Kidneys

Ureters

Suprarenal Glands
Sylvia Santos and Olatunji S.Y.
 Learning Objectives
• By the end of this lecture you should be able to:

✔ Describe the position and relations of kidneys

✔ Describe the coverings of the kidneys
✔ Describe the internal macroscopic structure of the kidney

✔ List the sites of constrictions of the ureter

✔ Describe the arterial supply of the ureter

✔ Describe the relations and blood supply of the suprarenal

glands
Kidneys
Kidneys
 Kidneys
● Kidneys are a pair of bean-shaped excretory organs situated on the
posterior abdominal wall, one on each side of the vertebral column.
● The kidneys produce urine that is conveyed by the ureters to the
urinary bladder in the pelvis.
● They lie retroperitoneally, weighs 150gm
● Extends from vertebra T12 to L3

● The right kidney usually lies slightly lower than the left kidney due
to the presence of the liver
Kidneys
 Kidneys
● The transpyloric plane passes through the upper part of the hilus of
the right kidney and through the lower part of the hilus of the left
kidney

● Left kidney is longer and more slender than the right kidney
 Kidneys
External features:
- upper and lower poles
- anterior and posterior surfaces
- convex lateral border and concave medial
border
● Renal hilum on the middle of the medial border :
Structures seen from anterior to posterior are
- Renal vein
- Renal artery
- Renal pelvis
 Kidneys
• Renal hilum opens
to the renal sinus,
a space occupied
by the calyces,
renal pelvis,
vessels and nerves
and a variable
amount of fat
 Kidneys
● Coronal section of a kidney shows an outer reddish-brown cortex and an inner
medulla.

● The renal medulla is made up of about 10 conical masses called renal pyramids.

● The cortical extensions in between the pyramids are renal columns

● The apices of renal pyramids form renal papillae which project into minor
calyces.

● Many minor calyces join to form 2 to 3 major calyces.

● Major calyces join to form a funnel-shaped dilatation called renal pelvis.

 Kidneys
Path of urine drainage
Kidneys
Anterior Relations
Kidneys
Posterior Relations
 Kidneys
Coverings of kidney:
● Fibrous capsule : Thin membrane, closely invests
kidney. (It can be easily stripped off from normal
kidneys, in diseased cannot be stripped)

● Perirenal or Perinephric fat : layer of adipose tissue

outside the fibrous capsule. Fills up extra space in the
renal sinus and thickest at borders
●
Renal fascia : is a membrane condensation of
extraperitoneal fascia.
- At the lateral margins of each kidney, the anterior and
posterior layers of the renal fascia fuse.
● Renal fascia : - Above the suprarenal
gland renal fascia blends with fascia that
covers the diaphragm.
- Medially, the anterior layer continues
over the vessels in the hilum and fuses
with the connective tissue associated with
abdominal aorta and the IVC. The
posterior layer passes between the kidney
and the fascia covering the quadratus
lumborum muscle to fuse with the fascia
covering the psoas major muscle
- Inferiorly, anterior and posterior layers
enclose the ureters
● Pararenal or paranephric fat : abundant
posteriorly, fills the paravertebral gutter,
posterolateral to kidney
Kidneys
Kidneys
 Kidneys
Arteries
• Renal arteries are branches of the abdominal aorta (right renal artery is longer)
– Each renal artery gives rise to five segmental arteries

Veins
• Renal veins drain into the inferior vena cava (left renal vein is longer, involved in nutcracker syndrome -
could be compressed between superior mesenteric artery in the front and aorta behind)

Lymphatics
• Drain into the lumbar or lateral aortic lymph nodes

Nerves
• From vagus and thoracic splanchnic nerves, through the renal plexus
Kidneys
 Kidneys - Clinical Anatomy
Renal transplantation
• Performed in selected cases of renal failure
• Kidney can be removed from the donor sparing suprarenal gland,
which is easily separable
• Transplanted into the iliac fossa of the recipient
 Kidneys - Clinical Anatomy

Renal Cysts
● Cysts in the kidney, multiple or solitary, are common findings during
ultrasound examinations and dissection of cadavers.
● Adult polycystic disease of the kidneys is an important cause of renal
failure; it is inherited as an autosomal dominant trait
 Kidneys - Clinical Anatomy
• Horseshoe kidney is a condition in which the kidneys are fused together at the
lower end or base. By fusing, they form a "U" shape, which gives it the name
"horseshoe."

• Horseshoe kidney occurs during fetal development, as the kidneys move into
their normal position in the flank area
• Horseshoe kidney occurs in about one in 500 children.
• Horseshoe kidney can occur alone or in combination with other disorders.
• The most common disorders seen with horseshoe kidney include:
Turner syndrome,
Trisomy 18
 Kidneys - Clinical Anatomy
Horse-shoe shaped kidney
- Due to fusion of the lower poles of left and right kidneys.
- This U-shaped kidney usually lies at the level of L3—L5 vertebrae
because the root of the inferior mesenteric artery prevented normal
ascent of the abnormal kidney.
 Kidneys - Clinical Anatomy

