KIDNEYS
The ovoid kidneys lie
retroperitoneally on the posterior
abdominal wall, one on each side of
the vertebral column at the level of
the T12-L3 vertebrae. The right
kidney usually lies slightly inferior to
the left kidney, probably owing to its
relationship to the liver.
RELATIONS
Posteriorly to the diaphragm, which separates
them from the pleural cavities and the 12th pair of
ribs. More inferiorly, the posterior surfaces of the
kidney are related to the quadratus lumborum
muscle.
The subcostal nerve and vessels and the
iliohypogastric and ilioinguinal nerves descend
diagonally across the posterior surfaces of the
kidneys.
The liver, duodenum, and ascending colon are
anterior to the right kidney. The right kidney is
separated from the liver by the hepatorenal recess.
The left kidney is related to the stomach, spleen,
pancreas, jejunum, and descending colon.
RENAL STRUCTURE
Each kidney has a dark brown outer cortex and a
light brown inner medulla. The medulla is composed
of about a dozen renal pyramids, each having its
base oriented toward the cortex. The cortex extends
into the medulla between adjacent pyramids as the
renal columns. Extending from the bases of the renal
pyramids into the cortex are striations known as
medullary rays.
The renal sinus, which is the space within the hilum,
contains the upper expanded end of the ureter, the
renal pelvis. This divides into two or three major
calyces, each of which divides into two or three
minor calyces. Each minor calyx is indented by the
apex of the renal pyramid, the renal papilla.
BLOOD SUPPLY
ARTERIES
The renal artery arises from the aorta at the level of the
second lumbar vertebra. Each renal artery usually divides
into five segmental arteries that enter the hilum of the
kidney. Lobar arteries arise from each segmental artery,
one for each renal pyramid. Before entering the renal
substance, each lobar artery gives off two or three
interlobar arteries. The interlobar arteries run toward the
cortex on each side of the renal pyramid. At the junction
of the cortex and the medulla, the interlobar arteries give
off the arcuate arteries, which arch over the bases of the
pyramids. The arcuate arteries give off several
interlobular arteries that ascend in the cortex. The
afferent glomerular arterioles arise as branches of the
interlobular arteries.
Multiple renal veins contribute to the
formation of the left and right renal veins,
both of which are anterior to the renal
arteries (Fig. 4.125). Importantly, the longer
left renal vein crosses the midline anterior to
the abdominal aorta and posterior to the
superior mesenteric artery and can be
compressed by an aneurysm in either of
these two vessels.
The lymphatic drainage of each kidney is to
the lumbar nodes around the origin of the
renal artery.
URETERS
The ureters are muscular ducts (25-30 cm
long) with narrow lumina that carry urine
from the kidneys to the urinary bladder. They
run inferiorly from the apex of the renal
pelvis at the hilum of the kidneys, passing
over the pelvic brim at the bifurcation of the
common iliac arteries. They then run along
the lateral wall of the pelvis and enter the
urinary bladder. The abdominal parts of the
ureters adhere closely to the parietal
peritoneum and are retroperitoneal
throughout their course.
The ureters are normally constricted to
a variable degree in three places:
(1) At the junction of the ureters and
renal pelvis.
(2) Where the ureters cross the brim
of the pelvic inlet.
(3) During their passage through the
wall of the urinary bladder. These
constricted areas are potential sites of
obstruction by ureteric (kidney) stones.
Arterial branches to the abdominal
portion of the ureter arise consistently from
the renal arteries, with less constant
branches arising from the testicular or
ovarian arteries, the abdominal aorta, and
the common iliac arteries. The branches
approach the ureters medially and divide
into ascending and descending branches,
forming a longitudinal anastomosis on the
ureteric wall.
Veins draining the abdominal part of the
ureters drain into the renal and gonadal
(testicular or ovarian) veins.
SUPRARENAL GLANDS
•The suprarenal (adrenal) glands are located
between the superomedial aspects of the kidneys
and the diaphragm.
•The shape and relations of the suprarenal glands
differ on the two sides. The pyramidal right gland
is more apical (situated over the superior pole)
relative to the right kidney. The crescent-shaped
left gland.
•Each suprarenal gland has two parts: the
suprarenal cortex and suprarenal medulla.
•The right suprarenal gland is more pyramidal in
shape and apical in position relative to the right
kidney, whereas the left gland is more crescentic
and lies more medial to the superior half of the
THE SUPRARENAL ARTERIES AND VEINS
The endocrine function of the suprarenal glands makes
their abundant blood supply necessary.
Suprarenal arteries arise from three sources:
1.Superior suprarenal arteries from the inferior
phrenic arteries.
2.Middle suprarenal arteries from the abdominal
aorta near the level of origin of the SMA.
3.Inferior suprarenal arteries from the renal
arteries.
The venous drainage of the suprarenal gland is into a
large suprarenal vein. The short right suprarenal vein
drains into the IVC, whereas the longer left suprarenal
vein, often joined by the inferior phrenic vein, empties
into the left renal vein.
Quiz/
QI/
1.……..…, ..………, ………… and …………. are
branches of the lumbar plexus.
2.The somatic nerves of the posterior
abdominal wall are …………….. And
…………. .
3.The posterior abdominal wall formed
by four muscles ………………, ………….,
…...……., …………… .
4.The bones of the posterior abdominal
wall are …………………., ………………..,
…………………… .
5.The abdominal aorta are divided into
………………. And ……………………. .
