Kidney and Ureter

-Dr.M.S.Arathi,M.D.
Assistant Professor of Anatomy,
CHRI.
 OBJECTIVES

• KIDNEY IN DETAIL
• URETER
 KIDNEY
• INTRODUCTION
• SITUATIONS
• PRESENTING PARTS
• RELATIONS
• COVERINGS
• BLOOD SUPPLY
• LYMHATIC DRAINAGE
• NERVE SUPPLY
• APPLIED ANATOMY
 KIDNEY
▪ Pair of excretory organs.
▪ Situation-Posterior
abdominal wall
▪ Retroperitoneal
▪ Vertebral level
T12 to L3.
▪ Right kidney is lower than
left due to presence of
liver.
 DIMENSIONS
• Shape-bean shaped
with the hilum facing
medially
• Length-11cm
• Breath-6cm
• Thickness – 3cm
• Weight-150 gms
• Moves with
respiration-
subdiaphragmatic
organ
 PRESENTING PARTS
TWO SURFACES
1. Anterior surface
2. Posterior surface

TWO ENDS
3. Superior pole
4. Inferior pole

TWO BORDERS
5. Medial
6. Lateral
 UPPER POLE
⚫ 2.5cms from median plane
⚫ Level – opposite to T12
⚫ Thicker and more rounded

LOWER POLE
⚫ 7.5 cms from median plane
⚫ Level-opposite to L-3
⚫ 2.5 cms above iliac crest
 BORDERS
MEDIAL BORDER
Hilum in middle
Level-lower border of L1
vertebrae
Structures passing through
hilum (from before
backwards- VAP)
1. Renal vein
2. Renal artery
3. Pelvis of ureter

LATERAL BORDER
Convex ,thin on more
posterior plane.
 PERITONEAL RELATIONS
• Both kidneys are retroperitoneal organs.
• hepatic & jejunal areas of right kidney &
gastric & jejunal areas of left kidney are covered by
peritoneum. rest of anterior surfaces are devoid of
peritoneum.
 RIGHT KIDNEY- ANTERIOR SURFACE

RELATIONS
1. Suprarenal gland
2. Duodenum
3. Colon
4. Jejunum
5. Liver
 LEFT KIDNEY- ANTERIOR SURFACE
RELATIONS
1. Supra renal gland
2. Stomach
3. Pancreas
4. Colon
5. Jejunum
6. Spleen
ANTERIOR RELATIONS
POSTERIOR SURFACE-COMMON
RELATIONS
• Flat- non peritoneal
a. Upper part
b. Lower part
 a)UPPER PART - RELATIONS
1. Diaphragm origin from
medial & lateral arcuate
ligaments.
2. Costo-diaphragmatic recess
of pleura
3. 11 & 12 ribs on left side
4. 12th rib alone on right side.
 b)LOWER PART-
POSTERIOR SURFACE
Medial to lateral
1. Psoas major
2. Quadratus lumboram
3. Transversus abdominus

4. Subcostal vessels and

nerve
5. Ilio-hypogastric nerve
6. Ilio inguinal nerve

7. 4th lumbar artery-right

side only.
POSTERIOR RELATIONS
In situ relations of both kidneys

IVC

Aorta
Lt.
Kidney
Rt. Kidney reas
Pan c

SM vessels

Duodenum
 COVERINGS OF KIDNEY
From inside to outside
1. Fibrous capsule-(True
capsule)-condensation
of fibrous stroma of
organ.
2. Perinephric fat.
3. Renal Fascia of Gerota
(False capsule)
4. Paranephric fat -
More abundant along
lower part of
 1.FIBROUS CAPSULE
• Formed by condensation of
parenchyma of kidney.
Easily stripped from
kidney.

2.PERINEPHRIC
FAT
▪ The fat is more along
the borders & renal
sinus.
 3.RENAL FASCIA OF GEROTA
⚫ Condensation of extraperitoneal connective tissue.
⚫ Anterior layer-Thin-Fascia of Toldt.
⚫ Posterior layer-Thick-Fascia of Zuckerkandl.
 TRACED HORIZONTALLY
⚫ Anterior layer crosses
midline & is continuous
with opposite side.
⚫ Posterior layer blends
with psoas fascia & is
attached to sides of
lumbar vertebral bodies.
⚫ A medial septum
connects anterior &
posterior layers at hilum
thereby closing
perinephric space.
 VERTICAL TRACING
UPPER POLE : Both layers
fuse & re-split to enclose
suprarenal gland in a
separate compartment.
reunite & blend with
subdiaphragmatic fascia.
LOWER POLE: Both layers
extend along ureters
ununited & blend with
iliac fascia.
 STRUCTURE OF KIDNEY
CROSS SECTION-
1.Renal substance.
2.Renal sinus.

