anatomy of kidney and ureter

1. Anatomy of kidney , suprarenal gland and ureter
Dr. Mohamed Elfiky
Professor of anatomy and embryology

2. Suprarenal Glands
• They are endocrine glands closely related to the upper pole of the Rt. and Lt. kidneys.
• The suprarenal glands are associated with the superior pole of each kidney . They consist of an
outer cortex and an inner medulla. The right gland is shaped like a pyramid, whereas the left
gland is semilunar in shape and the larger of the two.
• The suprarenal glands are surrounded by the perinephric fat and enclosed in the renal fascia,
though a thin septum separates each gland from its associated kidney.
• Anterior to the right suprarenal gland is part of the right lobe of the liver and the inferior vena
cava, whereas
• anterior to the left suprarenal gland is part of the stomach, pancreas, and, on occasion, the
spleen. Parts of the diaphragm are posterior to both glands.
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3. Suprarenal Glands
Item Right Suprarenal Left Suprarenal
Shape Triangular Semilunar
Site on the upper pole of the Rt. kidney on the upper pole and tilting on the medial border
reaching the hilum of Lt. kidney
venous drainage into the inferior vena cava into the left renal vein
Arterial supply 1- Superior suprarenal a. : from the phrenic
artery.
2- Middle suprarenal a. : from abdominal
aorta.
3- Inferior suprarenal a. : from the renal artery.
1- Superior suprarenal a. : from the phrenic artery.
2- Middle suprarenal a. : from abdominal aorta.
3- Inferior suprarenal a. : from the renal artery.
Relations
• Anteriorly
• Posteriorly
• Medially
Liver and IVC
Right Kidney
Right coeliac ganglion
Lesser sac and stomach
Left kidney
Left coeliac ganglion Mohamed el fiky

4. KIDNEYS(RENES)
Position :One on each side, the kidneys lies behind the peritoneum of the
posterior abdominal wall , extending from the level of last thoracic vertebra to level of
third lumber vertebra.
Dimensions : The kidney is 4.5 inches long, its breadth is 2.5 inches while its
thickness is one inch.
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Renal fat and fascia : The kidneys are enclosed in and associated with a unique
arrangement of fascia and fat ( 4 capsule ) :
q Renal capsule, it is true fibrous capsule surround the kidney
q Perirenal fat, Immediately outside the renal capsule, there is an accumulation of
extraperitoneal fat-the perinephric fat
q Renal fascia. Enclosing the perinephric fat is a membranous condensation of the
extraperitoneal fascia
q Pararenal fat: a final layer of paranephric fat (completes the fat and fascias associated
with the kidney

5. Renal fat and fascia
True fibrous capsule
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6. Kidney structure
Hilum of the kidney, which is a deep vertical slit through which renal vessels,
lymphatics, and nerves enter and leave the substance of the kidney
Renal cortex : the outer layer and an inner renal medulla. The renal cortex is a
continuous band of pale tissue that completely surrounds the renal medulla.
Renal columns: Extensions of the renal cortex project into the inner aspect of the
kidney, dividing the renal medulla into discontinuous aggregations of triangular
shaped tissue (the renal pyramids).
Renal pyramids : are directed outward, toward the renal cortex, while the apex of
each renal pyramid projects inward, toward the renal sinus. The apical projection
(renal papilla) is surrounded by a minor calyx.
The minor calices receive urine and represent the proximal parts of the tube that will
eventually form the ureter In the renal sinus,
major calyx : several minor calices unite to form a, and two or three major calices
unite to form the renal pelvis,
Renal pelvis which is the funnel-shaped superior end of the ureters.
Renal cortex
Renal columns
Renal pyramids
The minor calices
major calyx
Renal pelvis
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Renal sinus

