05-Kidney, Ureter
FUNCTIONAL ANATOMY
OF KIDNEYS, URETERS
&
SUPRARENAL GLANDS
By Prof. Saeed Abuel Makarem
KIDNEYS
Its main function is to excrete most of the waste products of metabolism
It control the water and electrolyte balance of the body
It maintain acid-base balance of the blood
The waste products leave the kidneys as urine, which passes down the ureters to the urinary bladder
The urine leaves the body through the urethra
Kidneys are reddish brown in color
Lie behind the peritoneum of the posterior abdominal wall
It lie high up on either side of the vertebral column
Are largely under cover of the costal margin
The right kidney lies slightly lower than the left due to the large size of right lobe of the liver
KIDNEYS
With contraction of the diaphragm during respiration, both kidneys move downward in a vertical direction as much as 2.5 cm
On the medial border of each kidney is a vertical slit called the hilum
The hilum extends into a large cavity called the renal sinus
The hilum transmits the renal vein, two branches of renal artery, ureter, and the third branch of renal artery from the front backward (V.A.U.A
.)
KIDNEYS
1- Fibrous capsule:
It surrounds the kidney
2- Perirenal fat:
It covers the fibrous capsule
3- Renal fascia: it is a condensation of connective tissue that encloses the kidneys and suprarenal glands, it is continuous laterally with the fascia transversalis
4- Pararenal fat: it lies external to the renal fascia, and forms part of the retroperitoneal fat
COVERINGS
Each kidney has a dark brown outer cortex and a light brown inner medulla
Medulla is composed of about a dozen renal pyramids
Each pyramid having its base directed laterally toward the cortex, and its apex, (the renal papilla), projecting medially
The cortex extends into the medulla between adjacent pyramids as the renal column
RENAL STRUCTURE
Extending from the bases of the renal pyramids into the cortex are striations known as medullary rays
The renal sinus within the hilum, contains the upper expanded end of the ureter, the renal pelvis
Renal pelvis divides into two or three major calyces , which divides into two or three minor calyces
RENAL STRUCTURE
RIGHT KIDNEY
Suprarenal gland
Liver,
Second part of the duodenum,
Right colic flexure
Coils of small intestine
LEFT KIDNEY
Suprarenal gland,
Spleen,
Stomach,
Pancreas (body),
Left colic flexure,
Descending colon
Coils of jejunum
ANTERIOR RELATIONS OF
THE KIDNEYS
RIGHT KIDNEY
Diaphragm,
Costodiaphragmatic recess of the pleura,
Twelfth rib & last intercostal space,
Psoas major
Quadratus lumborum,
Transversus abdominis muscle
Subcostal nerve (T12)
Iliohypogastric nerve (L1)
Ilioinguinal nerve (L1)
LEFT KIDNEY
Same as the right except it is higher it reaches up to the
11 th rib.
Posterior Relations of the
Kidneys
BLOOD SUPPLY
The renal artery arises from the aorta at the level of the second lumbar vertebra
Each renal artery divides into five segmental arteries that enter the hilum of the kidney, four infront and one behind the renal pelvis
Lobar artery arise from each segmental artery, one for each renal pyramid
Each lobar artery gives two or three interlobar arteries
The interlobar arteries run toward the cortex on each side of the renal pyramid
Interlobar arteries give the arcuate arteries at the junction of the cortex and medulla
The arcuate arteries give several interlobular arteries
Afferent glomerular arterioles arise as branches of interlobular arteries
BLOOD SUPPLY
VEINS, LYMPH,
NERVE SUPPLY
Renal vein emerges from the hilum in front of the renal artery and drains into the IVC
Left renal vein is longer than the right renal vein
Lateral aortic lymph nodes lie around the origin of the renal artery
Renal sympathetic plexus: afferent fibers that travel through the renal plexus enter the spinal cord in the 10 th ,
11 th , and 12 th thoracic nerves
The two ureters are muscular tubes that extend from the kidneys to the posterior surface of the urinary bladder
The urine is propelled along the ureter by peristaltic contractions
Each ureter measures about
25 cm long
Each ureter has three constrictions along its course,
1- Where the renal pelvis joins the ureter,
2- As it crosses the pelvic brim,
3- Where it pierces the bladder wall ( intra-mural part)
URETERS
URETER
The renal pelvis is the funnelshaped expanded upper end of the ureter
It lies within the hilum of the kidney and receives the major calyces
It enters the pelvis by crossing the bifurcation of the common iliac artery in front of the sacroiliac joint
It runs downward & forward on the lateral wall of the pelvis to enter the lateral angle of the bladder
Anterior:
Duodenum,
Terminal part of the ileum,
Right colic vessels,
Iliocolic vessels,
Right testicular or ovarian vessels, and the
Root of the mesentery.
Posterior:
Right psoas muscle,
Bifurcation of the right common iliac artery
RELATIONS, RIGHT URETER
Anterior:
Sigmoid colon,
Sigmoid mesocolon,
Left colic vessels,
Left testicular or ovarian vessels
Posterior:
Left psoas muscle,
Bifurcation of left common iliac artery
RELATIONS, LEFT URETER
Upper end is supplied by the renal artery
Middle portion by
(gonadal) testicular or ovarian artery
In the pelvis is supplied by the superior vesical artery
The lymph drains to the lateral aortic nodes and the iliac nodes
BLOOD SUPPLY
NERVE SUPPLY
Renal, testicular (or ovarian), and hypogastric plexus (in the pelvis)
Afferent fibers travel with the sympathetic nerves and enter the spinal cord in the first and second lumbar segments
The two suprarenal glands are yellowish retroperitoneal organs that lie on the upper poles of the kidneys
They are surrounded by the renal fascia
Separated from the kidneys by the perirenal fat
Each gland has a yellow cortex and a dark brown medulla
SUPRARENAL GLANDS
The cortex secretes hormones include:
Mineral corticoids , which control fluid and electrolyte balance.
Glucocorticoids , which control carbohydrates, fats, and proteins.
Sex hormones , which probably play a role in the prepubertal development of the sex organs
The medulla secretes the catecholamine, epinephrine and norepinephrine
SUPRARENAL GLANDS
Left suprarenal gland is crescentic in shape
Extends along the medial border of the left kidney from the upper pole to the hilum
It lies behind the:
The pancreas,
The lesser sac,
The stomach
It rests posteriorly on the diaphragm
LEFT SUPRARENAL GLANDS
The right suprarenal gland is pyramidal in shap and caps the upper pole of the right kidney
It lies behind the right lobe of the liver and extends medially behind the IVC
It rests posteriorly on the diaphragm
RIGHT SUPRARENAL GLANDS
Arteries:
Three arteries supplying each gland,
1Superior suprarenal artery: from inferior phrenic artery
2Middle suprarenal from aorta.
3Inferior suprarenal from renal.
Veins :
A single vein emerges from the hilum of each gland:
The right suprarenal vein drains into the IVC .
The left suprarenal vein drains into the left renal
BLOOD SUPPLY
The suprarenal glands of the human fetus are 10 to 20 times larger than the adult glands relative to body weight, and are large compared with the kidneys.
These large glands result from the extensive size of the fetal cortex.
Dr. L. Tchakarov 25
