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Renal Anatomy
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Functional renal system anatomy and clinical cases
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RENAL SYSTEM ANATOMYUPPER UNIARY TRACT
• superior and inferior poles; inner medulla, arranged in pyramids and out cortex surounded by a
capsule
• Functions of the kidney are excretion and electrolyte balance
• Minor and major calyces and renal pelvis are lined with transitional epithelium
• At the renal hilum the renal vein, artery and ureters from anterior to posterior
• the renal vein has to be ontop of the renal artery as if it was underneath then the pressure of the
renal artery would compress the vein. Also IVC is more anterior than aorta
• Lymph from the kidney drains into the para-aortic node as it is a paired organ
• They lie in the paravertebral gutters of T12-L3
• Left kidney T12-L2 hilum at L1, Right kidney L1-L3 Hilum at L2
• Hilum of left kidney lies on the transpyloric plane
• The left kidney is higher than right kidney as the liver presses down onto the right kidney
• In the normal supline position the medial boarder of the kidney is more anterior than the lateral
boarder hence superior pole is more anterior than the inferior pole.
• There are 3 capsules to the kidney:
- Renal fibrous capsule which adheres to the surface of the kidney
- Perirenal/perinephron solid, protective adipose tissue
- Renal fascia extraperitoneal fascia
• Posterior relations to the kidney:
- Muscles: diaphrage, psoas mjor, transverse abdominus and quadratus lumborum
- Bones: 12th floating rib
- Nerves: subcostal, iliohypogastrc, ilioinguinal
• Anterior relations to the RIGHT kidney:
- Inferior surface of liver, second part of duodenum, suprarenal gland, ascending colon
• Anterior relations to the LEFT kidney:
- Pancreatic tail, spleen, duodenum and ligament of treitz (ligament which wraps around
the end of the
oesophagus and the
top of the
duodenum.
,
,BLOOD SUPPLY:
• Blood supply to the kidneys is renal vessels which arise at L1-L2, There can also be accessory
renal arteries.
INNERVATION:
• Sypatheitc innervation pass from the sympathetic chain to renal plexus and along renal vessels
(gonadal plexuses)
• Afferent sympathetic fibres enter the spinal cord at T12-L2 (sensory to renter the spinal cord to
brain for feedback) e.g conveying pain
• Most of the renal nerves are vasomotor and so can enlarge when need to increase stimulation
HAEMATURIA
• Haematuria: blood in urine
• Paired organs drain into the para-aortic/lumbar nodes.
• Signs of maligmeancy fed flag: painless haematuria, above 50, urethral discharge, poor urinary
stream.
• Renal cell carcinoma may present with haematuria
ADRENAL GLANDS:
• Right adrenal gland lies posterior to the liver, left lies posterior the the stomach and pancreas
• Lie within the coverings of the perinephric fat and renal fascia
• Adrenal glands have the greatest blood supply rate per gram of tissue
• outer cortex and inner medulla
• Shape: right adrenal gland is pyramidal, left is semilunar and larger
• Supplied by superior and inferior suprarenal arteries which are branches from the inferior phrenic
artery, aorta and renal arteries
• Functions of the medulla: Chromafftin cells source of adrenaline and NA production
• Functions of the cortex: production of hormones, aldosterone, cortisol, androgen
POLYCYTIC KIDNEYS:
• Polycystic kidneys, horseshoe kidney,
pelvic kidney, duplications of the ureter
(may fuse before badder or enter
bladder)
• In horseshoe kidneys they do no
reach L1-L3 due to being trapped by
IMA. Still fully functional only need
to be surgically separated if compress
IMA
,• Be aware that some of the anomalies may predispose to infection or stone formation.
URETERS:
• The ureters are about 25 cm in length and are covered in transitional epithelium
• They have a muscular ring and so can peristalsis
• The ureters cross the abdomen and the pelvis
• The ureters are retroperitoneal along with the kidneys and renal glands
• Constrictions of the ureters include:
- Pelvic -ureteric junction
- At the pelvic brim (crossing external iliac artery)
- As transverses bladder wall
• pelvic ureters are from the pelvic brim where the bifurcation of the common iliac artery occurs.
• it turns anteriorly and medially at the level of the ischial spine (e.g forward and inwards)
• The ureters pass obliques through the bladder wall to prevent the back flow of urine back up the
ureters under pressure. this way the bladder can compress the distal end of the ureters to prevent
back flow.
• Blood supply to the ureters are the from the
local arteries alog its course (venous
drainage via corresponding veins: aorta,
renal, gonadal artery, internal iliac arteral and
inferior vesical artery
• Lymph drainage is lateral aortic nodes
• Abdominal ureters drain into common iliac
nodes
,BLADDER:
• The bladder sits n the pelvis
• parts of the bldder consits of a superior surfce, apex, neck, and trigone which is smooth in the
bladder
• The bladder contains rugae for expansion
• Mucosa is transitional ureothelium
• Max capacity of urine is 500 ml and sensation of urination arrives at approx 150 ml
• Embryology: Urachus (obliterated allantosis) - median umbilical vein. attached to apex of bladder
continues in fold of peritoneum on anterior abdomen - median umbilical fold.
• Medial umbilical ligament and used to the the cord of umbilical artery. Deep surface of anterior
abdominal wall covered by medial umbilical folds.
• empty bladder lies in true pelvis, posterior to pubic symphysis
• As increases in volume, expand to becomes intra-abdomenal (palpated in supra-pubic region)
• Relations:
- Anterior: pelvic symphyasis
- Posterior: Rectum, uterus, upper vagina, seminal vesicle, vas deferens, cervix.
- Lateral: Levator ani, obturator internus
- Superior: Peritoneum, sigmoid colon, small intestine
- Inferior: Prostate, colon, uterus flops ontop, levator ani.
• Vas deferns, seminal vesicle, ejaculatory duct join up to urethra at the prostatic urethra in the
prostate.
• blood supply: superior and inferior vesical arteries from internal iliac artery
• Venous supply: Vesical venous plexus (male: communicates with the prostatic plexus) drains into
internal iliac veins
• Lymph drainage: into internal and external iliac nodes (which then drain into para aortic nodes)
• Innervation of bladder: Sympathetic trunk, parasympatheitc, pelivic splanchnic nerves S2-S4
• Fibers join pelvic (inferior hypogastric) plexus on each side of the bladder then to bladder itself
, FEMALE URETHRA
• Female urethra is between 4-5cm approx 2 inches
• supported by embedded in the anterior wall of the vagina
• Approx. 2cm behind the clitoris
• External urethral meatus opening is where the urine exits the body.
MALE URETHRA
• 20cm approx 8inches
• 4 parts:
- Pre-prostatic :embedded with neck of bladder
- Prostatic urethra: within prostate, 15-20 prostatc ducts empty into prostatic sinus on each
side of the urethral crest, opening of ejaculatory ducts on either side of prostatic tube
- Membranous (intermediate) urethra: through external sphincter and perineal membrane
- Penile (spongy) urethra: within bulb and corpus spongiosum of penis
- External urethral meatus opening: end of glans
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