FUNCTIONAL%20ANATOMY%20OF%20KIDNEYS,%20URETERS%20

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FUNCTIONAL ANATOMY OF KIDNEYS, URETERS
SUPRARENAL GLANDS

• By Dr. Mujahid Khan

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Kidneys

• The two kidneys function to excrete most of the
  waste products of metabolism
• They control the water and electrolyte balance of
  the body
• 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 in the urethra

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Kidneys

• Kidneys are reddish brown in color
• Lie behind the peritoneum high up on the
  posterior abdominal wall 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

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Kidneys

• With contraction of 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.)

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Coverings

• Fibrous capsule It surrounds the kidney
• Perirenal fat It covers the fibrous capsule
• Renal fascia it is a condensation of connective
  tissue that encloses the kidneys and suprarenal
  glands, it continuous laterally with the fascia
  transversalis
• Pararenal fat it lies external to the renal
  fascia, and forms part of the retroperitoneal fat

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Renal Structure

• 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 oriented toward the
  cortex, and its apex, the renal papilla,
  projecting medially
• The cortex extends into the medulla between
  adjacent pyramids as the renal column

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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

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Relations of Right Kidney

• Anteriorly The suprarenal gland, the liver, the
  second part of the duodenum, and the right colic
  flexure
• Posteriorly The diaphragm, the
  costodiaphragmatic recess of the pleura, the
  twelfth rib, and the psoas, quadratus lumborum,
  and transversus abdominis muscles, the subcostal
  (T12), iliohypogastric and ilioinguinal (L1)
  nerves

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Relations of Left Kidney

• Anteriorly The suprarenal gland, the spleen, the
  stomach, the pancreas, the left colic flexure,
  and coils of jejunum
• Posteriorly The diaphragm, the
  costodiaphragmatic recess of the pleura, the 11th
  and 12th ribs, and the psoas, quadratus lumborum,
  and transversus abdomnis muscles, the subcostal
  (T12), iliohypogastric and ilioinguinal
  (L1)nerves

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Blood Supply

• The renal artery arises from the aorta at the
  level of 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
• They are distributed to different segments of the
  kidney called segmental arteries
• Lobar artery arise from each segmental artery,
  one for each renal pyramid

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Blood Supply

• Each lobar artery gives off two or three
  interlobar arteries
• The interlobar arteries run toward the cortex on
  each side of the renal pyramid
• Interlobar arteries give off the arcuate arteries
  at the junction of the cortex and medulla
• The arcuate arteries give off several
  interlobular arteries
• Afferent glomerular arterioles arise as branches
  of interlobular arteries

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Veins, Lymph, Nerve Supply

• Renal vein emerges from the hilum in front of the
  renal artery and drains into the IVC
• Lateral aortic lymph nodes around the origin of
  the renal artery
• Renal sympathetic plexus, the afferent fibers
  that travel through the renal plexus enter the
  spinal cord in the 10th, 11th, and 12th thoracic
  nerves

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Ureter

• 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
• Have three constrictions along its course, where
  the renal pelvis joins the ureter, where it is
  kinked as it crosses the pelvic brim, and where
  it pierces the bladder wall

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Ureter

• The renal pelvis is the funnel-shaped 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 down the lateral wall of the pelvis and
  turns forward to enter the lateral angle of the
  bladder

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Relations, Right Ureter

• Anterior The duodenum, the terminal part of the
  ilium, the right colic and iliocolic vessels, the
  right testicular or ovarian vessels, and the root
  of the mesentery of the small intestine
• Posterior The right psoas muscle, and the
  bifurcation of the right common iliac artery

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Relations, Left Ureter

• Anterior The sigmoid colon and sigmoid
  mesocolon, the left colic vessels, the left
  testicular or ovarian vessels
• Posterior The left psoas muscle, and the
  bifurcation of the left common iliac artery

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Blood Supply

• Upper end is supplied by the renal artery
• Middle portion is supplied by 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

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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

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Suprarenal Glands

• The two suprarenal glands are yellowish
  retroperitoneal organs that lie on the upper
  poles of the kidneys
• They are surrounded by renal fascia
• Separated from the kidneys by the perirenal fat
• Each gland has a yellow cortex and a dark brown
  medulla

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Suprarenal Glands

• The cortex secretes hormones include mineral
  corticoids, which is concerned with the control
  of fluid and electrolyte balance
• Glucocorticoids, concerned with the control of
  carbohydrates, fats, and proteins
• Sex hormones, which probably play a role in the
  prepubertal development of the sex organs
• The medulla secretes the catecholamines
  epinephrine and norepinephrine

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Right Suprarenal Glands

• The right suprarenal gland is pyramid shaped 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

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Left Suprarenal Glands

• The left suprarenal gland is crescentic in shape
• Extends along the medial border of the left
  kidney from the upper pole of the hilus
• Lies behind the pancreas, the lesser sac, and the
  stomach
• It rests posteriorly on the diaphragm

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Blood Supply

• Arteries The arteries supplying each gland are
  three in number inferior phrenic artery, aorta,
  and renal artery
• Veins A single vein emerges from the hilum of
  each gland and drains into the IVC on the right
  and into the renal vein on the left

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Nerve Supply and Lymph

• Preganglionic sympathetic fibers derived from the
  splanchnic nerves supply the glands
• Most of the nerves end in the medulla of the
  gland
• The lymph drains into the lateral aortic nodes

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