DR.K.SARAVANAN
PAIR OF EXCRETORY ORGANS
 Excrete the end products of metabolism and
excess water
 Maintaining electrolyte and water bal...
 Reddish-brown

in colour.
 Situated posteriorly behind the peritoneum
on each side of the vertebral column
Superiorly -...








Bean shaped
11 cm in length, 6 cm in breadth and 3 cm in
antero-posterior dimension
The left kidney may be 1....
1. Fibrous capsule:
 Thin membrane
 Closely invests the kidney and renal sinus
 Can be easily stripped off
2. Perirenal...






Dense, elastic connective tissue sheath
enveloping kidney and suprarenal gland
together with perirenal fat.
Poste...








Single multilaminated structure which is
fused posteromedially with the muscular
fasciae of psoas major and qu...






In the midline superiorly - anterior and
posterior renal fasciae fuse and attached to
the crura of their respecti...







Right - anterior fascial layer blends with the
right inferior coronary ligament at the level of
the upper pole ...




Laterally the anterior and posterior leaves
fuse with the iliac fascia, and medially with
the periureteric connectiv...









Two poles, superior and inferior
Sup- broad, inf- pointed.
Two surfaces- anterior and posterior.
Anterior –...
Hilum
 renal vein (anterior)
 renal artery (intermediate)
 pelvis of the kidney (posterior).

Right kidney –
 anterior relations
 Right suprarenal gland
 Below this - right lobe of the liver
 Narrow medial area -...




Lateral border –
Rt lobe of liver
Hepatic flexure of the colon



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Left kidney
Medial area of the superior pole - left
suprarenal gland
Lateral half of the anterior surface – s...




Below the pancreatic and splenic areas, a
narrow lateral strip -retroperitoneal left colic
flexure and the beginning...
Embedded in fat and devoid of peritoneum.
 Superiorly are the diaphragm and the medial
and lateral arcuate ligaments.
 M...




The upper pole of the right kidney is level
with the 12th rib, and that of the left with the
11th and 12th ribs.
The...






Internal pale medulla and external reddish
brown cortex.
Renal medulla consists of striated, conical
renal pyrami...





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Renal cortex is subcapsular.
Arching over the bases of the pyramidscortical arches or lobules and extending
bet...









Hilum of the kidney leads into a central renal
sinus, lined by the renal capsule
Renal pelvis, vessels and f...







Calyces drain into the infundibula
Renal pelvis is normally formed from the
junction of two infundibula, from u...







Renal arteries
About 20% of the cardiac output
Arises from abdominal aorta
Near the renal hilum, each artery d...
Subdivisions of the renal arteries are
described sequentially as
1. Segmental,
2. Lobar,
3. Interlobar,
4. Arcuate
5. Inte...








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Five arterial segments have been identified
Apical segment - anteromedial region of the
superior pole.
Sup...






Branches of segmental arteries are
lobar, usually one to each renal pyramid.
Each lobar artery subdivide into two...






Divides further into interlobular arteries
which diverge radially into the cortex.
Terminations of adjacent arcua...





lateral rami of interlobular arteries
Efferent glomerular arterioles from most
glomeruli (except at juxtamedullary...








vascular supply of the renal medulla is largely
from efferent arterioles of juxtamedullary
glomeruli
Efferent ...







Renal veins
Venous ends of the peritubular plexuses
converge to join interlobular veins, one with
each interlob...





Collecting vessels from the intra-renal plexus
form four or five trunks which follow the
renal vein to end in the ...






Kidney is composed of 1 to 3 million
uriniferous tubules, bounded by a delicate
connective tissue with blood
ves...
1.Renal corpuscle - filtration from the plasma,
2.Renal tubule - selective resorption from
the filtrate to form the urine









Small rounded structures 0.2 mm in diameter
Each has a central glomerulus of vessels and
a glomerular (bowma...
Blind expanded end of a renal tubule
 deeply invaginated by the glomerulus.
 lined by a simple squamous epithelium on it...


Luminal membrane and the slit diaphragm
are covered by a dense surface coat rich in
sialoglycoproteins – negative charg...






Proximal convoluted tubule is connected to
the capsule by a short neck
This straightens as it approaches the
medu...




