KIDNEYS

Dr. Shreyansh Pachore.

 Synonyms: Ren (in Latin); Nephros (in Greek)
 The kidneys are two bean-shaped, reddish-brown
organ within the abdomen situated on the posterior
abdominal wall.
 They are the major excretory organs and remove
the waste products of protein metabolism and
excess of water and salts from the blood and are
thus essential for maintaining the electrolyte and
water balance in the tissue fluids of the body,
necessary for survival.
 LOCATION
 The kidneys lie on the posterior abdominal wall,
one on each side of the vertebral column, behind
the peritoneum, opposite 12th thoracic and upper
three lumbar (T12-L3)vertebrae.
 They occupy epigastric, hypochondriac, lumbar and
umbilical regions.
1. The right kidney lies at a slightly lower level
than the left one due to the presence of liver on
the right side.
2. The left kidney is little nearer to the median
plane than the right.
3. Their long axes are slightly oblique being
directed downward and laterally so that their
upper ends or poles are nearer to each other than
the lower poles.
4. The upper poles are 2.5 cm away from the
midline, the hilum are 5 cm away from the
midline, and the lower poles are 7.5 cm away from
the midline.
Both kidneys move downward in vertical direction
for 2.5 cm during respiration.

5. Transpyloric plane passes through the upper part

of the hilum of the right kidney and through the
lower part of the hilum of the left kidney.
 SHAPE AND MEASUREMENTS
 Shape: Bean shaped.
 Measurements:
Length: 11 cm.
(left kidney is slightly longer and narrower).
Width: 6 cm.
Thickness: (antero-posterior) 3 cm.
Weight:- 150 g in males; 135 g in females.
 EXTERNAL FEATURES
 Each kidney presents the following external
features:
 Two poles (superior and inferior).
 Two surfaces (anterior and posterior).
 Two borders (medial and lateral). and
 Hilum.
 POLES
 The superior (upper) pole is thick and round and
lies nearer to the median plane than the inferior
pole. It is related to the suprarenal gland.
 The inferior (lower) pole is thin and pointed and
lies 2.5 cm above the iliac crest.
 SURFACES
 The anterior surface is convex and faces antero-
laterally.
 The posterior surface is flat and faces postero-
medially.

However, in practice it is difficult to recognize

anterior and posterior surfaces. This however is
done easily by seeing the relationship of structures
present at the hilum.
 BORDERS
 The medial border of each kidney is convex above
and below near the poles and concave in the
middle.
It slopes downward and laterally, and presents a
vertical Fissure in its middle part called hilum/hilus
which has anterior and posterior lips.
 The lateral border of each kidney is convex.
 HILUM
 The medial border (central part) of the kidney
presents a deep vertical slit called hilum.
 It transmits, from before backward, the following
structures:
 Renal vein.
 Renal artery.
 Renal pelvis.
 Subsidiary branch of renal artery.
In addition to the above structures the hilum also
transmits lymphatics and nerves.
 RELATIONS
 ANTERIOR RELATIONS :-
The anterior relations of two kidneys are different.

Anterior surface of the right kidney:

 Right suprarenal gland.
 Right lobe of the liver.
 Second part of the duodenum.
 Hepatic (right colic) flexure.
 Jejunum.
 Out of these, liver and jejunum are separated from
the kidney by peritoneum.
Anterior surface of the left kidney:
 Left suprarenal gland.
 Spleen.
 Stomach.
 Pancreas and splenic vessels.
 Left colic flexure.
 Jejunum.

Out of these, stomach, spleen, and jejunum are

separated from the kidney by peritoneum.
 POSTERIOR RELATIONS
 The posterior relations of two kidneys are the same
except that right kidney is related to one rib while
left kidney is related to two ribs
 Four muscles: Diaphragm, Quadratus lumborum,
Psoas major, and Transversus abdominis.
 Three nerves: Subcostal (T12), iliohypogastric (L1),
and ilioinguinal (Ll). The subcostal nerve is
accompanied by the subcostal vessels.
 One or two ribs: The right kidney is related to the
12th rib whereas the left kidney is related to the
11th and 12th ribs.
 CAPSULES (COVERINGS) OF KIDNEY
From within outwards, the kidney is surrounded by
four capsules/coverings as follows:-

 Fibrous capsule (true capsule).

 Perirenal (perinephric) fat.
 Renal fascia (false capsule).
 Pararenal (paranephric) fat.
FIBROUS CAPSULE (TRUE CAPSULE)
It is a thin membrane which closely invests the
kidney. It is formed by the condensation of fibrous
connective tissue in the peripheral part of the
organ. It is readily stripped off from the surface of
the normal kidney. The capsule passes through the
hilum to line the renal sinus and becomes
continuous with the walls of calyces where they
are attached with the kidney. If the kidney is
inflamed, this capsule becomes firmly adherent to
the organ and cannot be stripped off.
 PERIRENAL (PERINEPHRIC) FAT
 It is a layer of adipose tissue, surrounding the
fibrous capsule of the kidney. It fills the space
inside the loosely fitting sheath of the renal fascia
enclosing the kidney and suprarenal gland. This
fatty capsule is thickest at the borders of kidney
and is prolonged through hilum into the renal sinus.
In chronic debilitating diseases, the depletion of
perinephric fat can cause downward displacement
of the Kidney, which may lead to Kinking of the
ureter.
 RENAL FASCIA (FALSE CAPSULE/
FASCIA OF GEROTA)
 It is a fibroareolar sheath, which surrounds the kidney
and perirenal fat.
 It consists of the following two layers:
An ill-defined anterior layer (fascia of Toldt).
A well-defined posterior layer (fascia of Zuckerkandl).

