Anatomy of the kidney and ureter at a glance

1. KIDNEYS, URETERS ANDKIDNEYS, URETERS AND
SUPRARENALSUPRARENAL
GLANDSGLANDS
Dr. Benjamin NnamaniDr. Benjamin Nnamani

2. OUTLINEOUTLINE
• Introduction
• Kidneys
• Ureters
• Suprarenal glands
• Conclusion

3. INTRODUCTIONINTRODUCTION

4. KIDNEYSKIDNEYS

5. KIDNEYSKIDNEYS
• The normal kidney measures about 12 X 6
X 3 cm
• It weighs about 130 g

6. KIDNEYSKIDNEYS

7. KIDNEYSKIDNEYS
• The kidney possesses a capsule which
gives the fresh organ a glistening
appearance
• All surfaces are usually smooth and
convex

8. KIDNEYSKIDNEYS

9. LOCATION OF THE KIDNEYSLOCATION OF THE KIDNEYS
• The kidneys lie high up on the posterior
abdominal wall behind the peritoneum
• It is largely under cover of the costal
margin
• At best only their lower poles can be
palpated in the normal individual

10. LOCATION OF THE KIDNEYSLOCATION OF THE KIDNEYS

11. LOCATION OF THE KIDNEYSLOCATION OF THE KIDNEYS

12. THE HILUM OF THE KIDNEYSTHE HILUM OF THE KIDNEYS
• The hilum is a vertical slit-like depression
at the medial border
• It transmitt the renal vessels and nerves
and the renal pelvis
• It faces somewhat forwards as well as
medially

13. KIDNEYSKIDNEYS

14. KIDNEYSKIDNEYS

15. THE HILUM OF THE KIDNEYSTHE HILUM OF THE KIDNEYS
• The hilum of the right and left kidney lies
near the transpyloric plane 5 cm from the
midline
– The right is just below while the left just above
the transpyloric plane

16. THE HILUM OF THE KIDNEYSTHE HILUM OF THE KIDNEYS

17. RELATIONS OF THERELATIONS OF THE
KIDNEYSKIDNEYS
• Posteriorly the relations of both kidneys
are similar comprising mostly the
– Diaphragm
– Transversus abdominis
– Quadratus lumborum muscles
– Psoas
– The subcostal vein, artery and nerve
– The iliohypogastric and ilioinguinal nerve

18. POSTERIOR RELATIONS OFPOSTERIOR RELATIONS OF
THE KIDNEYSTHE KIDNEYS

19. POSTERIOR RELATIONS OFPOSTERIOR RELATIONS OF
THE KIDNEYSTHE KIDNEYS

20. RELATIONS OF THERELATIONS OF THE
KIDNEYSKIDNEYS
• The hilum of the kidney lies over
– Psoas
– Aponeurosis of origin of transversus
abdominis

21. RELATIONS OF THERELATIONS OF THE
KIDNEYSKIDNEYS
• The right suprarenal gland is pyramidal in
shape
– It surmounts the upper pole of the right kidney
– It is behind the inferior vena cava and the
bare area of the liver

22. RELATIONS OF THERELATIONS OF THE
KIDNEYSKIDNEYS
• The left suprarenal gland is crescentic in
shape
– It is applied to the medial border of the left
kidney above its hilum
– It is behind the peritoneum of the posterior
wall of the lesser sac

23. RELATIONS OF THERELATIONS OF THE
KIDNEYSKIDNEYS

24. RELATIONS OF THERELATIONS OF THE
KIDNEYSKIDNEYS
• The anterior relations of the two kidneys
are symmetrical
– Peritoneum of the posterior abdominal wall
– Upper part of the kidneys
• Right is liver and duodenum
• Left is stomach, spleen and pancreas
– The lateral part of the lower pole is related to
hepatic and splenic flexures of the colon on
the right and left sides respectively
– The medial part of the lower pole related to
coils of jejunum

25. ANTERIOR RELATIONS OFANTERIOR RELATIONS OF
THE KIDNEYSTHE KIDNEYS

26. COVERING OF THE KIDNEYSCOVERING OF THE KIDNEYS

27. COVERING OF THE KIDNEYSCOVERING OF THE KIDNEYS
• The kidney is covered by fibrous
connective tissue capsule

28. COVERING OF THE KIDNEYSCOVERING OF THE KIDNEYS
• The perinephric fat lies outside the renal
capsule
– It is more solid consistency than the general
body fat
– It is in the shape of an inverted cone, filling
the funnel-shaped hollow of the suprailiac part
of the paravertebral gutter
– It plays a part in retaining the kidney in
position

