Kidneys and Suprarenal

glands
Dr Nto, Nto Johnson
Department of Anatomy
Faculty of Medical Sciences
University of Nigeria Enugu Campus
 Introduction

Kidneys are essential life

Excretion: produce Urine
Regulate water and electrolyte balance,
acid base balance (osmoregulation)
Endocrine function: produce renin and
erythropoitin
Shape,

Colour and Location
They are two
reddish brown
organs
Bean Shaped
They lie
retroperitoneally on
the posterior
abdominal wall
One on each side of
the vertebral column
Surface Marking
Their upper ends are at the level the T12
vertebrae
Their lower ends lie at the level of the L3
vertebrae
The hilum of the right kidney lies just
below the transpyloric plane
The hilum of the left kidney lies just
above the transpyloric plane
Both hilum are 5cm from the midline
Dimensions and Weight
A normal kidney: 12x6x3 cm
Weighs about 130g
Surfaces, Margins and Poles
Each kidney has
Anterior and Posterior surface
Medial and Lateral margins
Superior and Inferior poles
At the concave medial margin of each
kidney is a vertical cleft, the renal hilum
The hilum leads to a recess, the renal
sinus
Relations
Anterior Surface
of the right kidney
 Right suprarenal gland
 Liver
 Duodenum
 Right colic flexure
 Small intestine
Peritoneum: liver and
small intestine
Relations cont’d
Anterior surface of the
left kidney
 Left suprarenal gland
 Spleen
 Stomach
 Pancrease
 Splenic vessels
 Left colic flexure
 Jejunum
Peritoneum:
stomach(omental
bursa), spleen &
jejunum (greater sac)
 Relations cont’d
Posterior surface
Embedded in fat and devoid of
peritoneal covering
 The right rest upon the 12th rib
 The left rest upon the 11th &
12th ribs
 Diaphragm
 costodiaphragmatic recess
 Quadratus lumborum muscle
 Psoas major muscle
 Trnsversus abdominis
 Subcostal nerves and vessels
 Iliohypogastric &ilioinguinal
nerves
 Relations cont,d
Superior pole
 Suprarenal glands
 Renal hilum and sinus
The renal hilum is a vertical cleft on the
medial margin of each kidney, through
which vessels enter or leave the renal sinus.
From anterior to posterior: Renal vein,
Renal artery and Renal pelvis
Renal sinus is a space within the kidney
occupied by renal pelvis, renal calyces,
vessels, nerves and variable amount of fat.
The renal pelvis is a flattened, funnel shaped
expansion of the superior end of the ureter
The renal pelvis receives two or three Major
calyces
Each major calyx divides into two or three minor
calyses
Each minor calyx is indented by the renal papilla,
the apex of the renal pyramid.
The renal pyramids and their associated cortex
form the lobe of the kidney.
Blood supply- Arterial supply
The renal arteries
 Paired branches of the abdominal aorta
 The right is longer and passes posterior to IVC
 Arise at the level of the disc between L1 and L2
 Each artery typically gives rise to an Anterior and
Posterior division
 Posterior division-posterior segment
 Anterior division- Apical, upper, middle and
inferior segments
 The segmental arteries do not anastamose
Blood supply- Venous drainage
Renal veins
The segmental veins communicate with each
other
Unite at the hilum to form the right and left renal
veins
The left renal vein is longer and receives the left
suprarenal vein, the left gonadal and
communicates with the ascending lumbar vein
Each renal vein drains to the IVC
Nerve Supply
Renal nerve plexus
Sympathetic and Parasympathetic fibres
plexus supplied by abdominopelvic splanchnic
nerves

