, which leads to pellagra.
|Location of Reabsorption||Reabsorbed nutrient||Notes|
|Early proximal tubule||Glucose (100%), amino acids (100%), bicarbonate (90%), Na+ (65%), Cl− (65%), phosphate (65%) and H2O (65%)||
|Skinny descending loop of Henle||H2O||
|Thick ascending loop of Henle||Na+ (10–20%), Ok+, Cl−; not directly induces para mobile reabsorption of Mg2+, Ca2+||
|Early distal convoluted tubule||Na+, Cl−||
|Gathering tubules||Na+(3–5%), H2O||
|Examples of gear which might be reabsorbed within the kidneys, and the hormones that affect these processes.|
Secretion is the reverse of reabsorption: molecules are transported from the peritubular capillary via the interstitial fluid, then via the renal tubular cell and into the ultrafiltrate.
The final step within the processing of the ultrafiltrate is excretion: the ultrafiltrate passes out of the nephron and travels via a tube referred to as the gathering duct, which is a part of the gathering duct system, after which to the ureters the place it’s renamed urine. Along with transporting the ultrafiltrate, the gathering duct additionally takes half in reabsorption.
The kidneys secrete quite a lot of hormones, together with erythropoietin, calcitriol, and renin. Erythropoietin is launched in response to hypoxia (low ranges of oxygen at tissue stage) within the renal circulation. It stimulates erythropoiesis (manufacturing of pink blood cells) within the bone marrow. Calcitriol, the activated type of vitamin D, promotes intestinal absorption of calcium and the renal reabsorption of phosphate. Renin is an enzyme which regulates angiotensin and aldosterone ranges.
Blood stress regulation
Though the kidney can not straight sense blood, long-term regulation of blood stress predominantly relies upon upon the kidney. This primarily happens via upkeep of the extracellular fluid compartment, the dimensions of which relies on the plasma sodium focus. Renin is the primary in a collection of vital chemical messengers that make up the renin–angiotensin system. Adjustments in renin in the end alter the output of this method, principally the hormones angiotensin II and aldosterone. Every hormone acts through a number of mechanisms, however each improve the kidney’s absorption of sodium chloride, thereby increasing the extracellular fluid compartment and elevating blood stress. When renin ranges are elevated, the concentrations of angiotensin II and aldosterone improve, resulting in elevated sodium chloride reabsorption, enlargement of the extracellular fluid compartment, and a rise in blood stress. Conversely, when renin ranges are low, angiotensin II and aldosterone ranges lower, contracting the extracellular fluid compartment, and reducing blood stress.
Two organ methods, the kidneys and lungs, preserve acid-base homeostasis, which is the upkeep of pH round a comparatively secure worth. The lungs contribute to acid-base homeostasis by regulating carbon dioxide (CO2) focus. The kidneys have two essential roles in sustaining the acid-base stability: to reabsorb and regenerate bicarbonate from urine, and to excrete hydrogen ions and glued acids (anions of acids) into urine.
Regulation of osmolality
The kidneys assist preserve the water and salt stage of the physique. Any important rise in plasma osmolality is detected by the hypothalamus, which communicates straight with the posterior pituitary gland. A rise in osmolality causes the gland to secrete antidiuretic hormone (ADH), leading to water reabsorption by the kidney and a rise in urine focus. The 2 elements work collectively to return the plasma osmolality to its regular ranges.
Numerous calculations and strategies are used to attempt to measure kidney perform. Renal clearance is the amount of plasma from which the substance is totally cleared from the blood per unit time. The filtration fraction is the quantity of plasma that’s truly filtered via the kidney. This may be outlined utilizing the equation. The kidney is a really advanced organ and mathematical modelling has been used to higher perceive kidney perform at a number of scales, together with fluid uptake and secretion.
Nephrology is the subspeciality below Inside Medication that offers with kidney perform and illness states associated to renal malfunction and their administration together with dialysis and kidney transplantation. Urology is the specialty below Surgical procedure that offers with kidney construction abnormalities equivalent to kidney most cancers and cysts and issues with urinary tract. Nephrologists are internists, and urologists are surgeons, whereas each are sometimes referred to as “kidney medical doctors”. There are overlapping areas that each nephrologists and urologists can present care equivalent to kidney stones and kidney associated infections.
There are lots of causes of kidney illness. Some causes are acquired over the course of life, equivalent to diabetic nephropathy whereas others are congenital, equivalent to polycystic kidney illness.
Medical phrases associated to the kidneys generally use phrases equivalent to renal and the prefix nephro-. The adjective renal, that means associated to the kidney, is from the Latin rēnēs, that means kidneys; the prefix nephro- is from the Historical Greek phrase for kidney, nephros (νεφρός). For instance, surgical removing of the kidney is a nephrectomy, whereas a discount in kidney perform known as renal dysfunction.
Kidney harm and failure
Usually, people can stay usually with only one kidney, as one has extra functioning renal tissue than is required to outlive. Solely when the quantity of functioning kidney tissue is significantly diminished does one develop continual kidney illness. Renal substitute remedy, within the type of dialysis or kidney transplantation, is indicated when the glomerular filtration price has fallen very low or if the renal dysfunction results in extreme signs.
