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1. ANATOMY OF KIDNEY
1
DR.MANOJ ARYAL
DM RESIDENT NEPHROLOGY
NAMS BIR HOSPITAL

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ANATOMY OF
KIDNEY
• Paired ovoid, reddish-brown retroperitoneal organs
situated in the posterior part of the abdomen on each
side of the vertebral coloumn
• Lie on the psoas muscles; thus the longitudinal axes
of the kidneys are oblique .
• The upper poles more medial and posterior than
the inferior poles.
• The medial aspect of each kidney is rotated anteriorly
at an angle of approximately 30 degrees.

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• The exact position of the kidney within
the retroperitoneum varies
The kidneys move inferiorly approximately
3 cm (one vertebral body) during
inspiration and during changing body
position from supine to the erect.

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DIMENSIO
NS
• Length- 10 to 12 cm
• Width- 5.0 to 7.5 cm
• Thickness- 2.5 to 3.0 cm.
Weight of kidney = approx. 125-170
gm. ( 10- 15 gm lighter in females).

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Right kidney vs left
kidney
Right kidney Left
kidney
• Reside betweenthe top
of the 1st lumbar
vertebra to the bottom
of the 3rd lumbar
vertebra.
• The right kidney is
slightly shorter and
wider because of
downward
compression by the
liver.
• The right kidney is
related to the 12th
• Between the 12th
thoracic vertebra and
the 3rd lumbar
vertebra.
• Left kidney is related
to the 11th and 12th
ribs

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RELATIO
NS
• Surfaces of kidney are -
anterior and
posterior.
• Borders are - medial and lateral.
• Poles of kidney are – superior and
inferior.
• Anteriorly kidney is related -
abdominal viscera
• Posteriorly - osteomuscular area

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ANTERIOR
RELATIONS
RIGHT KIDNEY LEFT
KIDNEY
• right adrenal gland
• liver
• second part of
duodenum
• ascending colon
• hepatic flexure of colon.
• Left adrenal
• Pancreas
• splenic vessels
• Stomach
• Spleen
• Dj flexure
• Ligament of trietz
• Descending colon
• Splenic flexure of
colon
• Loops of jejunum.

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POSTERIOR RELATIONS OF
KIDNEY
LEFT KIDNEY RIGHT
KIDNEY
• Projection of 11th rib
• Area for diaphragm
• Projection of 12th rib
• Area for aponeurosis
of transversus
abdominis muscle
• Area for
quadratus
lumborum
muscle
• Area for psoas major
• Area for diaphragm
• Projection of 12th rib
• Area for aponeurosis
of transversus
abdominis muscle
• Area for quadratus
lumborum muscle
• Area for psoas major
muscle

11. LEF
T
RIGH
T
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APPLIED
ANATOMY
• Posterior reflection of the pleura
extends inferiorly to the 12th rib
• Lung edge lies above the 11th rib (at the
10th intercostal space)
• Risk of injury to the lung from a 10th
intercostal percutaneous approach to
the kidney

14. Relationship to ribs and
pleura
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MEDIALBORD
ER
» In medial border of each kidney there is a vertical fissure
called renal hilum/porta
• Renal vessels, nerves, lymphatics, enter and exit through
through hilum
• Concavity of hilum is continous with deep declivityin
medial border of kidney called renal sinus
• Within renal sinus is renal pelvis, a funnel shaped sac
formed by widely expanded portion of proximal ureter and
by junction of major calices

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• Intra renal pelvis denotes the pelvis
that is almost covered by renal
parenchyma.
• Renal pelvis almost bifurcates or
trifurcates within the sinus producing
2/3 major calyx.
• Each major calyx again divide into 5-14
minor calyxes receiving collecting ducts (
500).
• Renal pelvis commonly lies posterior to
renal vessels.

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• LATERALBORDER :
Related to perirenal fascia, gerota’s fascia,
para renal fascia.

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GEROTA’S FASCIA
• Encloses the kidney & perirenal fat
and adrenals.
• Anatomic barrier to spread of
malignancy
• Superiorly and laterally it is closed
• Medially it crosses the midline to fuse
with the fellow of opposite Side
• Inferiorly it remains open- perinephric
fluid can track into pelvis

19. RENAL
FASCIA
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• Two distinct regions :-
Cortex - pale outer region
Medulla - darker inner region
• Renal medulla - 8 to 18 striated, distinct, conically shaped
areas called renal pyramids.
• The apex of the pyramids forms the renal papilla, and each
papilla is cupped by an individual minor calyx.
• The base of the pyramids is positioned at the corticomedullary
boundary.
• Renal cortex is approximately 1 cm in thickness and covers
the base of each renal pyramid peripherally and extends
downward between the individual pyramids to form the
columns of Bertin .

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• Interlobar arteries traverse these
columns of Bertin
• Therefore percutaneous access to the
collecting system is usually performed
through a renal pyramid into a calyx to
avoid these columns of Bertin containing
larger blood vessels
• The functional unit of the kidney is the
nephron. Approximately 0.4 to 1.2 million
nephrons are found in each adult kidney.

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• The cortex made up of the glomeruli with
PCT & DCT.
• The renal pyramids are made up of
loops of Henle and collecting ducts.
• Ducts join to form the papillary ducts (about
20), which open at the papillary surface
(area cribosa) and drain urine into the
collecting system(into the fornix of a minor
calyx).

