A.

SWAROOPA
MSC(NURSING)
VITAL ORGANS
 Organs of the Renal System
• 2Kidneys
• 2Ureters
• Urinary bladder
• Urethra
• Not many
structures, but
very important!

3 Figure 23.1a
LOCATION:
Kidneys
 Kidneys are a pair of excretory organs situated on the
posterior abdominal wall,
 above the waist,
 extending from upper border of T12 to L3 vertebra,
 partially protected 11th & 12th pairs of ribs.
 Renal Anatomy

• Paired retroperitoneal bean-shaped organs

• Located in the dorsal upper lumbar region
• Encased in the renal fat pad
 Kidneys
Right kidney is slightly lower than the left because the
liver occupies considerable space on the right side
superior to the kidney.

“THEY ARE THE RETRO PERITONEAL ORGANS”

 Kidneys
COLOR AND SHAPE:
Red color and bean shaped.

CAPSULES OR COVERINGS OF KIDNEYS

 Fibrous capsule,
 Peri-renal fat,
 Renal fascia and
 Para-renal fat
HEIGHT & WEIGHT:
Each kidney is 11 cm (4-5”) long, 6 cm (2-3”) broad and
3 cm (1”) thick, weight 150 g in males and 135 g in
females.

11 cm

3cm

8
6cm
ORGANS ASSOCIATED WITH THE KIDNEYS

SUPERIORLY- RIGHT ADRENAL GLAND.

ANTERIORLY- RIGHT LOBE OF THE LIVER ,
DUODENUM, & HEPATIC FLEXTURE OF THE COLON.
TH
POSTERIORLY-12 RIB DIAPHRAGM, MUSCLES OF
POSTERIOR ABDOMINAL WALL (PSOAS MAJOR,
QUADRATUS LUMBORUM & TRANSVERSUS
ABDOMINIS.
OURRER ROLE -
Muprarenal pland
OLOWE R ROLE -2.Scrrs
aDave iliac cyes£
OM EDEAL DORDER
xAbove bilum —a4xenal
@la I3cI
 Gortex
Inner laayeer Meclulla
oof Peritoneal relations:
fibrous capsule

Renal sinus R e n a l
The kidneys
p y r a m i are
Adipose tissue retroperitoneal. Co n n ec t i
in renal sinus
Certain areasm inofo r each
c a
Renal pelvis
kidney anteriorly
are ocovered
n to in
by l y peritoneum,
x

Renal papilla
whereas others are "bare“.
Ureter Renal
lobe
Renal columns
Outer laJHfi O
 fibrous capsule

12
Internal Structure of the Kidney
Renal Lobe

Renal pyramids

Renal papilla

Renal Columns

13
Human Kidney
 Protection of the Kidneys
• 3 layers of connective
tissue: Renal cortex

– Inner layer- Renal capsule

– Middle layer- Adipose

capsule
Retroperitoneal space
– Outer layer-Renal fascia

15
 3 layers of tissue surrounds the each
kidney

DEEP LAYER ( RENAL CAPSULE ) is a smooth

transparent sheet of dense irregular connective tissue
that continous with the outer coat of the ureter. It
serves as barrier against trauma and helps to
maintain the shape of kidney.
Middle layer: the adipose capsule : is a mass
of fatty tissue surrounding the renal capsule.
it also protects the kidney from trauma.

Superficial layer: renal fascia is another thin

layer of dense irregular connective tissue that
covers surrounding structures and to the
abdominal wall.
GROSS STRUCTURE OF THE KIDNEY
Longitudinal section there are 3 areas.
I. Fibrous capsule
II. Cortex
III. Medulla
RENAL FIBROUS CAPSULE: surrounds the kidney,
made of dense fibrous connective tissue.

19
 CORTEX: A reddish brown layer of tissue
immediatelybelowthecapsuleandoutsidethe pyramids.

20
 MEDULLA:theinnermostlayer consistingofpale
conical shaped striations called renal pyramids.

21
 HILUM:itistheconcavemedialborder ordeep
Surface anatomy of the Kidney
fissure of the kidney where the renal blood & lymph
vessels , urater &nerve enters.
• Hilum is located on
the medial surface

Renal Sinus:
Space within hilus.
Kidneys receive
blood vessels and
nerves.
RENAL PELVIS: it is the funnel shaped structure
which acts as a receptacle of the urine formed by
the kidney.