Lymphatics
Lymphatics from the kidney drain to the para-
aortic nodes at the level of L2
Applied Anatomy
Nephroptosis - is a condition in which one or both
kidneys drop around 5 centimeters below their correct
position in the abdomen when a person stands up.
Horseshoe kidney- also known as ren arcuatus,
renal fusion or super kidney, is a congenital
disorder affecting about 1 in 500 people that is more
common in men, often asymptomatic, and usually
diagnosed incidentally. Usually lies at L3-L5 because
of restriction by the inferior mesenteric artery
 Applied Anatomy
Pyelonephritis(infection of kidney pelvis): Bacteria
may infect the kidney, usually causing back pain and
fever. A spread of bacteria from an untreated bladder
infection is the most common cause of pyelonephritis.
Glomerulonephritis: An overactive immune system
may attack the kidney, causing inflammation and
some damage. Blood and protein in the urine are
common problems that occur with
glomerulonephritis. It can also result in kidney failure.
Kidney stones (nephrolithiasis): Minerals in urine
form crystals (stones), which may grow large enough to
block urine flow. It's considered one of the most
painful conditions. Most kidney stones pass on their
own but some are too large and need to be treated.
Applied Anatomy cont’d
Nephrotic syndrome: Damage to the kidneys
causes them to spill large amounts of protein
into the urine. Leg swelling (edema) may be a
symptom.
Polycystic kidney disease: A genetic condition
resulting in large cysts in both kidneys that
impair their function.
Acute renal failure (kidney failure): A sudden
worsening in kidney function. Dehydration, a
blockage in the urinary tract, or kidney damage
can cause acute renal failure, which may be
reversible.
 Applied Anatomy cont’d
Chronic renal failure: A permanent partial loss of kidney
function. Diabetes and high blood pressure are the most
common causes.
End stage renal disease (ESRD): Complete loss of kidney
function, usually due to progressive chronic kidney disease.
People with ESRD require regular dialysis for survival.
Papillary necrosis: Severe damage to the kidneys can cause
chunks of kidney tissue to break off internally and clog the
kidneys. If untreated, the resulting damage can lead to total
kidney failure.
Diabetic Nephropathy: High blood sugar from diabetes
progressively damages the kidneys, eventually causing
chronic kidney disease. Protein in the urine (nephrotic
syndrome) may also result.
Hypertensive nephropathy: Kidney damage caused by high
blood pressure. Chronic renal failure may eventually result.
Applied Anatomy cont’d
Kidney cancer: Renal cell carcinoma is the most common cancer
affecting the kidney. Smoking is the most common cause of
kidney cancer.
Interstitial nephritis: Inflammation of the connective tissue
inside the kidney, often causing acute renal failure. Allergic
reactions and drug side effects are the usual causes.
Minimal change disease: A form of nephrotic syndrome in which
kidney cells look almost normal under the microscope. The
disease can cause significant leg swelling (edema). Steroids are
used to treat minimal change disease.
Nephrogenic diabetic inspidius: The kidneys lose the ability to
concentrate the urine, usually due to a drug reaction. Although it's
rarely dangerous, diabetes insipidus causes constant thirst and
frequent urination.
Renal cyst: A benign hollowed-out space in the kidney. Isolated
kidney cysts occur in many normal people and almost never
impair kidney function.
The Suprarenal glands
Introduction
Adrenal glands
Two small flattend bodies
Yellow in color
Retroperitoneal
Superomedial aspect of each kidney
Connective tissue, Perinephric fat
5ox30x10 mm
5gm
 The right suprarenal gland
Shape: Pyramidal
Location: Upper pole pole of the right kidney and
diaphragm
Surfaces: Anterior and Posterior surface, and a
Base
Borders: Medial and Lateral border
Anterior relations: IVC and Liver
Posterior surface: Diaphragm and Rt Kidney.
Inferior relation upper part of the medial and
anterior surfaces of the Rt Kidney
Medial relation: right colic ganglion and inferior
phrenic artery
 The left suprarenal gland
Shape: Crescentric
Location: Medial border of the upper part of
left kidney
Surfaces: Anterior and Posterior surface, and
a Base
Borders: Medial and Lateral border
Anterior relations: cardia of stomach and
spleen, and pancreas and splenic artery
Posterior relations: Kidney and left crus of
diaphragm
Medial relations: left colic ganglion
Each gland has a hilum- veins and
lymphatics
Arteries- multiple sites
Each consist of an outer cortex and an
inner medulla
Suprarenal cortex- mesodermal origin.
Secretes corticosteroids and androgens
Suprarenal medulla- nervous tissue
derived from neural crest. Chromaffin cell
secrete cathecolamines (epinehrine and
norepinehrine)
Blood supply
Arterial supply
Suprarenal arteries arise from three sources
Superior suprarenal arteries-inferior
phrenic arteries
Middle suprarenal artery- Abdominal aorta
Inferior suprarenal artery- renal arteries
Venous drainage
The right suprarenal vein drains into the IVC
The left is joined by the inferior phrenic and
then empties into the left renal vein
Lymphatic drainage
Lymphatics drain to the para-aortic nodes

Innervation
Richly innervated by the celiac plexus and
abdominopelvic splanchnic nerves
Applied
Hypersecretions leads to Cushing’s
syndrome.
Hyposecretions leads to Addison’s
disease.
Thank you