URINARY SYSTEM

Functions of the Kidney

A. Excretion
B. Blood volume control
C. Ion concentration
D. pH regulation
E. Red blood cell concentration
 Kidney
The kidneys are reddish brown and lie behind the
peritoneum high up on the posterior abdominal
wall on either side of the vertebral column;
The right kidney lies slightly lower than the left
kidney because of the large size of the right lobe of
the liver.
Each kidney is about 11.25 cm. in length, 5 to 7.5
cm. in breadth, and rather more than 2.5 cm. in
thickness. The left is somewhat longer, and
narrower, than the right. The weight of the kidney
in the adult male varies from 125 to 170 gm., in the
adult female from 115 to 155 gm.
Kidney
Kidney
Kidney
 Coverings of the Kidney
1. Fibrous capsule: This surrounds the kidney and is
closely applied to its outer surface.
2. Perirenal fat: This covers the fibrous capsule.
3. Renal fascia: 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.
4. Pararenal fat: This lies external to the renal fascia and
is often in large quantity. It forms part of the
retroperitoneal fat.
The perirenal fat, renal fascia, and pararenal fat
support the kidneys and hold them in position on the
posterior abdominal wall.
Coverings of the Kidney
 Relations of the 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 12th rib; and the psoas,
quadratus lumborum, and transversus abdominis
muscles
Relations of the Kidney
Relations of the Kidney
Relations of the Kidney
 Hilum of the Kidney
On the medial concave border of each kidney is a
vertical slit that is bounded by thick lips of renal
substance and is called the hilum. The hilum
extends into a large cavity called the renal sinus.
The hilum transmits, from the front backward, the
renal vein, two branches of the renal artery, the
ureter, and the third branch of the renal artery
(VAUA). Lymph vessels and sympathetic fibers also
pass through the hilum.
Hilum of the Kidney
 CORTEX & MEDULLA
Each kidney has a dark brown outer cortex and a
light brown inner medulla.
 Medulla
The medulla is composed of about a dozen renal
pyramids, each 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 columns.
Extending from the bases of the renal pyramids into
the cortex are striations known as medullary rays.
 Renal Sinus
The renal sinus is the space within the hilum,
contains the upper expanded end of the ureter, the
renal pelvis. This divides into two or three major
calyces, each of which divides into two or three
minor calyces. Each minor calyx is indented by the
apex of the renal pyramid, the renal papilla.
 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 of the muscle coat,
assisted by the filtration pressure of the glomeruli.
URETER
URETER
 Ureter
Each ureter measures about 10 in. (25 cm) long and has
three constrictions along its course. 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.
The ureter emerges from the hilum of the kidney and
runs vertically downward behind the parietal
peritoneum on the psoas muscle, which separates it
from the tips of the transverse processes of the lumbar
vertebrae. It enters the pelvis by crossing the
bifurcation of the common iliac artery in front of the
sacroiliac joint. The ureter then runs down the lateral
wall of the pelvis to the region of the ischial spine and
turns forward to enter the lateral angle of the bladder.
 Blood Vessels of Ureter
Arteries:
Upper end - Renal artery
Middle portion - Testicular or Ovarian artery
In the pelvis - Superior vesical artery

Veins:
Venous blood drains into veins that correspond to
the arteries.
Lymphatic & Nerve Supply of Ureter

Lymphatic Drainage: The lymph drains to the

lateral aortic nodes and the iliac nodes.

Nerve Supply: Renal, Testicular (or ovarian), and

Hypogastric plexuses (in the pelvis)
Clinical Significance of Anatomical
Constrictions of Ureter
There are three sites of anatomic narrowing of the
ureter where stones may be arrested, namely, the
pelviureteral junction, the pelvic brim, and where
the ureter enters the bladder.
X-ray of the Kidney
 Urinary Bladder

The urinary bladder is situated immediately behind

the pubic bones within the pelvis. It stores urine
and in the adult has a maximum capacity of about
500 mL. The bladder has a strong muscular wall. Its
shape and relations vary according to the amount
of urine that it contains. The empty bladder in the
adult lies entirely within the pelvis; as the bladder
fills, its superior wall rises up into the hypogastric
region. In the young child, the empty bladder
projects above the pelvic inlet; later, when the
pelvic cavity enlarges, the bladder sinks into the
pelvis to take up the adult position.
 Blood Supply of Urinary Bladder
• Arteries
• The superior and inferior vesical arteries,
branches of the internal iliac arteries.
• Veins
• The veins form the vesical venous plexus
which drains into the internal iliac vein.
• Lymph Drainage
• Internal and external iliac nodes.
Urinary Bladder Incontinence
 URINARY INCONTINENCE

Definition: Involuntary or uncontrolled loss

of urine

Types:
A. Stress Incontinence
B. Urge Incontinence
C. Reflex Incontinence
D. Overflow Incontinence
 STRESS INCONTINENCE

Definition: Involuntary loss of

urine without detrussor contraction when
intravesical pressure exceeds urethral
pressure
 URGE INCONTINENCE

Definition: Involuntary urination is

preceded by a warning
 OVERFLOW INCONTINENCE

Definition: Involuntary urine loss

associated with over distention of the
bladder