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Renal anatomy& physiology

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  • 1. Renal System Anatomy & PHYSIOLOGY DR. AMAR UL-ALA BUTT CONSULTANT UROLOGIST 06-R-M-12967 (MOH 88/458) BURAIDAH CENTRAL HOSPITAL(7/1)
  • 2. Renal system summary Functions: 1. Remove wastes from the body (urine) 2. Regulates fluid balance, maintains homeostasis Structures:  2 kidneys - filter blood, produce urine  2 ureters - transport urine (kidneys to bladder)  bladder - reservoir for urine  urethra - transport of urine
  • 3. Renal anatomy  lies retroperitoneal, on posterior abdominal wall  lies from T12-L3 of vertebral column, next to m. psoas major  superior parts are protected by ribs 11, 12  tilted: superior poles are closer to midline than inferior
  • 4. KIDNEY FEATURES 2 Poles – Upper – Lower 2 Borders – Lateral – Medial – has hilum 2 Surfaces – Anterior – Posterior
  • 5. RIGHT KIDNEY ANTERIOR RELATIONS Right suprarenal gland Liver Duodenum Colon Coils of small intestine
  • 6. LEFT KIDNEY ANTERIOR RELATIONS Left suprarenal gland Stomach Spleen Pancreas Colon Coils of small intestine
  • 7. KIDNEY POSTERIOR RELATIONS Diaphragm Psoas major Transversus abdominis Quadratus lumborum Last ribs Ilioinguinal N Iliohypo- gastric N Rt Lt
  • 8. Renal anatomy  R kidney lower than L (due to R lobe of liver)  ~ 12cm long x 5cm wide x 2.5cm thick  bean-shaped , reddish- brown organs  renal hilum  kidney levels change during respiration and postural changes
  • 9. External surface – 3 layers of tissue 1. renal fascia (outer) – CT attaches kidney to posterior abdominal wall – flexible, allows kidney to move with respiration – covered by layer of fat 2. perirenal fat (middle layer) – protective cushion 3. renal capsule (innermost) – layer of collagen fibres - barrier against trauma, infection etc. – kidney hangs suspended by collagen fibres and packed in soft cushion of adipose tissue
  • 10. Internal anatomy outer cortex, inner medulla  6-18 conical renal pyramids  apex - renal papilla projects into the renal sinus renal columns  extend from cortex inward to renal sinus between adjacent renal pyramids  granular texture similar to that of the cortex
  • 11. Internal anatomy  ureter enters renal sinus, it expands to form a chamber called - renal pelvis  pelvis branches to form 2-3 major calyces  branch further to form 6-8 minor calyces  Each minor calyx surrounds the papilla of a renal pyramid  ducts within papilla connect to wall of the calyx and discharge urine produced in the cortex and medulla  Urine passes through the calyces into the ureter
  • 12. Left kidney: coronal section
  • 13. KIDNEY BLOOD SUPPLY IVC Abdominal aorta Renal A Renal V
  • 14. Blood supply to the kidney: Renal arteries from abdominal aorta enter hilum and branch: 1. Interlobar arteries - pass through renal columns and reach junction between medulla and cortex 2. Arcuate arteries run parallel with the base of the pyramids 3. Interlobular arteries move up into the cortex and branch to form the afferent arteriole The peritubular capillaries unite to form the interlobular veins, arcuate vein, interlobar vein, renal vein The renal vein exits at hilus and joins the IVC
  • 15. Blood supply to kidney
  • 16. Nephron = Functional unit of the kidney, ~ 1.2 million nephrons per kidney! Tubular components: 1. Glomerular (Bowman’s) capsule – double-walled cup – simple squamous epithelium 2. Proximal convoluted tubule - coiled 1st section – simple cuboidal epithelium with microvilli 3. Loop of Henle - hair-pin loop – thin descending limb, thick ascending limb 4. Distal convoluted tubule - last section – simple cuboidal epithelium – specialised region - Juxta glomerular apparatus Distal convoluted tubule opens into the collecting system collecting ducts papillary ducts minor calyx…
  • 17. Nephron
  • 18. Vascular component of nephron Made up of blood vessels: 1. Glomerulus - network of capillaries within Bowman’s capsule 2. Afferent arteriole - leading into glomerulus 3. Efferent arteriole - leading out of glomerulus 4. Peritubular capillaries - surrounding tubules 5. Vasa recta - specialised loops of blood vessels around long Loop of Henle (juxtamedullary nephrons)
  • 19. Nephrons: 85% are cortical, 15% are juxtamedullary
  • 20. Renal corpuscle
  • 21. Ureters Pyelogram (colour-enhanced)  tubes that transport urine from renal pelvis to bladder  20-30 cm long  muscular walls - peristaltic waves force urine down to bladder  retroperitoneal  pressure in the bladder compresses ureter, helps prevent backflow of urine  (physiological valve) - still allows urine to flow into the bladder
  • 22. RIGHT URETER, RELATIONS –Anteriorly  Duodenum  Terminal part of ileum  Right colic & iliocolic vessels  Right gonadal vessels  Root of mesentry –Posteriorly  Right psoas major muscle  Bifurcation of right common iliac A