23
IT HAS NUMBER OF DISTAL BRANCHES CALLED CALYCES ,
EACH OF WHICH SOROUNDS APEX OF THE RENAL PYRAMID.

URINE FORMED IN THE KIDNEY PASES THROUGH PAPILLA

AT THE APEX OF THE PYRAMID INTO MINOR CALYX THEN
INTO MAJOR CALYX BEFORE PASSING THROUGH THE PELVIS
INTO THE URETER.
THE WALLS OF THE PELVIS CONTAINS SMOOTH
MUSCLE AND ARE LINED WITH TRANSITIONAL
EPITHELIUM.

PERISTALYSIS OF THE SMOOTH MUSCLE IN THE

WALLS OF THE CALYCES PROPELS URINE
THROUGH THE PELVIS , URETERS TO THE
BLADDER.

25
The ureteric pelvis usually divides into two or
three short tubes, the major calices, each of
which subdivides into 7 to 14 minor calices.

Each minor calyx receives the openings of

collecting tubules on papillae that project into
the calices
Intravenous pyelogram:

Note the calices and the

pelves of the ureters,
which differ in shape and
level.
Renal Pedicle:

The ureter and renal

vessels near the hilus form
the pedicle.

The renal vein anterior, the

ureter is posterior, and the
arteries little high.
The glomerular capillaries called the glomerulus.
The usual direction of blood flow is:
• Arteries

• Arterioles

• Capillaries

• Venueles

• veins
BLOOD SUPPLY TO KIDNEY
ARTERIAL SUPPLY
ABDOMINAL AORTA

RENAL ARTERIES

SEGMENTAL ARTERIES

INTERLOBAR ARTERIES

ARCUATE ARTERIES

INTER LOBULAR

FORMS 5-8 CAPILLARIES

 inte‹aaular

’Main
rwzsJ

Arterial supply
BLOOD SUPPLY TO KIDNEY VENOUSSUPPLY

INFERIOR VENACAVA

RENAL VEINS

SEGMENTAL VEINS

INTERLOBAR VEINS

ARCUATE VEIN

INTER LOBULAR VEINS

 lrunk

Venous drainage
 erlobular
aery
Segmental Arcuate

Afcuate

Rreal

Renal
Interlobular
arteries
Renal IntsrlDbar vein

Interlobar artery

YBIPS

Arcua
arteies
Autonomic plexuses in the abdomen and pelvis

Regulates blood flow to the kidney by

causing vasodilation or vaso constriction
of renal arterioles.
Filtering & phagocytosis
Proliferation of
lymphocytes
Lumbar aortic
nodes
MUSCLES ATTACHED TO KIDNEYS

QUADRATUS
LUMBORUM
MUSCLE

ILLIACUS MUSCLE

PSOAS
MAJOR
MUSCLE
Parts of the kidney:
1. Renal pyramid
2. Efferent vessel
3. Renal artery
4. Renal vein
5. Renal hilum
6. Renal pelvis
7. Ureter
8. Minor calyx
9. Renal capsule
10. Inferior renal capsule
11. Superior renal
capsule
12. Afferent vessel
13. Nephron
14. Minor calyx
15. Major calyx
16. Renal papilla
17. Renal column

40
 MICROSCOPIC ANATOMY OF THE KIDNEYS

• The functional unit of the lungs is the

alveolus.
• The functional unit of the liver is the lobule.
• The functional unit of the kidney is the
NEPHRON and smaller number of collecting
tubules.
• Each kidney has about 18 lobes and 1 million
nephrons.

41
 Capfilaries

Glomerulu

CoJJect1ng
du
Vein

Artery To the ureter

Loop of He rile
 Two types of nephrons
Cortical nephrons with short loop of Henle.
Juxtamedullary nephrons with long loops of Henle.
DIFFERENCES BETWEEN TYPES OF NEPHRON
CORTICAL NEPHRONS
i. 85% of nephrons JUXTRA MEDULLARY
are in this type. NEPHRONS
ii. Most of the parts of i. 15%.
nephron are in
ii. begins at the
cortex only.
junction of the
iii. Length of LH is
cortex and medulla.
short.
iii. long.
iv. Accompanied by
iv. vasa recta.
peritubular
capillary net work.
AReent aFeJale
fiNerini aderbk
gh
Pessure

Bowmans

Glomeulus

Glomarula
fiItr#e
PCT
0
The glomerular filtration membranes are consist of 3
layers of capillary wall.

---Endothelium.
---Basement membrane.
---Epithelial podocytes.