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MINOR
CALYX
• The renal papillae drain into the minor
calyces, (the most peripheral portions of
the intrarenal collecting system).
• Range in number from 5 to 14 (mean- 8)
• Simple (drains one papilla)
• Compound (drains two or three papillae)

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• Three calyceal groups: upper, middle, and lower.
• Minor calyces, either directly or after coalescing
into major calyces, drain by infundibula into the
renal pelvis
• Compound calyces of the poles of the
kidney are oriented facing their respective
poles.
• Simple calyces usually come in pairs, with one
facing anteriorly and one facing posteriorly

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• Drainage of the upper pole into the renal pelvis is
by a single midline infundibulum in the majority of
kidneys.
• Drainage from the lower pole is via a single
infundibulum in about half of human kidneys.
• The middle calyces are typically arranged in a
series of paired anterior and posterior calyces.
• In about two thirds of kidneys, there are two major
calyceal systems—an upper one and lower one—and
the middle calyces drain into either or both systems

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RENAL
VASCULATURE
• The renal arteries arise from the aorta at the level of the intervertebral
disk between the L1 and L2 vertebrae.
• Each artery divides into five segmental end arteries that do not
anastomose significantly with other segmental arteries.
• The renal artery usually divides to form anterior and posterior divisions.
• The anterior division supplies anterior two thirds of the kidney, and the
posterior division supplies the posterior one third of the kidney.
• Typically, the anterior division divides into four anterior segmental
branches: apical, upper, middle, and lower.
• The posterior segmental artery - first and most constant branch, which
separates from the renal artery before it enters the renal hilum

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SEGMENTAL
BRANCHES
• End arteries- so injury lead to segmental infarction.
• First and most constant branch POSTERIOR
SEGMENTAL BRANCH
• Four anterior branches
• APICAL
• UPPER
• MIDDLE
• LOWER
• Posterior segmental artery passes posterior to renal
pelvis

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• In the renal sinus, the segmental arteries branch into lobar
arteries, which further subdivide in the parenchyma to form
interlobar arteries.
• The interlobar arteries progress peripherally within the
cortical columns of Bertin, avoiding the renal pyramids
but in a close association with the minor calyceal
infundibula.
• At the base (peripheral edge) of the renal pyramids, the
interlobar arteries branch into arcuate arteries.
• Instead of moving peripherally, the arcuate arteries parallel
the edge of the corticomedullary junction and move
radially, where they eventually divide to form the afferent
arteries to the glomerulus.

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ANOMALIES OF RENAL
ARTERY
• Multiple renal arteries- kidney supplied by more
than one artery. MC on left side.
• Accessory renal artery – 2 or more branch
supply the same renal segment. MC on left side
30 to 35%
• They enter either in upper pole/ lower pole of
kidney.
• Such accessory artery can cause ureteric
obstruction lead to secondary HUN..
• But ligation of accessory renal artery result in a
portion of infarction
• Arterial anomalies are more common on left
and venous anomalies are more common
on right.

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COMMON ANATOMIC
VARIANTS OF
VESSEL
• Occurs in 25- 40%
• M.C is supernumery arteries- More
common on Left side.
• Lower pole arteries can cross ant to
collection system and cause PUJ
obstruction

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RENAL
VEIN
• The vein is located directly anterior to
the renal artery.
• This position can vary up to 1-2 cm
cranially or caudally relative to the artery

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LEFT RENAL
VEIN
• The left renal vein - 6 to 10 cm in length
and drains into IVC after passing posterior
to the superior mesenteric artery and
anterior to the aorta
• Left renal vein enters the IVC at a slightly
more cranial level and a more
anterolateral location
• The left renal vein receives the left
adrenal vein superiorly, lumbar vein
posteriorly, and left gonadal vein
inferiorly

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RIGHT RENAL
VEIN
• The right renal vein is generally 2 to 4
cm in length and enters the right lateral
to posterolateral edge of the IVC
• Right renal vein enters the IVC at a
slightly more caudal level.
• The right renal vein typically do not
receive any branches

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• Unlike the arterial supply, the venous
drainage communicates freely through
“Venous Collars” around the infundibula,
• Extensive collateral circulation is
present in the venous drainage of the
kidney.
• Surgically, this is important, because unlike
the arterial supply, occlusion of a
segmental venous branch has little effect
on venous outflow

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BRODEL’SLINE/AVASCULAR
PLANE
• Slightly behind the convex border at the
posterior half of kidney (approximately 2/3
rd way from lateral border ).
• Incision in this area will permit to
remove stone within renal calices
with minimal damage.

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LYMPHATI
CS
• Largely follow blood vessels through the
column of bertin.
• Lymphatics empty to LN near renal hilum
• L KIDNEY:-
-Lt lateral para- aortic LN
• R KIDNEY:-
-Rt inter aortocaval and Rt lateral
para caval LN and anterior and posterior
inferior venacaval nodes.

45. LYMPHATICS OF RIGHT
KIDNEY
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46. LYMPHATICS OF LEFT
KIDNEY
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NERVE
SUPPLY
• SYMPATHETIC - From T8 to L1 through
celiac and aortico renal ganglion
- Vasoconstriction
• PARA SYMPATHETIC- From vagus
- vasodilatation

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