Dialysis is a remedy that substitutes for the perform of regular kidneys. Dialysis could also be instituted when roughly 85%-90% of kidney perform is misplaced, as indicated by a glomerular filtration price (GFR) of lower than 15. Dialysis removes metabolic waste merchandise in addition to extra water and sodium (thereby contributing to regulating blood stress); and maintains many chemical ranges throughout the physique. Life expectancy is 5–10 years for these on dialysis; some stay as much as 30 years. Dialysis can happen through the blood (via a catheter or arteriovenous fistula), or via the peritoneum (peritoneal dialysis) Dialysis is usually administered 3 times per week for a number of hours at free-standing dialysis facilities, permitting recipients to guide an in any other case basically regular life.
- Congenital hydronephrosis
- Congenital obstruction of urinary tract
- Duplex kidneys, or double kidneys, happen in roughly 1% of the inhabitants. This prevalence usually causes no issues, however can often trigger urinary tract infections.
- Duplicated ureter happens in roughly one in 100 stay births
- Horseshoe kidney happens in roughly one in 400 stay births
- Nephroblastoma (Syndromic Wilm’s tumour)
- Nutcracker syndrome
- Polycystic kidney illness
- Renal agenesis. Failure of 1 kidney to type happens in roughly one in 750 stay births. Failure of each kidneys to type was once deadly; nonetheless, medical advances equivalent to amnioinfusion remedy throughout being pregnant and peritoneal dialysis have made it doable to remain alive till a transplant can happen.
- Renal dysplasia
- Unilateral small kidney
- Multicystic dysplastic kidney happens in roughly one in each 2400 stay births
- Ureteropelvic Junction Obstruction or UPJO; though most circumstances are congenital, some are acquired.
Many renal illnesses are identified on the premise of an in depth medical historical past, and bodily examination. The medical historical past takes under consideration current and previous signs, particularly these of kidney illness; current infections; publicity to substances poisonous to the kidney; and household historical past of kidney illness.
Kidney perform is examined for utilizing blood exams and urine exams. A regular blood take a look at is for urea and electrolytes, generally known as a U and E. Creatinine can be examined for. Urine exams equivalent to urinalysis can consider for pH, protein, glucose, and the presence of blood. Microscopic evaluation may establish the presence of urinary casts and crystals. The glomerular filtration price (GFR) may be calculated.
Renal ultrasonography is important within the analysis and administration of kidney-related illnesses. Different modalities, equivalent to CT and MRI, ought to at all times be thought-about as supplementary imaging modalities within the evaluation of renal illness.
The function of the renal biopsy is to diagnose renal illness through which the etiology is just not clear primarily based upon noninvasive means (medical historical past, previous medical historical past, remedy historical past, bodily examination, laboratory research, imaging research). Typically, a renal pathologist will carry out an in depth morphological analysis and combine the morphologic findings with the medical historical past and laboratory information, in the end arriving at a pathological analysis. A renal pathologist is a doctor who has undergone normal coaching in anatomic pathology and extra specifically coaching within the interpretation of renal biopsy specimens.
Ideally, a number of core sections are obtained and evaluated for adequacy (presence of glomeruli) intraoperatively. A pathologist/pathology assistant divides the specimen(s) for submission for mild microscopy, immunofluorescence microscopy and electron microscopy.
The pathologist will look at the specimen utilizing mild microscopy with a number of staining methods (hematoxylin and eosin/H&E, PAS, trichrome, silver stain) on a number of stage sections. A number of immunofluorescence stains are carried out to judge for antibody, protein and complement deposition. Lastly, ultra-structural examination is carried out with electron microscopy and should reveal the presence of electron-dense deposits or different attribute abnormalities which will recommend an etiology for the affected person’s renal illness.
Within the majority of vertebrates, the mesonephros persists into the grownup, albeit normally fused with the extra superior metanephros; solely in amniotes is the mesonephros restricted to the embryo. The kidneys of fish and amphibians are sometimes slim, elongated organs, occupying a good portion of the trunk. The gathering ducts from every cluster of nephrons normally drain into an archinephric duct, which is homologous with the vas deferens of amniotes. Nevertheless, the scenario is just not at all times so easy; in cartilaginous fish and a few amphibians, there may be additionally a shorter duct, just like the amniote ureter, which drains the posterior (metanephric) components of the kidney, and joins with the archinephric duct on the bladder or cloaca. Certainly, in lots of cartilaginous fish, the anterior portion of the kidney could degenerate or stop to perform altogether within the grownup.
In essentially the most primitive vertebrates, the hagfish and lampreys, the kidney is unusually easy: it consists of a row of nephrons, every emptying straight into the archinephric duct. Invertebrates could possess excretory organs which might be generally known as “kidneys”, however, even in Amphioxus, these are by no means homologous with the kidneys of vertebrates, and are extra precisely referred to by different names, equivalent to nephridia. In amphibians, kidneys and the urinary bladder harbour specialised parasites, monogeneans of the household Polystomatidae.