29. COVERING OF THE KIDNEYSCOVERING OF THE KIDNEYS
• The renal fascia surrounds the perinephric
fat
– It separates the kidney from the suprarenal
gland
– It is not a very obvious membrane in the
living, but appears more convincingly in the
coagulated dissecting-room cadaver
– In truth it is a vague condensation of the
areolar tissue between the parietal
peritoneum and the posterior abdominal wall

30. KIDNEYS (RENAL PELVIS)KIDNEYS (RENAL PELVIS)

31. KIDNEYS (RENAL PELVIS)KIDNEYS (RENAL PELVIS)
• The renal pelvis is the funnel-shaped
commencement of the ureter
• It is normally the most posterior of the
three main structures in the hilum
• Its upper and lower extremities receive
two or three major calyces

32. KIDNEYS (RENAL PELVIS)KIDNEYS (RENAL PELVIS)
• The pelvis, like the ureter, is lined by
transitional epithelium
• There are smooth muscle as well as
connective tissue in its wall
• Its proper name is the renal pelvis, not the
pelvis of the ureter

33. BLOOD SUPPLY ANDBLOOD SUPPLY AND
SEGMENTS OF THE KIDNEYSEGMENTS OF THE KIDNEY
• They are supplied by two wide-bored renal
arteries
• They originate from the abdominal aorta
– Arise at right angles
– They lie behind the pancreas and renal veins

34. BLOOD SUPPLY ANDBLOOD SUPPLY AND
SEGMENTS OF THE KIDNEYSEGMENTS OF THE KIDNEY
• Based on its blood supply, each kidney
possesses five segments
• In the region of the hilum the artery
typically gives rise to an anterior and a
posterior division

35. BLOOD SUPPLY ANDBLOOD SUPPLY AND
SEGMENTS OF THE KIDNEYSEGMENTS OF THE KIDNEY
• The posterior division supplies the
– Posterior segment
• The anterior division gives branches that
supply the
– Apical segments
– Upper segments
– Middle segments
– Lower segments

36. BLOOD SUPPLY ANDBLOOD SUPPLY AND
SEGMENTS OF THE KIDNEYSEGMENTS OF THE KIDNEY
• Veins from the renal segments
communicate with one another profusely
(unlike the arteries)
• They eventually form five or six vessels
that unite at the hilum to form the single
renal vein
• The usual order of structures in the hilum
of each kidney is vein, artery, ureter from
front to back

37. BLOOD SUPPLY ANDBLOOD SUPPLY AND
SEGMENTS OF THE KIDNEYSEGMENTS OF THE KIDNEY

38. BLOOD SUPPLY ANDBLOOD SUPPLY AND
SEGMENTS OF THE KIDNEYSEGMENTS OF THE KIDNEY

39. URETERSURETERS

40. URETERSURETERS
• The ureter is 25 cm long
• Its points of narrowest calibre are at the
– Pelviureteric junction
– Halfway mark where it crosses the pelvic brim
– At its termination in the bladder mucosa

41. POINTS OF NARROWESTPOINTS OF NARROWEST
CALIBRE URETERSCALIBRE URETERS

42. COURSE OF THE URETERSCOURSE OF THE URETERS

43. COURSE OF THE URETERSCOURSE OF THE URETERS

44. COURSE OF THE URETERSCOURSE OF THE URETERS

45. COURSE OF THE URETERSCOURSE OF THE URETERS
• The ureter passes down on Psoas major
• It is under cover of the peritoneum
• It crosses the genitofemoral nerve
• It is itself crossed superficially by the
gonadal vessels

46. COURSE OF THE URETERSCOURSE OF THE URETERS
• On the right the upper part is behind the
duodenum
– Lower down it is crossed by the root of the
mesentery and by the right colic, ileocolic and
superior mesenteric vessels

47. COURSE OF THE URETERSCOURSE OF THE URETERS
• On the left it is lateral to the inferior
mesenteric vessels
– It is crossed by the left colic vessels
– Just before entering the pelvis it is crossed by
the apex of the sigmoid mesocolon
– It leaves the psoas muscle at the bifurcation
of the common iliac artery, over the sacroiliac
joint, and passes into the pelvis

48. BLOOD SUPPLY OF THEBLOOD SUPPLY OF THE
URETERSURETERS

49. BLOOD SUPPLY OF THEBLOOD SUPPLY OF THE
URETERSURETERS
• The upper end is supplied by the ureteric
branch of the renal artery
• The lower end by branches from the
inferior and superior vesical and middle
rectal (and uterine) arteries
• The middle reaches of the ureter are
supplied by branches from the gonadal
artery and by branches from the common
iliac as well