  • 23. LEFT URETER, RELATIONS –Anteriorly  Sigmoid colon  Sigmoid mesocolon  Left colic vessels  Left gonadal vessels –Posteriorly  Left psoas major muscle  Bifurcation of left common iliac A
  • 24. URETER CONSTRICTIONS 1. Where it joins the renal pelvis 2. Where it crosses the pelvic brim 3. Where it pierces the bladder wall
  • 25. Bladder  hollow muscular organ  retroperitoneal, posterior to pubic symphysis  Capacity ~ 300-400 ml (max = 1000 ml)  empty: looks like a deflated balloon, rugae  full spherical rises above abdominal cavity  Males: anterior to rectum, above prostate  Females: inferior to uterus, anterior to vagina
  • 26. URINARY BLADDER FEATURES Apex: points anteriorly---median umbilical lig. Base: (posterior surface) Superior surface 2 Inferiolateral surfaces Neck: rests on prostate
  • 27. Support of bladder  superior surfaces - peritoneum  middle umbilical ligament - superior border to umbilicus  lateral umbilical ligaments - sides of bladder to umbilicus  At base, tough ligamentous bands anchor bladder to pelvic and pubic bones Trigone : triangular area bounded by openings of ureters and exit to urethra  cystitis - inflammation of the bladder wall
  • 28. Cross section of ureter & bladder lined by transitional epithelium to allow for stretch of wall  lamina propria - mucous membrane – elastin fibres  smooth muscle (m. detrusor) – inner and outer longitudinal – middle circular  contraction compresses bladder and expels contents into urethra  internal sphincter - involuntary control
  • 29. Urethra Female ~ 4cm long – opens to exterior between clitoris and vaginal opening Male ~ 20 cm long – passes through prostate gland – pierces urogenital diaphragm – enters penis and extends throughout length – opens at urethral orifice
  • 30. MALE URETHRA PARTS Prostatic part: – The widest part – About 3 cm Membranous part: – In the urogenital diaphragm – About 1.25 cm Penile part: – In the penis – About 15 – 16 cm long
  • 31. FUNCTIONS OF THE KIDNEY 1) Regulate the osmotic pressure (osmolality) of the body fluids by excreting osmotically dilute or concentrated urine. 2) Regulate the concentrations of numerous ions in blood plasma, including Na, K, Ca, Mg, Cl, bicarbonate (HCO3), phosphate, and sulfate. 3) Play an essential role in acid-base balance by excreting H, when there is excess acid or HCO3, when there is excess base.
  • 32. FUNCTIONS OF THE KIDNEY 4) Regulate the volume of the ECF by controlling Na and water excretion. 5) Help to regulate arterial blood pressure by adjusting Na excretion and producing various substances (e.g.,renin) that can affect blood pressure. 6) Eliminate the waste products of metabolism, including urea (the main nitrogen-containing end- product of protein metabolism in humans), uric acid (an end-product of purine metabolism), and creatinine (an end-product of muscle metabolism).
  • 33. FUNCTIONS OF THE KIDNEY 7) Remove many drugs (e.g.penicillin) and foreign or toxic compounds. 8) Are the major production sites of certain hormones, including erythropoietin and 1,25- dihydroxy vitamin D3 9) Degrade several polypeptide hormones, including insulin, glucagon, and parathyroid hormone 10) Synthesize ammonia, which plays a role in acid- base balance
  • 34. FUNCTIONS OF THE KIDNEY 11) Synthesize substances that affect renal blood flow and Na excretion, including arachidonic acid derivatives (prostaglandins, thromboxane A2) and kallikrein (a proteolytic enzyme that results in the production of kinins).  When the kidneys fail, a host of problems ensue. Dialysis and kidney transplantation are commonly used treatments for advanced (end-stage) renal failure
  • 35. Bone Structure Vitamin D Activation Calcium Balance Blood Formation Erythropoietin Synthesis Cardiac Activity Potassium Balance Regulation of Blood pH Recovery of Bicarbonate Blood Pressure Water Balance Sodium Removal Metabolic End Products Removal of Urea, Creatinine etc. Functions of the Kidney Manifold Tasks of the Kidney Functions Healthy Kidney
  • 36. Functions of the Kidney Filtration and Reabsorption 1500 l blood per day through the renal arteries 180 l filtrate per day in the glomeruli 60 l urine per day at the end of the proximal tubules 20 l urine per day at the beginning of the distal tubules 10 l urine per day at the end of the distal tubules 1,5 l urine per day at the end of the collecting ducts real removal: 1,5 l urine Healthy Kidney
  • 37. Micturition reflex: Stretch receptors stimulated when filled to ~ 220 ml  afferent fibres to spinal cord  motor neurons to sm in bladder wall  contracts m. detrusor and increases pressure  need to relax both internal and external sphincter - external under voluntary control  if external sphincter does not relax, internal sphincter remains closed & sm in bladder wall relaxes again  Once volume exceeds 500 ml, micturition reflex may generate enough P to open internal sphincter  leads to reflexive relaxation of external sphincter
  • 38. Thank you All the best with your studies ANY QUESTIONS