The tubule wall shows a focal thickening, the
macula densa, where it comes close to the
vascular pole of its parent ...






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PROXIMAL CONVOLUTED TUBULE
Lined by cuboidal or low columnar epithelium
Brush border of tall microvilli on it...





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
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LOOP OF HENLE
Thin segment (30 μm in diameter), lined by
low cuboidal to squamous cells
Thick segment (6...




1 in 1200 individuals and results from failure
of metanephric blastema to join with a
ureteric bud on the affected s...








Failure of the kidney to ascend into the renal
fossa in utero
1 in 2500 live births
CROSSED RENAL ECTOPIA
nor...





1 in 400 individuals.
A transverse bridge of renal tissue, the
isthmus, connects the two renal masses.
lies betwee...
Thank you
Kidney
Kidney
Kidney
Kidney
Kidney
Kidney
Kidney
Kidney
Kidney
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Kidney

  1. 1. DR.K.SARAVANAN
  2. 2. PAIR OF EXCRETORY ORGANS  Excrete the end products of metabolism and excess water  Maintaining electrolyte and water balance in the tissue fluids  Endocrine functions- erythropoietin, renin and 1,25-di-hydroxycholecalciferol 
  3. 3.  Reddish-brown in colour.  Situated posteriorly behind the peritoneum on each side of the vertebral column Superiorly -upper border of the T12, inferiorly– center of body of L3  The right is usually slightly inferior to the left.  Left is a little longer and narrower.  Left lies nearer the median plane. 
  4. 4.      Bean shaped 11 cm in length, 6 cm in breadth and 3 cm in antero-posterior dimension The left kidney may be 1.5 cm longer weight -150 g in men and 135 g in women In fetus and newborn, the kidney normally has 12 lobules.
  5. 5. 1. Fibrous capsule:  Thin membrane  Closely invests the kidney and renal sinus  Can be easily stripped off 2. Perirenal fat  Adipose tissue outside the capsule  Thickest at the borders
  6. 6.    Dense, elastic connective tissue sheath enveloping kidney and suprarenal gland together with perirenal fat. Posterior fascia of zuckerkandl and the anterior fascia of gerota, fuse laterally forming lateral conal fascia Lateral conal fascia continues anterolaterally behind the colon to blend with the parietal peritoneum.
  7. 7.     Single multilaminated structure which is fused posteromedially with the muscular fasciae of psoas major and quadratus lumborum. Extends anteromedially behind the kidney as a bilaminated sheet Divides into a thin anterior lamina, passing around the front of the kidney -anterior perirenal fascia Thicker posterior lamina which continues anterolaterally as the lateral conal fascia, fusing with the parietal peritoneum.
  8. 8.    In the midline superiorly - anterior and posterior renal fasciae fuse and attached to the crura of their respective hemidiaphragms Superior aspect of the perirenal space is open and in continuity with the bare area of the liver on the right and the subphrenic extraperitoneal space on the left. The posterior fascial layer blends bilaterally with the fascia of psoas major and quadratus lumborum as well as the inferior phrenic fascia
  9. 9.     Right - anterior fascial layer blends with the right inferior coronary ligament at the level of the upper pole of the kidney and bare area of the liver Left - anterior layer fuses with the gastrosplenic ligament at the level of the suprarenal gland. Anterior perirenal fascia extends across the midline in front of the great vessels Below this level the two fasciae merge and attached to the great vessels or iliac vessels
  10. 10.   Laterally the anterior and posterior leaves fuse with the iliac fascia, and medially with the periureteric connective tissue. Inferior apex of the cone is open anatomically towards the iliac fossa
  11. 11.       Two poles, superior and inferior Sup- broad, inf- pointed. Two surfaces- anterior and posterior. Anterior – irregular and posterior surface – flat. Lateral borders- convex Medial borders- convex adjacent to the poles, concave between them showing a depression, the hilum and slope inferolaterally.
  12. 12. Hilum  renal vein (anterior)  renal artery (intermediate)  pelvis of the kidney (posterior). 
  13. 13. Right kidney –  anterior relations  Right suprarenal gland  Below this - right lobe of the liver  Narrow medial area - descending part of the duodenum  Inferiorly –  Laterally with the retroperitoneal right colic flexure  Medially with part of the intraperitoneal small intestine(jejunum). 