Renal substance
Contains
1.Outer cortex.
2.Inner medulla.
 1.CORTEX
Granular in appearance
Contains-
1. Renal columns-
between adjacent
pyramids
2. Cortical arches-
between base of
pyramid and surface
of kidney

25
 2.MEDULLA

• 8-18 renal pyramid

• Pyramid -Pale striated
conical structure
• Base towards cortex
• Apex towards renal sinus
opens into minor calyx
at renal papilla
 RENAL SINUS

• Space with in kidney

extending from hilum
• Wall of the sinus is
lined by capsule
Contents
1. Renal artery
2. Renal vein
3. Renal pelvis
RENAL ANGLE
• Angulation between
lower border of 12th rib
and lateral border of
erector spinae muscle
• Posterior surface of
lower part of kidney
lies in this angle
Clinical significance -
⮚ Renal colic pain
⮚ Retroperitoneal
approach
 RENAL PELVIS
Includes
▪ Major calyx- 2 or 3
formed by the
union of
minor calyces.

▪ Minor calyces-7-13 -
dilated outer end –cup
shaped depression to
receive renal papillae.

▪ Pelvis of ureter-funnel
shaped dilatation-passes
downwards medially
 ARTERIAL SUPPLY
▪ Renal arteries - branches
of aorta.
▪ At hilum -divides into
anterior & posterior
division.
▪ Each division then divides
into segmental branches.
▪ Seg. A Interlobar .A
Arcuate.A Lobar.A
Interlobular .A
Aff.Glomerular.A
Eff Glomerular .A.
▪ 1 litre of blood circulates
 ARTERIAL VASCULAR SEGMENTS
▪ anterior division divides into
4 segmental branches at
hilum.
▪ Apical, Upper anterior,
Middle anterior & Lower
segmental arteries
▪ Posterior division continues
as posterior segmental
artery.
▪ Each of portion of kidneys
supplied by segmental
branches.
▪ five independent vascular 31
 VENOUS DRAINAGE
• Right and left renal
veins
• Both drains into-Inferior
vena cava
• Left is longer and drains
blood from left kidney,
left gonadal, left
suprarenal
 LYMPHATIC DRAINAGE
▪ Lateral aortic lymph nodes

NERVE SUPPLY

▪ Sympathetic- derived from renal plexus

Origin-T10,T11,T12and L1
⦿Vaso motor in function & stimulates
production of renin by juxta glomerular
apparatus.
 URETERS
• INTRODUCTION
• SITUATIONS
• PARTS
• RELATIONS
• LEVELS OF CONSTRICTIONS
• BLOOD SUPPLY
• LYMHATIC DRAINAGE
• NERVE SUPPLY
• APPLIED ANATOMY
 URETERS
Pelvis
• Pair of thick walled
cylindrical tubes
• length.-25 cms
• Transmits urine from
kidney to urinary
bladder

PARTS
1. Pelvis of ureter
2. Abdominal part
3. Pelvic part
 1.PELVIS OF URETER

▪ Funnel shaped
dilatation of upper part
of ureter
▪ Formed in renal sinus
by union of major
calyces
▪ Passes downwards
medially ,continuous
with abdominal part of
ureter at level of lower
pole of kidney
▪ Capacity-5-7 ml.
 2.ABDOMINAL PART OF URETER
• Runs downwards
medially beneath
peritoneum of posterior
abdominal wall.
• Enters pelvic cavity-
crossing bifurcation of
common iliac artery.
RELATIONS-RIGHT URETER
● 2nd and 3rd parts of
duodenum
1. Right colic vessels
2. Ileo-colic vessels
3. Right gonadal vessels
4. Root of mesentery
5. Terminal part of ileum
 RELATIONS-LEFT URETER
● Left colic vessels
1. Sigmoid vessels
2. Left gonadal vessels
3. Apex of sigmoid
mesocolon
 3.PELVIC PART OF URETER

• Part within pelvis

• From right sacroiliac joint to posterolateral
angle of internal trigone of bladder
 BLOOD SUPPLY OF URETERS
1. Abdominal part: Renal &
Gonadal ,Right & Left Colic
& Posterior abdominal
wall arteries.
2. Pelvic part : Internal iliac,
Common iliac, External
iliac &Inferior vesical
arteries.
In addition uterine &
vaginal arteries also
supply in females.
Arteries divide into
 LYMPHATIC DRAINAGE
Into para aortic , internal iliac & external iliac
lymph nodes.

NERVE SUPPLY
▪ Sympathetic- derived from renal plexus
Origin-T10,T11,T12and L1
 LEVELS OF CONSTRICTION OF
THREE CONSTRICTIONS
URETERS
1. Pelvi-ureteric junction.
2. Pelvic brim.
3. At its opening into urinary
bladder.
IMPORTANCE
a. Stones will get impacted.
b. During catheterization
care should be taken.
 APPLIED ANATOMY
• Stones may be formed
anywhere in calyces,
renal pelvis, ureters &
urinary baldder.
• leads to obstructive
uropathy &
hydronephrosis.
• Kidneys or ureters may
be injured during various
surgical procedures.
 CONGENITAL LOBULATED KIDNEY
• Embryologically , kidneys
develop as multiple lobes,
later, they all fuse &
surface become smooth.
Sometimes , lobulation
may be present in adult
life also.
 ACCESSARY RENAL ARTERIES

• Either they could be

extra branches from
aorta or segmental
arteries directly arising
from aorta.
 DIALYSIS
1.HAEMO
DIALYSIS

2.PERITONEAL DIALYSIS-
CONTINUOUS AMBULATORY
PERITONEAL DIALYSIS (CAPD)
RENAL TRANSPLANTATION
THANK ‘U’