Anatomy of Kidney 2025 PDF

Anatomy of kidney Renal mod. Anatomy department  OBJECTIVES At the end of the lecture, students should be able to:  Describe anatomy of the kidneys  Describe their shape, surfaces, borders and state factors of fixation  Identify the relations of...

Anatomy of kidney Renal mod. Anatomy department  OBJECTIVES At the end of the lecture, students should be able to:  Describe anatomy of the kidneys  Describe their shape, surfaces, borders and state factors of fixation  Identify the relations of the kidneys  Identify Surface anatomy of the kidney  Mention the blood supply of kidneys  Mention lymphatic drainage of the kidneys  Outline course of ureter Kidneys The two kidneys function to excrete most of the waste products of metabolism. Location and Description  The kidneys are reddish brown and lie behind the peritoneum (Retroperitoneal) on post. Abdominal wall, one on each side of vertebral column.  Extends from 12th thoracic to 3rd lumbar vertebra.  Right kidney is 1/2 inch lower than the left (due to large size of right lobe of liver)  The hilum of the kidney lies opposite L 1 vertebra (transpyloric plane). Location and Description  The upper end of the right reaches 11th intercostal space while the Lt reaches 11th rib.  Lower end of RT kidney is 1.5 inches above the iliac crest while lower end of Lt Kidney is 2 inches above the iliac crest.  Trans pyloric plane (L1) passes through the upper part of the hilum of the right kidney but through the center of hilum of Lt kidney.  The upper poles of the two kidneys are closer to the median plane than their lower poles. Shape: bean shaped It has Two poles (ends) Upper end: thick opposite T12 V, 1inch from midline Lower end: thin and small, opposite L3V, 3 inches from midline Two surfaces: Anterior surface: irregular, related to organs Posterior Surface: flat, resting on posterior abdominal wall T12 Two borders: Lateral border: convex Medial border: concave, at its middle part, there is a hilum. L3 Hilum of kidney: It is a vertical slit at the middle part of medial border of kidney where the vessels enter the kidney. It extends into large cavity inside kidney called renal sinus which receive vessels. The hilum transmits from the front backward: - Renal vein anterior. -Renal artery in the middle. -Pelvis of ureter posterior. -Lymphatics and Autonomic nerve fibers Identification of the side of kidney.  The renal vein most anterior and the pelvis of ureter most posterior  Hilum is in medial border.  Ureter projects downward. Coverings The kidneys have the following coverings: 4 capsules 1-Fibrous capsule: This surrounds the kidney and is closely applied to its outer surface.(true capsule) 2-Perirenal fat: (fatty capsule) This covers the fibrous capsule. 3-Renal fascia: (False capsule).This is derived from fascia transversalis. This is a condensation of connective tissue that lies outside the perirenal fat and encloses the kidneys and suprarenal glands; it is continuous laterally with the fascia transversalis. Below, Its two layers remain separate & enclose the ureter. 4-Pararenal fat: This lies external to the renal fascia and is often in large quantity. It is mainly behind kidney. The perirenal fat, renal fascia, and pararenal fat support the kidneys and hold them in position on the posterior abdominal wall. Relations of the kidneys Anterior Right kidney 1- Suprarenal gland: to upper end. 2- Right lobe of liver: to upper part of anterior surface 3- 2nd part of duodenum: anterior to medial border and hilum. 4- right colic flexure: to lower lateral part of anterior surface. 5- Jejunum to lower medial part of anterior surface Relations of the kidneys Anterior Left kidney 1- Supra renal gland: to upper end. 2- Jejunum : to lower medial part of anterior surface 3- Spleen: to upper lateral part of anterior surface. 4- Pancreas and splenic vessels: to middle part of ant. Surface and hilum. 5- Stomach: to upper part of ant. surface between spleen laterally, suprarenal medially& pancreas below. 