  14. 14.    Lateral border – Rt lobe of liver Hepatic flexure of the colon
  15. 15.      Left kidney Medial area of the superior pole - left suprarenal gland Lateral half of the anterior surface – spleen Central quadrilateral area - retroperitoneal pancreas and splenic vessels Between the suprarenal and splenic areas stomach separated by a layer of peritoneum
  16. 16.   Below the pancreatic and splenic areas, a narrow lateral strip -retroperitoneal left colic flexure and the beginning of the descending colon. extensive medial area - intraperitoneal loops of jejunum.
  17. 17. Embedded in fat and devoid of peritoneum.  Superiorly are the diaphragm and the medial and lateral arcuate ligaments.  More inferiorly, from medial to lateral  Psoas major  Quadratus lumborum  Aponeurotic tendon of transversus abdominis,  Subcostal vessels  Subcostal, iliohypogastric, and ilioinguinal nerves. 
  18. 18.   The upper pole of the right kidney is level with the 12th rib, and that of the left with the 11th and 12th ribs. The diaphragm separates the kidney from the pleura, which descends to form the costodiaphragmatic recess.
  19. 19.    Internal pale medulla and external reddish brown cortex. Renal medulla consists of striated, conical renal pyramids, their bases peripheral, their apices converging to the renal sinus which is the space around the renal pelvis extending to the interior. At the renal sinus they project into minor calyces as papillae.
  20. 20.     Renal cortex is subcapsular. Arching over the bases of the pyramidscortical arches or lobules and extending between them towards the renal sinus as renal columns Pyramid + cortical arch forms a lobe of the kidney The cortex close to the medulla is sometimes termed the juxtamedullar cortex.
  21. 21.      Hilum of the kidney leads into a central renal sinus, lined by the renal capsule Renal pelvis, vessels and fat. Within the renal sinus, collecting tubules open onto the summits of the renal papillae to drain into minor calyces, which are funnel-shaped expansions of the upper urinary tract Each minor calyx surrounds either a single papilla or rarely, groups of two or three papillae. The minor calyces unite with their neighbours to form two to three major calyces
  22. 22.     Calyces drain into the infundibula Renal pelvis is normally formed from the junction of two infundibula, from upper and lower pole calyces There may be a third draining the calyces in the mid-portion of kidney. Funnel-shaped renal pelvis tapers as it passes inferomedially, traversing the renal hilum to become continuous with the ureter
  23. 23.      Renal arteries About 20% of the cardiac output Arises from abdominal aorta Near the renal hilum, each artery divides into an anterior and a posterior division, and these divide into segmental arteries supplying the renal vascular segments. Accessory renal arteries are common (30%) and usually arise from the aorta above or below (most commonly below) the main renal artery and follow it to the renal hilum
  24. 24. Subdivisions of the renal arteries are described sequentially as 1. Segmental, 2. Lobar, 3. Interlobar, 4. Arcuate 5. Interlobular arteries 6. Afferent and efferent glomerular arterioles 
  25. 25.       Five arterial segments have been identified Apical segment - anteromedial region of the superior pole. Superior (anterior) segment - rest of the superior pole and the central anterosuperior region. Inferior segment -whole lower pole. Middle (anterior) segment - between anterior and inferior segments. Posterior segment - whole posterior region between the apical and inferior segments.
  26. 26.    Branches of segmental arteries are lobar, usually one to each renal pyramid. Each lobar artery subdivide into two or three interlobar arteries, extending towards the cortex around each pyramid. At the junction of the cortex and medulla, interlobar arteries dichotomize into arcuate arteries which diverge at right angles over the base of pyramid
  27. 27.    Divides further into interlobular arteries which diverge radially into the cortex. Terminations of adjacent arcuate arteries do not anastomose but end in the cortex as additional interlobular arteries End arteries
  28. 28.    lateral rami of interlobular arteries Efferent glomerular arterioles from most glomeruli (except at juxtamedullary and, sometimes, at intermediate cortical levels) soon divide to form a dense peritubular capillary plexus around the proximal and distal convoluted tubules Two sets of capillaries – glomerular and peritubular.