7. q The centre of the hilum lies in the transpyloric plane ,
q The centre of the hilum lies in the transpyloric plane , 5 cm from the median
plane (point B).
q The upper pole lies 5 cm above the hilum and 2 1⁄2 cm from the median plane
(point A).
q The lower pole lies 5 cm below the hilum and 7 1⁄2 cm from the median plane
(point C).
Surface anatomy on the anterior abdominal wall
A
B
C
A
B
C
The area of the kidney is represented on the back by a rectangular area called Morris
parallelogram. This rectangular area is formed by 2 horizontal lines opposite the 11th thoracic
spine and 3rd lumbar spine , and 2 vertical lines drawn 1 inch and 3 inches from the median
plane .
Surface anatomy of the kidney
Surface anatomy on the posterior abdominal wall
q N.B.: Transpyloric plane passes through the upper part of the hilum of right kidney, but
through the centre of the hilum of the left kidney.
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8. Mohamed el fiky
Relations of the kidney
Posterior relations
Lt. kidney Rt. kidney

9. Relations of the kidney
Anterior relations of right kidney
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10. Relations of the kidney
Anterior relations of left kidney
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11. Anatomy of the The Ureters
• The ureters are tubes (right and left)
which carry urine from the kidney to the
urinary bladder.
• Each ureter is about 25-30 cm long.
• Nearly 1/2 of the course of each ureter
lies in the abdomen while the other 1/2
lies in the pelvis.
• Each ureter passes 2 cm inside the wall
of the urinary bladder (intra- mural
part) before opening into it.
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12. A- Abdominal part of the ureter
Beginning: Each ureter begins at the pelvis of the ureter near the hilum of the kidney at
the level of L1.
Course: Each ureter descends vertically downwards behind the peritoneum of the
abdominal wall opposite the tips of transverse processes of the lower 4 lumbar
vertebrae (L2-L3). Each ureter enters the pelvis by crossing in front of the bifurcation
of the common iliac artery (opposite sacro-iliac joint).
Posterior Relations : The same of right and left.
1- Medial border of psoas major (& minor if present) separating it from tips of
transverse processes of L2 - L5 vertebrae.
2- Genito-femoral nerve. Mohamed el fiky

13. Mohamed el fiky
Anterior relations of Rt. ureter
Anterior Relations of Rt. ureter
Anterior Relations: Different from right to left side.
A- Right Ureter :
1- 3rd part of duodenum.
2- Three arteries:
a. Right colic artery.
b. Ilio-colic artery.
c. Gonadal artery.
3- Three structures related to mesentery:
a. Root of the mesentery.
b. Sup. mesenteric vessels.
c. Coils of small intestine.

14. Medial Relations:
I.V.C. is medial to Rt. ureter, Inferior mesenteric
a. is medial to Lt. ureter
b- Left Ureter :
1- Peritoneum of posterior abdominal wall. 2- 3 arteries
cross in front of it:
a. Left colic a.
b. Sigmoidal as.
c. Left gonadal a.
3- Medial limb of sigmoid mesocolon and coils of
sigmoid colon.
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Anterior relations of Lt. ureter

15. B- Pelvic part of the ureter
Beginning : Each ureter enters the pelvis opposite the sacro-iliac joint by crossing infront of the bifurcation of the
common iliac artery.
Course :
1- Each ureter passes downwards and backwards along the lower border of the internal iliac artery.
2- At the level of the ischial spine, it curves forwards and medially to open into the postero-superior angle of urinary
bladder.
Relations :
• Medially : it is covered by peritoneum .
• Laterally : it crosses (from above downwards)
• External iliac artery and vein .
• Obturator nerve, artery and vein.
N.B.
1- In male , the ureter is crossed by the vas deference near the wall of urinary bladder .
2- In female , the ureter passes closely lateral to upper end of the vagina below the uterine artery .
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16. Mohamed el fiky

17. Constrictions Of The Ureter :
1- At the pelvi-ureteric junction .
2- At the pelvic brim (at the junction of abdominal and pelvic parts)
3-4- Opposite ischeal spine .
4- At its lower end ( intra-mural part)
C- Intra-mural part
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1. The ureter joins the postero-superior angle of the bladder ,
running a very oblique course through its wall for 2 cm
before opening into its lumen.
2. This arrangement provides a valve like mechanism
preventing reflux of urine into the ureter when the urinary
bladder is distended.
1
2
3
4

18. Blood Supply
Segmental blood supply from all
arteries along its course.
A : Abdominal aorta.
R : Renal artery.
T : Testicular artery.
I : Inferior vesical artery.
C : Common iliac artery.
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