Fluid that filtered from the capillary blood into the

bowman's space is called filtrate and forms the
primary urine .
 Histology of Filtration Membrane
1) Endothelium of glomerulus
– Single layer of capillary endothelium with
fenestrations
– Prevents RBC passage; WBCs.
 Histology of Filtration Membrane
2) Basement membrane of glomerulus
– Between endothelium and visceral layer of glom. capsule
– Prevents passage of large protein molecules
 Histology of Filtration Membrane
3) Filtration slits in podocytes
– Podocytes
• specialized epithelium of visceral layer
• footlike extensions with filtration slits between extensions
– Restricts passage of medium-sized proteins
THE FILTRATE THEN DIFFUSES ACROSS BOWMANS SPACE
AND INTO THE TUBULES OF THE NEPHRON.

IN THE TUBULES SOME SUBSTANCES ARE ADDED TO THE

FILTRATE AS PART OF THE URINE FORMATION.

AND SOME SUBSTANCES REABSORBED OUT OF THE FILTRATE

AND BACK IN TO THE BLOOD.
*- @ 'structures auñ Puuetinus
22 4 f m°% e
LOOP OF HENLE
REABSORPS THE WATER AND IONS FROM THE
URINE
• AND CONTROLS THE CONCENTRATION OF
URINE.
– THICK PORTION
– THIN PORTION
• DISTAL CONVOLUTED TUBULE: regulate Na, K,
PH AND FURTHER DILUTION OF URINE TAKES
PLACE.
• COLLECTING DUCT WHICH JOINS WITH SEVERAL
TUBULES TO COLLECT THE FILTRATE AND FINAL
NA REGULATION TAKES PLACE.

57
PROXIMAL CONVOLUTED TUBULE (PCT)
LOOP OF HENLE
Descending limb of the loop of henle
ASCENDING LIMB OF THE LOOP OF HENLE
DISTAL CONVOLUTED TUBULE( DCT)
COLLECTING
 TUBULE HISTOLOGY
• PCT : cuboidal cells with apical microvilli
• Descending Loop and beginning of Ascending
Loop: simple squamous epithelium.
• Ascending limb of the Loop:
– cuboidal & columnar epithelial cells.
• DCT, collecting ducts :
– cuboidal with specialized cells.
The Nephron
 JUXTAGLOMERULAR APPARATUS
 The distal end of the renal
tubule passes next to the
glomerulus to form the
juxtaglomerular
apparatus (juxta means
“next to”).

 The juxtaglomerular
apparatus (JGA) consists
of cells located in and
around the glomerulus
and the glomerular
capsule.

66
Constitution of the
3ux†nplomeru1nr Appnrntus
KIDNEY FUNCTIONS
 URETERS
The ureter is continous with the funnel
shaped renal pelvis.
The ureters are the tubes that convey urine
from the kidneys to the urinary bladder.
Thetwouretersaremusculartubesthat
extendfromthekidneystotheposterior
surfaceof theurinarybladderwherethe
urine is propelled along the ureter by
peristaltic contractions
The ureter is a retroperitoneal, distensible muscular
tube that connects the kidney with the bladder.
Because of this arrangements (psoas major
muscle, sacro illiac joint , posterior wall of the
bladder ) when urine accumulates and the
pressure in the bladder rises, the ureters are
compressed and the openings occluded. This
prevent reflux of urine into the ureters (towards
kidneys).
 Ureter
• relations
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
 RELATIONS TO URETER
 ANTERIOR:
• Duodenum,
• Terminal part of the ileum,
• Right colic vessels,
• Iliocolic vessels,
• Right testicular or ovarian vessels.
 POSTERIOR:
• Right psoas muscle,
• Bifurcation of the
right common iliac artery
CONSIST OF 3 LAYERS OF TISSUE:
1) Outer covering of fibrous tissue.

2) Middle muscular layer consisting of smooth muscle fibers.

3) Inner layer
the mucosa,
lined with transitional
epithelium.
 Blood
• 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
Sympathetic supply
from renal,
Testicular, ovarian
hyogastric & pelvic
plexus.