50. BLOOD SUPPLY OF THEBLOOD SUPPLY OF THE
URETERSURETERS
• The veins of the ureter drain into the renal,
gonadal and internal iliac veins

51. LYMPH DRAINAGE OF THELYMPH DRAINAGE OF THE
URETERSURETERS
• The lymphatics run back alongside the
arteries
• The abdominal portion of the ureter drains
into para-aortic nodes below the renal
arteries
• The pelvic portion into nodes on the side
wall of the pelvis alongside the internal
iliac arteries

52. NERVE SUPPLY OF THENERVE SUPPLY OF THE
URETERSURETERS
• Sympathetic fibres are from T1-L2
segments of the cord
– They reach the ureter via the coeliac and
hypogastric plexuses
• Parasympathetic fibres is from the pelvic
splanchnic nerves
• Pain fibres accompany sympathetic
nerves from the kidney

53. SUPRARENAL GLANDSSUPRARENAL GLANDS

54. SUPRARENAL GLANDSSUPRARENAL GLANDS

55. SUPRARENAL GLANDSSUPRARENAL GLANDS

56. SUPRARENAL GLANDSSUPRARENAL GLANDS
• These glands lie one alongside the upper
part of each kidney
• They are somewhat asymmetrical
• They are rather yellowish in colour
• They lie within their own compartment of
the renal fascia

57. RIGHT SUPRARENALRIGHT SUPRARENAL
GLANDSGLANDS
• The right suprarenal gland is pyramidal in
shape and surmounts the upper pole of
the right kidney
• It lies between the inferior vena cava and
the right crus of the diaphragm
• Its right border projecting to the right of the
vena cava and its upper part coming into
contact with the bare area of the liver

58. RIGHT SUPRARENALRIGHT SUPRARENAL
GLANDSGLANDS

59. RIGHT SUPRARENALRIGHT SUPRARENAL
GLANDSGLANDS
• Only the lower half of it has a peritoneal
covering (hepatorenal pouch, greater sac)
• The right inferior phrenic vessels are near
its medial border

60. LEFT SUPRARENAL GLANDSLEFT SUPRARENAL GLANDS

61. LEFT SUPRARENAL GLANDSLEFT SUPRARENAL GLANDS
• The left suprarenal gland is crescentic in
shape
• It drapes over the medial border of the left
kidney above the hilum
• Its lower pole is covered in front by the
body of the pancreas and the splenic
artery

62. LEFT SUPRARENAL GLANDSLEFT SUPRARENAL GLANDS
• The rest of the gland being covered with
peritoneum of the lesser sac and forming
part of the stomach bed
• It lies on the left crus of the diaphragm
with the left inferior phrenic artery adjacent

63. LEFT SUPRARENAL GLANDSLEFT SUPRARENAL GLANDS
• The medial border is to the left of the
coeliac ganglion
• It is probably overlapped by the left gastric
vessels
• The left greater splanchnic nerve behind it

64. BLOOD SUPPLYBLOOD SUPPLY
SUPRARENAL GLANDSSUPRARENAL GLANDS

65. BLOOD SUPPLYBLOOD SUPPLY
SUPRARENAL GLANDSSUPRARENAL GLANDS
• Both glands receive blood from three
sources
– The inferior phrenic
– Renal arteries
– The aorta

66. BLOOD SUPPLYBLOOD SUPPLY
SUPRARENAL GLANDSSUPRARENAL GLANDS
• Each source provides several small
branches, not just a single vessel
• In contrast there is usually a single vein

67. BLOOD SUPPLYBLOOD SUPPLY
SUPRARENAL GLANDSSUPRARENAL GLANDS
• The right vein is only a few millimetres
long and enters the vena cava
• The left vein is longer and enters the left
renal vein

68. LYMPH DRAINAGE OFLYMPH DRAINAGE OF
SUPRARENAL GLANDSSUPRARENAL GLANDS
• To para-aortic nodes

69. NERVE SUPPLY OFNERVE SUPPLY OF
SUPRARENAL GLANDSSUPRARENAL GLANDS
• The main supply is by myelinated
preganglionic sympathetic fibres
• It is from the splanchnic nerves
– Via the aortic and renal plexuses

70. CONCLUSIONCONCLUSION
• We have discussed gross features of the
kidney, ureter and bladder

71. •ANY QUESTIONS?

72. THANK YOU FOR LISTENING!THANK YOU FOR LISTENING!

73. REFERENCESREFERENCES