Extensions:-
 Superiorly, the two layers first enclose the suprarenal
gland in a separate compartment and then fuse with
each other and become continuous with the
diaphragmatic fascia.
 Inferiorly, the two layers remain separate and enclose
the ureter. The anterior layer is gradually lost in the
extraperitoneal tissue of iliac fossa while the posterior
layer blends with the fascia iliaca.
 Laterally, the two layers unite firmly and become
continuous with the fascia transversalis.
 Medially, the anterior layer passes in front of the
kidney and renal vessels and merges with the
connective tissue surrounding the aorta and
inferior vena cava (IVC). The posterior layer passes
behind the kidney and is attached to fascia
covering the quadratus lumborum and psoas major.
At the medial border of the kidney, the two
layers are attached by a connective tissue septum
being pierced by the vessels. Because of this
attachment (septum), perirenal effusion of the
fluid does not usually extend across into the
opposite perirenal space.
 PARARENAL (PARANEPHRIC) FAT
 Itis a layer of fat lying outside the renal fascia. It
consists of considerable quantity of fat being more
abundant posteriorly and toward the lower pole of
the kidney. It fills the paravertebral gutter and
forms a cushion for the kidney.
 MACROSCOPIC STRUCTURE
When the kidney is split longitudinally, it presents the
kidney proper and the renal sinus.
1. Kidney Proper:-
The naked eye examination of the kidney proper
presents an outer cortex and an inner medulla.
 The cortex is located just below the renal capsule and
extends between the renal pyramids as renal columns
(columns of Bertini). The cortex appears pale yellow
with granular texture.
 The medulla is composed of 5-11 dark conical masses
called renal pyramids (pyramids of Malpighi).
The apices of renal pyramids form nipple-like
projections—the renal papillae which invaginate the
minor calyces.
A renal pyramid along with its covering cortical tissue
forms a lobe of the kidney.
 2. Renal Sinus:-
It is a cavity of considerable size present within the
kidney. It takes up a large part of the interior of
the kidney and opens at the medial border of the
kidney as hilus.
It contains:
 Greater part of the renal pelvis, major and minor
calyces.
 Renal vessels, Iymphatics, and nerves &
 Fat.
The sinus is lined by the continuation of the
true capsule of the kidney. Numerous nipple-like
elevations (renal papillae) indent the wall of the
sinus. The renal pelvis within the sinus is divided
into two or three large branches, called major
calyces, which further divides to form 5-11 short
branches called minor calyces.
Each minor calyx is indented and moulded around
the renal papilla.
The collecting tubules within the renal papilla open
into the minor calyx by perforating its wall and
capsule lining thei sinus. Thus, the pelvis of ureter
(upper funnel-shaped part of the ureter) is
connected with the kidney tissue through calyces.
 MIICROSCOPIC STRUCTURE
 Histologically, each kidney consists of 1 to 3
millions of uriniferous tubules.
 Each uriniferous tubule consists of components:
nephron and collecting tubule.
1. The nephron is the structural and functional unit
of kidney. The number of nephrons in each kidney
is about 1-3 milllion.
Each nephron consists of a glomerulus and a tubule
system. The glomerulus is a tuft of capillaries
surrounded by Bowman's capsule. The tubular
system consists of the proximal convoluted tubule,
loop of Henle, and distal convoluted tubule.
2. Each collecting tubule begins as a junctional
(connecting) tubule from the distal convoluted
tubule. Many collecting tubules unite together to
form collecting duct (duct of Bellini) which opens
on the apex of renal papilla.
The collecting tubules radiate from the renal
pyramid into the cortical region to form radial
striations called medullary rays.
 ARTERIAL SUPPLY
 Renal arteries arise directly from abdominal Aorta.
 Near hilum each renal artery divides into anterior
and posterior division.
 Anterior division supplies Apical, Upper, Middle and
Lower segments.
 Posterior division supplies only Posterior segment.
 Renal Artery
 Segmental Arteries
 Lobar Arteries
 Interlobar Arteries
 Arcuate Arteries
 Inter Lobular Arteries
 Afferent Arterioles
 Efferent Arterioles
 Peritubular Cappilary Plexus
 Inter Lobular veins
 Arcuate Veins
 Inter Lobar veins
 Renal Vein
 Venous Drainage –
Right and Left Renal veins.

 Lymphatic Drainage –
Para Aortic Lymph Nodes

 Nerve Supply –
Sympathetic – T10-L1
Para Sympathetic – Vagus nerve
 APPLIED ANATOMY
 Congenital Anomalies –
1. Congenital Polycystic Kidney – failing of
continuation of nephron and collecting tubules.
2. Horse Shoe Kidney – Fusion of lower poles of
Kidney
3. Renal Agenesis – Ocures when ureteric bud fails to
develop. A physician should never assume that a
patient has two kidneys.
 Renal Pain– Felt in loin and often radiates
downward and forward into groin. Due to either
stretching of renal capsule or due to spasm of
smooth muscles in renal pelvis
 Transplantation of Kidneys –
Done in chronic renal failures. Donar kidney is
placed retro-peritoneally in the illiac fossa with
hilum parallel to External illiac vessels. The renal
artery is anastomosed end to end with Internal
illiac Artery and Renal vein is anastomosed end to
Side to External illiac vein. The Ureter is implanted
into the Urinary Bladder.
THANK YOU… !!!