6-Descending colon and left colic flexure: to lower lateral part of anterior surface. Mention anterior relations of kidneys Posterior relation of Left Kidney Posterior relations of Right Kidney The diaphragm. The diaphragm. The costodiaphragmatic recess of the pleura. The costodiaphragmatic recess of the pleura. The 11th (the left kidney is higher) and 12th The 12th rib. ribs. The psoas, quadratus lumborum, and The psoas, quadratus lumborum, and transversus abdominis muscles. transversus abdominis muscles. The subcostal (T12), iliohypogastric, and The subcostal (T12), iliohypogastric, and ilioinguinal nerves (L1) run downward and ilioinguinal nerves (L1) run downward and laterally. laterally Mention posterior relations of the kidneys Stability of kidney( factors )  Attachment of the renal fascia to the surrounding fasciae.  The renal vessels connecting kidney to major vessels (aorta and I.V.C).  Intra- abdominal pressure.  Surrounding viscera.  The perirenal fat and pararenal fat hold the kidneys in position on the posterior abdominal wall. Blood Supply Arteries The renal artery arises from the aorta at the level of the second lumbar vertebra. The right renal artery is long,. Runs behind IVC and renal vein The right renal artery is short, runs behind left renal vein N.B Accessory renal artery: in 30% of cases From aorta: above or below the origin of renal art. Veins The renal vein emerges from the hilum in front of the renal artery and drains into the inferior vena cava. Lymphatic drainage: of the kidney pass directly to the para-aortic lymph nodes Nerve Supply The nerve supply is the renal sympathetic plexus. Surface anatomy of kidney On anterior abdominal wall - Hilum is in transpyloric plane (L1 V) 2 inches from midline. - Upper pole is 2 inches above hilum 1 inch from midline. - Lower pole is 2 inches below hilum 3 inches from midline From behind (Morris parallelogram): Two horizontal lines: T11 spine and L3 spine Two vertical lines: 1 inch from midline and 3 inches from midline. In this rectangle the outline of kidney is mapped as follows 1- Upper end: T12v 1 inch from midline. 2- Hilum: L1v 2 inches from midline. 3- Lower end:L3v 3 inches from midline  The ureters The ureters are two muscular tubes whose peristaltic contractions convey urine from the kidneys to the urinary bladder. Length: each one about 25-30 cm. Thickness: thick walled and narrow lumen. Diameter: 3 mm. Beginning: funnel-shaped renal pelvis which lies within the hilum at level of L1. Termination: at the postro-superior angles of the base of the urinary bladder. COURSE  each ureter descends downward behind the peritoneum opposite the transverse processes of L 2,3,4,5 in front of psoas major muscle.  Then it enters the pelvis by crossing the bifurcation of the common iliac artery(CIA) at the sacroiliac joint.  Then passes downwards and backwards along the internal iliac artery.  At the level of ischial spine, it curves medially to open into the postero-superior angle of the urinary bladder (pelvic part) CIA Parts: each ureter has three parts: 1-Abdominal part 2-Pelvic part 3-Intramural part (inside the urinary bladder wall). N.B: The relation of the Psoas major muscle with ureters is very important to easily identify location of the ureter in the computerized tomography (CT) of the abdomen. Relation Right ureter Left ureter Posterior The same: 1- medial border of the psoas major and minor muscles. The abdominal part of the ureter 2- Tips of transverse processes of L 2,3,4,5. 3- Genito- femoral nerve. 4-biforcation of the common iliac artery. Anterior *2nd, 3rd parts of Differs on duodenum both sides *three vessels: *three vessels: Rt colic vessels. Lt colic vessels. Sigmoidal Rt ileo colic vessels. vessels. Rt gonadal vessels. *three Lt gonadal vessels. *apex of mesenteric related the sigmoid meso colon structures: pelvic colon. Root of mesentery Superior mesenteric vessels Coils of small intestine Medial Inferior vena cava Inferior mesenteric vein Mention relations of abdominal part of the ureter Which of the following is anterior relation of left kidney A- liver B- ascending colon C- second part of duodenum D- stomach Which of the following structures is the most anterior structure of the hilum of kidney? A- pelvis of the ureter B- renal artery C- renal vein D- renal lymphatic vessels