Anatomy RCR1 Renal

Anatomy of the Renal System

 Kidneys – filter blood and maintain salt and water balance

 Ureters – actively move urine to the bladder
 Urinary bladder – stores urine
 Urethra – transmits urine from the bladder to the outside world
 THE KIDNEYS  Renal capsule is made up of CT, renal hilum is where all
tubular vessels enter and leave the kidney including the collecting ducts,
blood vessels and lymphs, the renal sinus is the space where fat and
vessels occupy inside
 The kidney is made up of 3 main parts
o Renal cortex – renal columns
o Renal medulla – pyramids, at tip is the renal papilla
o Renal sinus – minor calyces/major calyces and renal pelvis, begins
at
 Kidneys are located T11 to L3, deep to the 11th and 12th ribs, they can be
palpable in children and thin adults, examine with one hand behind in
costovertebral angle and other below the costal margin
 Kidneys are found in the abdominal cavity
 NEPHROPTOSIS – floating kidney, displacement
of dropping of the kidney
 Blood supply from the kidneys is 25% of the
total CO, the L and R renal arteries extend from
the abdominal aorta, the L and R veins drain to
the IVC

 Kidney transplantation – donor kidney is placed in the iliac fossa, renal

artery and veins connected to external iliac artery and vein, ureter
sutured into bladder
 Nerve supply –
o Renal plexus – derived from coeliac and aortic plexuses
o Sympathetic – T10 to L1, vasomotor nerves regulate blood flow
(loin to groin for pain)
o Parasympathetic – vagus nerve (unknown function)
 RENAL CALCULI – pain is transmitted via sympathetic nerves, referred
pain, radiates to back, groin, genitals
 Ureters – renal pelvis to bladder, retroperitoneal muscular tubes, lie
behind peritoneum, lie on psoas major muscle, cross pelvic brim as
bifurcation of common iliac artery, run on lateral walls of pelvis to enter
bladder posteriorly, peristalsis (contraction of SM walls)
 Normal constrictions of the ureters occurs at three areas
1. Uretopelvic junction
2. Cross common iliac vessels/pelvic brim
3. Enters the wall of the bladder
 RENAL + URETERIC CALCULI – can occur anywhere from kidney to
bladder, most commonly at the three constrictions, loin to groin pain,
referred pain to back, groin and genitals from afferent sympathetic nerves
 Urinary bladder – posterior to pubic symphysis, anterior to vagina on
female and rectum on male, ureters enter posteriorly and enter obliquely
through the muscle wall, the urethra leaves inferiorly
 Bladder – has trigone (smooth area between 2 uretal opening and
urethra), bladder wall is a SM detrusor muscle, internal urethral sphincter
controlled by ANS, smooth muscle (in males), in females but not visible,
external urethra sphincter controlled by SNS and skeletal muscle
 Nerve supply

 Urethra – males has three parts, the prostatic, membranous and penile
and is 20cm in length, female is only 3-4cm in length
 CYTOSCOPY – evaluate bladder cancer, infections and obstruction
 CATHETERISATION – to drain the bladder
 Micturition – occurs afferent nerve is stimulated by stretching and travels
to parasympathetic nerves S2-S4 (pelvis splanchnic nerves),
parasympathetic efferent stimulate and bladder contracts, sphincters and
inhibited and relax
 Imaging
o IV pyelogram – contrast excreted by kidneys, shows functioning
o Retrograde pyelogram – contrast inserted via urethra and can see
urinary tract
o Plain radiograph – will show calcified renal stones
o Ultrasound, CT, MRI
o Renal Arteriogram – to show renal arteries
Development of the Urinary System

 KIDNEYS
1. Pronephros  in the neck, 1 big nephron, not for blood but
interstitial fluid, not open to outside but into space in embryo
called coelom
2. Mesonephros a few primitive nephrons, grows v fast, not enough
nephrons to sustain life, drains into mesonephritic duct  cloaca
(common space for urine and GI system)
3. Metanephros origin of the permanent kidney, two parts
- URETIC BUD – forms the renal pelvis, major and minor
calyces and collecting ducts
- METANEPHROGENIC BLASTEMA – forms the nephrons and
kidney mass
 Origin – 3rd week, as flat and 3 layers of endo, meso and ectoderm, renal
system comes from the mesoderm and the intermediatrial mesoderm
(not paraxial or lateral planes)
 Anomalies = bifid renal pelvis (2 renal pelvises), duplicated ureters (2
uretic buds)
 NEPHRON (does not include collecting duct) forms from the
metanephrogenic blastema, glomerular shape invaginated around
Bowman’s capsule and nephron fuses with the collecting duct
 Anomalies = polycystic kidney disease, where collecting duct and nephron
did not fuse, still filters blood therefore no way out, the collecting duct
dilates and the cysts form filled with urine
 POSITION OF KIDNEY – L is higher than the R due to the liver, protected
by the rib cage, kidneys ascend, begins near pelvis or iliac arteries and
ascends upwards
 Anomalies – ectopic pelvic kidney (remains in pelvic region), horseshoe
kidney (fuse together and stuck below the inferior mesenteric artery),
accessory renal arteries (in 20%, new arteries made to supply the kidney
but the old ones remain so have multiple renal arteries)
 BLADDER AND URETHRA – note that the pelvic diaphragm, the skeletal
muscle part is the external urinary sphincter
 Urachus (allantois), filtrate is stored here, cloaca is split into anterior
(urogenital sinus), and the posterior (anal canal) which is split by the
urorectal septum, closed part of the urachus or the remnant part of the
urachus is the medial umbilical ligament
 Anomalies – urachial fistule (abnormal passage, where the urachus did
not close so into outside world), urachial cyst (additional space where
urachus was previously, a dilatation filled with urine)