Para sympathetic
supply from sacral
plexus.
 Ureters
• 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)
 CONSTRCTIONS

pelvic brim
Ureter
vesico ureteric junction
bfinary bl dd

Uethra
• The two suprarenal glands retroperitoneal organs
are yellowish that lie on the upper
 poles of the kidneys
SUPRARENAL GLANDS
• 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
 LEFT SUPRARENAL GLAND

• 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 stomach
• It rests posteriorly on the
diaphragm
 RIGHT SUPRARENAL
• The right suprarenal gland GLANDS
is pyramidal in shape 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.
a Two structurally and functionally
different endocrine tissues
a Different embryologicol origin.
Adrenal
gland
Cortex
a
Nedulla
 • The cortex secretes hormones
include: Suprarenal Glands
• 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
es• the catecholamine, epinephrine and norepinephrine
ARTERIES: Blood Supply
Three arteries supplying each gland,
• 1- Superior suprarenal artery: from
inferior phrenic artery
• 2- Middle suprarenal from aorta.
• 3- Inferior 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
URINARY BLADDER
• Collapsible muscular sac.
• Stores and expels urine.
• Lies on pelvic floor
posterior to pubic
symphysis.
– Males: anterior to
rectum.
– Females: just anterior
to the vagina and
uterus.
88
 The Final Common Pathway
• Urinary bladder
– hollow muscular organ
– generally smaller in females due to presence of a
uterus
– retroperitoneal in the pelvic cavity, posterior to the
pelvic symphysis
– freely movable.
– Bladder muscle is detrusor muscle.
90
91
The openings of the two ureters and the urethra mark a
triangular area called the trigone on the bladder floor.
S
T
R
U
C
T
U
R
E
OF
“TRIGONE”
Bladder- structure
3 layers
– Outer layer
• Loose connective tissue
– Middle layer
• Smooth muscle and
elastic fibres
– Inner layer
• Lined with
transitional
epithelium
93
• Bladder histology:

– Sphincters control entry from ureters.

– Exit at the urethra.

• circular smooth muscle fibers form internal urethral

sphincter.

• lower is the external urethral sphincter with skeletal

muscle for voluntary control.
URETHRA
–small tube from floor of bladder to exterior
of body.
• females -- fairly straight path exits anterior
to vagina.
• males -- passes through the prostate gland
and exits through the penis.
The Urethra
- conveys urine from the urinary bladder to the
outside of the body.

greater risk of
urinary tract
infections
FEMALES MALE
3-4 cm (1.5”) 20 cm (8”)
The male urethra has three regions:

1) prostatic urethra

2) membranous urethra

3) penile urethra.
Difficulty in voiding urine with
enlarged prostate
URETHRAL SPHINCTERS IN BOTH SEXES:
-Internal Urethral Sphincter- under involuntary control of
smooth muscle.
-External Urethral Sphincter - under voluntary control of skeletal
and levator ani muscle.

internal urethral sphincter

external urethral sphincter

HISTOLOGY
FEMALE: THREE COATS
Inner mucosa,
Intermediate thin layer of spongy tissue with plexus of
veins.
Outer muscular coat continuous with the bladder.
MALE TWO LAYERS
Inner mucous membrane and a muscularis
Outer submucosa tissue with various accessory structures
which connect to it.
Both genders have a stratified squamous epithelial
lining.
KNOW:
-Micturation center of
brain: pons.
-Parasympathetic: to
void.
-Sympathetic: inhibits
micturation.

100
CONGENITAL ANOMALIES OF KIDNEY:
AGENESIS (one or both fetal kidney are absent).
HYPOPLASIA (Small kidney).
ECTOPIC KIDNEYS (kidney is located in an abnormal position.
HORSE SHOE KINEYS (the kidneys are fused together at the lower
end or base.)
PAN CAKE KIDNEYS (renal fusion anomaly of the kidneys of the
crossed fused variety)
POLY CYSTIC KIDNEY (progressive enlargement of cysts in the
kidneys )
HYPOPLASIA ECTOPIC KIDNEY

HORSE SHOE PCKD PANCAKE KIDNEY

Epispadias & hypospadias:
Mutual opening located on dorsal or superior surface of the
penis. Ventral or inferior surface of the penis.
 Kid ney
b OFI B

UreteraI
f”•IOr10

B/aOde‹
"• tOFl g
Addison’s disease, chronic adrenal insufficiency,
hypocortisolism, and hypoadrenalism) is a rare,
chronic endocrine systemdisorder in which the adrenal
glands do not produce sufficient steroid
hormones (glucocorticoids and often mineralocorticoids)
 PHEOCHROMACYTOMA
DEFINITION:
Pheochromacytoma is a catecholamine
secreting tumor of the cromaffin cells of
the
sympathetic nervous system it is usually found
in the adrenal medulla.
 Urinary tract
infections

URINARY
RETENTION
is the inability to
empty the
bladder completely.
CHRONIC
RENAL
FAILURE
Dialysis
the clinical purification of blood by dialysis, as a
substitute for the normal function of the kidney.
 LcIT

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lliac crest

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