Kidney

Renes-renal
Nephros- nephron,nephritis
Defination

 Pair of excretory organs situated on

the posterior abd wall, one on each
side of the vertebral column, behind
the peritoneum.
 They remove waste products of
metabolism and excess of water and
salts from the blood and maintains it’s
pH.
Location

 Occupy epigastric, hypochondriac, lumbar

and umbilical regions.
 Vertically they extend from the upper
border of T12 to the centre of the body of
L3.
 Right kidney is slightly lower than the Left.
 Left kidney is a little nearer to the median
plane than right.
 The 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, Size, weight and orientation

 11cm long × 6cm broad × 3cm thick.

 Left kidney is a little longer and narrower than
rt kidney.
 On an average the kidney weights 150g g in
male and 135 g in females.
 Reddish brown in colour.
 Long axis of kidney is directed downwards and
laterally, so that the poles are nearer to the
median plane than the lower poles.
 The transverse axis is directed laterally and
backwards.
 In foetus the kidney is lobulated
and is made up of about 12
lobules
 After birth the lobules Gradually
fuse, so that in adults the kidney is
uniformly smooth.
External features

 Bean shaped
 2 poles- upper and lower
 2 borders- Medial and lateral
 2 surfaces- anterior and posterior
Poles

 Upper pole is broad and is in close

contact with the corresponding
suprarenal gland.
 Lower pole is pointed.
Surfaces

 Anterior surface- irregular

 Postetior- flat
Border

 Lateral- convex
 Medial- concave- Middle part shows
depression called hilum.
Hilum

 Following structures from

anterior to posterior side.
1. Renal veins
2. Renal artery
3. Renal pelvis – expanded
upper end of the ureter.
Relations of kidney

 Common
1. Upper pole – corresponding
suprarenal gland
2. Lower pole- lies above 2.5 cm
above the iliac crests.
3. Medial border- suprarenal gland
above the hilum and to the
ureter below the hilum.
Posterior relations

Diphragm
Medial and lateral arcuate ligament
Psoas major
Quadratus lumborum
 Transverse abdominis
 Subtotal vessels
 Subcostal, iliohypogastric and ilioinguinal nerves.
 Rt kidney- 12th rib
 Left kidney- 11th & 12th ribs.
Other relations of the right kidney
 Anterior relations
 Rt suprarenal gland.
 Liver
 2nd part of duodenum
 Hepatic flexure of colon-
covered by peritoneum
 Small intestine- covered
by peritoneum
 Lateral border is related to
rt lobe of the liver and to
the Hepatic flexure of the
colon.
Other relations of the Left kidney

 Anterior relations
 Lt suprarenal gland
 Spleen- covered by peritoneum.
 Stomach – covered by peritoneum.
 Pancreas
 Splenic vessels
 Splenic flexure & descending colon
 Jejunum- covered peritoneum.
Capsules or coverings of kidney

 Fibrous capsule-
1. Thin membrane
2. It can be easily stripped off
Perirenal or perinephric fat
Layer of adipose tissue lying
outside the fibrous capsule.
 Thickest at borders and fill up
the extra space in the renal
sinus.
Renal fascia
Perirenal fascia was originally described as being
made up of 2 separate layers.
Posterior layer called – zukerkandal layer
 Anterior layer – gerota.
Pararenal or paranephric body ( fat)

 It consist variable amount of fat

lying outside the renal fascia.
 More abundant posteriorly and
towards the lower pole of kidney.
Structure

 Naked eye Examination of a coronal Section of the kidney shows

1. Outer- reddish brown cortex
2. Inner- pale medulla
3. Space- renal sinus
Renal medulla is made up of
about 10 conical masses called
renal pyramids.
 Their apices form the renal
papillae which indent the
minor calyces.
Renal cortex

 Cortical arches or cortical lobules which forms caps over the bases of the
pyramids.
 Renal columns which dip in between the pyramids.
 Each pyramid along with the overland cortical arch forms A lobe of the kidney.
 Renal sinus is a space that extends into the kidney from the hilum. It contains
1. Branches of the renal artery
2. Tributaries of the renal vein.
3. Renal pelvis- renal pelvis divides into 2 to 3 major calyces and these in their
turn divide into 7 to 13 minor calyces.
4. Each minor calyx ends in an expansion which is indented by one to three renal
papillae.
Structure of uriniferous tubule.