  29. 29.     vascular supply of the renal medulla is largely from efferent arterioles of juxtamedullary glomeruli Efferent glomerular arterioles passing into the medulla divides into 12–25 descending vasa recta close to henle’s loop and collecting duct. Venous ends of capillaries converge to the ascending vasa recta, which drain into arcuate or interlobular veins. Proximity of descending and ascending vessels with each other and adjacent ducts provides the structural basis for the countercurrent exchange and multiplier phenomena
  30. 30.     Renal veins Venous ends of the peritubular plexuses converge to join interlobular veins, one with each interlobular artery. Interlobular veins pass to the corticomedullary junction end in arcuate veins (which accompany arcuate arteries), and anastomose with neighbouring veins. Arcuate veins drain into interlobar veins, which anastomose and form the renal vein.
  31. 31.    Collecting vessels from the intra-renal plexus form four or five trunks which follow the renal vein to end in the lateral aortic nodes INNERVATION Rami from the coeliac ganglion and plexus, aorticorenal ganglion, lowest thoracic splanchnic nerve, first lumbar splanchnic nerve and aortic plexus form a dense plexus of autonomic nerves around the renal artery.
  32. 32.     Kidney is composed of 1 to 3 million uriniferous tubules, bounded by a delicate connective tissue with blood vessels, lymphatics and nerves. Two embryologically distinct parts Nephron-produces urine Collecting duct-concentration of urine
  33. 33. 1.Renal corpuscle - filtration from the plasma, 2.Renal tubule - selective resorption from the filtrate to form the urine
  34. 34.      Small rounded structures 0.2 mm in diameter Each has a central glomerulus of vessels and a glomerular (bowman's) capsule, from which the renal tubule originates. Glomerulus A glomerulus is a collection of convoluted capillary blood vessels supplied by an afferent arteriole. An efferent arteriole emerges from the same point, the vascular pole of the corpuscle
  35. 35. Blind expanded end of a renal tubule  deeply invaginated by the glomerulus.  lined by a simple squamous epithelium on its outer (parietal) wall  glomerular, juxtacapillary (visceral) wall is composed of specialized epithelial podocytes  branch to form secondary or tertiary processes and give rise to terminal pedicels  separated by narrow (25 nm) gaps, the filtration slits
  36. 36.  Luminal membrane and the slit diaphragm are covered by a dense surface coat rich in sialoglycoproteins – negative charge.
  37. 37.    Proximal convoluted tubule is connected to the capsule by a short neck This straightens as it approaches the medulla-becomes descending thick limb of loop of henle and then ascending limb by an abrupt u-turn. Loop of henle are narrower and thin-walled in medulla - descending and ascending thin segments.
  38. 38.   The tubule wall shows a focal thickening, the macula densa, where it comes close to the vascular pole of its parent glomerulus at the start of the convoluted part of the distal tubule. The nephron finally straightens once more as the connecting tubule, which ends by joining a collecting duct
  39. 39.      PROXIMAL CONVOLUTED TUBULE Lined by cuboidal or low columnar epithelium Brush border of tall microvilli on its luminal surface Cytoplasm of proximal tubular cells is eosinophilic and nuclei are euchromatic and central. Cytoplasm is rich in mitochondria
  40. 40.        LOOP OF HENLE Thin segment (30 μm in diameter), lined by low cuboidal to squamous cells Thick segment (60 μm in diameter) composed of cuboidal cells Cells of the DISTAL TUBULE are cuboidal and resemble those in the proximal tubule. They have few microvilli COLLECTING DUCTS Simple cuboidal or columnar epithelium
  41. 41.   1 in 1200 individuals and results from failure of metanephric blastema to join with a ureteric bud on the affected side absence of the ipsilateral vas deferens and/or epididymis with other congenital anomalies including imperforate anus, cardiac valvular anomalies and oesophageal atresia
  42. 42.      Failure of the kidney to ascend into the renal fossa in utero 1 in 2500 live births CROSSED RENAL ECTOPIA normal location of the ureteric orifices within the bladder two renal masses are on the same side
  43. 43.    1 in 400 individuals. A transverse bridge of renal tissue, the isthmus, connects the two renal masses. lies between the inferior poles anterior to the great vessels
  44. 44. Thank you

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