The kidneys of reptiles encompass plenty of lobules organized in a broadly linear sample. Every lobule incorporates a single department of the ureter in its centre, into which the gathering ducts empty. Reptiles have comparatively few nephrons in contrast with different amniotes of an analogous dimension, probably due to their decrease metabolic price.
Birds have comparatively giant, elongated kidneys, every of which is split into three or extra distinct lobes. The lobes consists of a number of small, irregularly organized, lobules, every centred on a department of the ureter. Birds have small glomeruli, however about twice as many nephrons as equally sized mammals.
The human kidney is pretty typical of that of mammals. Distinctive options of the mammalian kidney, as compared with that of different vertebrates, embody the presence of the renal pelvis and renal pyramids and a clearly distinguishable cortex and medulla. The latter characteristic is as a result of presence of elongated loops of Henle; these are a lot shorter in birds, and never really current in different vertebrates (though the nephron typically has a brief intermediate phase between the convoluted tubules). It’s only in mammals that the kidney takes on its classical “kidney” form, though there are some exceptions, such because the multilobed reniculate kidneys of pinnipeds and cetaceans.
Kidneys of assorted animals present proof of evolutionary adaptation and have lengthy been studied in ecophysiology and comparative physiology. Kidney morphology, typically listed because the relative medullary thickness, is related to habitat aridity amongst species of mammals and weight-reduction plan (e.g., carnivores have solely lengthy loops of Henle).
Society and tradition
In historic Egypt, the kidneys, like the center, had been left contained in the mummified our bodies, in contrast to different organs which had been eliminated. Evaluating this to the biblical statements, and to drawings of human physique with the center and two kidneys portraying a set of scales for weighing justice, it appears that evidently the Egyptian beliefs had additionally linked the kidneys with judgement and maybe with ethical choices.
In keeping with research in fashionable and historic Hebrew, varied physique organs in people and animals served additionally an emotional or logical function, at this time principally attributed to the mind and the endocrine system. The kidney is talked about in a number of biblical verses at the side of the center, a lot because the bowels had been understood to be the “seat” of emotion – grief, pleasure and ache. Equally, the Talmud (Berakhoth 61.a) states that one of many two kidneys counsels what is sweet, and the opposite evil.
Within the sacrifices supplied on the biblical Tabernacle and afterward on the temple in Jerusalem, the monks had been instructed to take away the kidneys and the adrenal gland masking the kidneys of the sheep, goat and cattle choices, and to burn them on the altar, because the holy a part of the “providing for God” by no means to be eaten.
India: Ayurvedic system
In historic India, in response to the Ayurvedic medical methods, the kidneys had been thought-about the start of the tour channels system, the ‘head’ of the Mutra Srotas, receiving from all different methods, and due to this fact vital in figuring out an individual’s well being stability and temperament by the stability and combination of the three ‘Dosha’s – the three well being components: Vatha (or Vata) – air, Pitta – bile, and Kapha – mucus. The temperament and well being of an individual can then be seen within the ensuing shade of the urine.
Fashionable Ayurveda practitioners, a follow which is characterised as pseudoscience, have tried to revive these strategies in medical procedures as a part of Ayurveda Urine remedy. These procedures have been referred to as “nonsensical” by skeptics.
The Latin time period renes is said to the English phrase “reins”, a synonym for the kidneys in Shakespearean English (e.g. Merry Wives of Windsor 3.5), which was additionally the time when the King James Model of the Bible was translated. Kidneys had been as soon as popularly considered the seat of the conscience and reflection, and plenty of verses within the Bible (e.g. Ps. 7:9, Rev. 2:23) state that God searches out and inspects the kidneys, or “reins”, of people, along with the center.
The kidneys, like different offal, may be cooked and eaten.
Kidneys are normally grilled or sautéed, however in additional advanced dishes they’re stewed with a sauce that can enhance their taste. In lots of preparations, kidneys are mixed with items of meat or liver, as in combined grill. Dishes embody the British steak and kidney pie, the Swedish hökarpanna (pork and kidney stew), the French rognons de veau sauce moutarde (veal kidneys in mustard sauce) and the Spanish riñones al Jerez (kidneys stewed in sherry sauce) .
Kidney stones have been recognized and recorded about so long as written historic information exist. The urinary tract together with the ureters, in addition to their perform to empty urine from the kidneys, has been described by Galen within the second century AD.
The primary to look at the ureter via an inside method, referred to as ureteroscopy, reasonably than surgical procedure was Hampton Younger in 1929. This was improved on by VF Marshall who’s the primary revealed use of a versatile endoscope primarily based on fiber optics, which occurred in 1964. The insertion of a drainage tube into the renal pelvis, bypassing the uterers and urinary tract, referred to as nephrostomy], was first described in 1941. Such an method differed significantly from the open surgical approaches throughout the urinary system employed in the course of the previous two millennia.
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