 Each kidney is composed of 1 to 3 million uriniferous tubules.

 Each tubule consist of 2 parts which are emryologically distinct from
Each other.
The excretory part

The excretory part called nephron.

 Nephron is functional unit of kidney.
 Nephron comprises:
1. Renal corpuscle or malpighian corpuscle.
Made up of glomerulus, a tuft of
capillaries and bowman‘s capsule.
2. Renal tubule- for selective reabsorption of
substances from the glomerular filtrate
 Made up of the Proximal convoluted
tubule, loop of Henley with its descending
and ascending limbs, and the distal
convulated tubule.
Collecting part

 Begins as a junctional tubule from the distal convoluted tubule.

 Many tubules unite together to form the ducts of belling which open
into the minor calyces through the renal papillae.
Juxtaglomerular apparatus

 It is formed at the vascular pole of glomerulus which is intimately

related to its own ascending limb of the Henle’s loop near the distal
convoluted tubule. The apparatus consist of
1. Macula densa, formed by altered cells of the distal convoluted tubule.
2. Juxtaglomerular cells formed by the epitheloid cells in the Medial of
the afferent arteriole.
3. Some agranular cells between macula densa and the glomerulus
proper.
Vascular segments

 Renal artery gives 5 segmental branches,

4 from it’s anterior divisions and one from
it’s posterior division.
 Segments are apical , upper, Middle and
lower on anterior aspect.
 On posterior aspect segments seen are
posterior and parts of apical and lower
segments.
Blood supply
Lymphatic drainage

 Drain into the lateral aortic nodes located at the kevel of origin of the
renal arteries.
Nerve supply

 The kidney is supplied by the renal plexus, an off shoot of the coeliac
plexus
 It contains sympathetic T10-L1 fibers which are chiefly vasomotor.
 The afferent nerves of the kidney belong to segments.
Exposure of kidney from behind
Clinical anatomy

 Surgical exposure of kidney, when sometimes the 12th rib is rejected

for easier delivery of the kidney, danger of opening the pleural cavity
must be borne in mind.Lithography has replaced conventional
method to some degree
 Angle between the lower border of the 12th rib and the outer border of
the erector spinae is known as the renal angle.
 Blood from a ruptured kidney or pus in a perinephric abscess 1st
distends the renal fascia, then forces it’s way within the renal fascia
opposite side because of the fascial septum and midline attachment
of the renal fascia.
 Kidney is palpate bimanually, with one
hand placed in front and the other hand
behind the flank.
 When enlarged the lower pole of kidney
becomes palpable on deep inspiration.
 A floating kidney can move up and
down within the renal fascia, but not
from side to side
 In such a condition, the posterior layer
of renal fascia can be sutured with
diaphragm and kidney can be fixed in
position.
 Common diseases of kidney are nephritis, pyelonephritis, tuberculosis,
renal stones and tumours.
 Common manifestation of kidney diseases are renal oedema and
hypertension. Raised blood urea indicates suppressed kidney function and
renal failure.
 Kidney transplantation can be done in selected cases.
 One Common congenital condition of kidney is polycrystalline kidney
which leads to hypertension.
 In cases of chronic renal failure dialysis need to be done.
 It can be done as peritoneal dialysis or haemodialysis.
 The kidneys are likely to be injured due to penetrating injuries by kicks in
the renal angle, angle between the vertebral column and 12 th rib
 Kidney likely to have stones as urine
gets concentrated here.
 Kidney stones lies on the Jody of
vertebra.
 Gallstones lies ant to body of
vertebra.