Nephroptosis / Floating kidney

● Nephroptosis (dropped kidney) is distinguished
from an ectopic kidney (congenital misplaced
kidney) by a ureter of normal length that has
loose coiling or kinks because the distance to
the bladder has been reduced.
● Symptoms of intermittent pain in the renal
region, relieved by lying down, appear to result
from traction on the renal vessels
Nephroptosis
A 43-year-old woman presented with a 2-year history of an intermittent focal protruding abdominal mass. She
could palpate the mass around the epigastrium when she lies down supine but not in an erect position, and it
would disappear when she pushed it. She did not report abdominal pain, flank pain or haematuria. No abdominal
mass was palpable during physical examination either in the supine or erect position. A standing abdominal
radiograph showed a small and round-shaped right kidney descent (>5 cm) near the pelvis known as the ‘tennis
ball kidney’ (Figure 1A, arrow). Nephroptosis was confirmed after a supine radiograph showed that the right
kidney moved back into a normal anatomical site (Figure 1B arrow) and excluded an ectopic kidney. Her renal
function was normal and urinalysis was unremarkable. A renal ultrasonography showed no hydronephrosis.
Because she was relatively asymptomatic, only observation with follow-up was recommended
 Kidneys - Clinical Anatomy

Renal angle
- The angle between lower border of
12th rib and the spine
- Tenderness in the kidney is elicited by
applying pressure here
Suprarenal / Adrenal Glands
 Suprarenal Glands
• Located on the superomedial aspects of the kidneys and easily separable from it during
surgery
• Right gland is pyramidal in shape and left is semilunar

• Has two parts

– Outer cortex
• Secretes corticosteroids and androgens

– Inner medulla
• A mass of nervous tissue (derived from neural crest)
• Associated with sympathetic system
• The chromaffin cells of the medulla secrete catecholamines into the bloodstream
Suprarenal Glands
 Suprarenal Glands
Relations:

Anteriorly
- Right - liver, IVC
- Left - stomach, pancreas, spleen

Posteriorly
- crus of the diaphragm
Arteries
Suprarenal Glands
• Superior suprarenal arteries (from inferior phrenic artery)
• Middle suprarenal arteries (from abdominal aorta)
• Inferior suprarenal arteries (from renal artery)

Veins
• Right suprarenal vein (drains into IVC)
• Left suprarenal vein (drains into the renal vein)

Lymphatics
• Drain into the lumbar lymph nodes

Nerves
• From celiac plexus and thoracic splanchnic nerves
• Nerves to the medulla are mainly presynaptic sympathetic fibers that are distributed to the chromaffin cells
of the medulla
• Stimulation of the cells by the sympathetic nerve fibers lead to secretion and release of catecholamines,
which are given into the bloodstream
Suprarenal Glands
 Pheochromocytoma

A pheochromocytoma is a tumour of the adrenal medulla or

preganglionic sympathetic neurones. It secretes adrenaline and
noradrenaline uncontrollably, causing blood pressure to greatly
increase. Patients may present with palpitations, headaches and
diaphoresis (profuse sweating).
Ureters
 Ureters
• Muscular ducts that carry urine from kidneys to the urinary bladder
• About 25-30 cm long
• Ureters has abdominal and pelvic parts
• They extend retroperitoneally, at the pelvic brim the ureters cross the
bifurcation of the common iliac arteries
• They then run along the lateral walls of the pelvis and enter the
urinary bladder
 Ureters
Ureters enter the posterior wall of urinary bladder
– This part has an oblique course that constitutes a one way valve and
contraction of the bladder wall act as a sphincter preventing the reflux
Normal Constrictions at :
- ureteropelvic junction
- pelvic inlet
- entrance to the bladder

Kidney stones can become lodged at

these constrictions
 Ureters
Relations - Abdominal Part
Anteriorly Posteriorly
On the right: - psoas major
- genitofemoral nerve
- third part of the duodenum
- tips of transverse processes
- peritoneum
- right colic vessels
- ileocolic vessels
Medially
- gonadal vessels
- root of the mesentery On right
- terminal part of the ileum
- IVC
On the left side:
- peritoneum
- gondal artery On the left:
- left colic vessels - left gonadal bein
- sigmoid colon - inferior mesenteric vein
- sigmoid mesocolon
Ureters
 Ureters
Relations - Pelvic part:
Posteriorly
- internal iliac vessels
- lumbosacral trunk
- sacroiliac joint

Laterally
- fascia covering the obturator internus
- superior vesical artery
- obturator nerve and vessels
- inferior vesical vein
- middle rectal artery

In males ductus (vas) deferens crosses ureter superiorly from lateral to medial side. Seminal vesicle lies below
and behind the ureter

In females uterine artery crosses superiorly from lateral medial side

Water (ureter) under the bridge (uterine artery)
 Ureters
Arteries
Abdominal part
– Renal arteries, testicular (or ovarian arteries), abdominal aorta
Pelvic part
– Common and internal iliac arteries
– Inferior vesical arteries (in male), uterine arteries (in female)

Veins
• Accompany the arteries having the corresponding names

Lymphatics
• Drain into the lumbar, common iliac, external and internal iliac lymph nodes

Nerves
• Derive from the adjacent autonomic plexuses (renal, aortic, superior and inferior hypogastric)
 Clinical Anatomy
Urinary tract stones (Calculi) (Nephrolithiasis)
- Stones are polycrystalline aggregates of calcium, phosphate, oxalate, urate, etc.
- Factors that lead to stone formation – dehydration(leads to increased reabsorption of water from tubules but
resulting in highly concentrated urine, rich in solutes which may form stones) , pH of urine, infection and
metabolic conditions (gout).
Symptoms
- Colicky pain – from loin to groin - (lumbar to inguinal region) - due to hyperperistalsis ; Referred pain to
cutaneous areas supplied by T11 to L2 (Renal colic pain)
- Nausea
- Hematuria (blood in urine)
- Pyuria (pus in the urine)
- Dysuria (painful voiding of urine)
- Oliguria (low urine output)
- Hydronephrosis

- Lithotripsy - is a medical procedure that uses shock waves to break up renal stones. After the procedure,
the tiny pieces of stones pass out of your body in your urine.
Thank You