FUNCTIONAL FUNCTIONAL ANATOMYANATOMY

OF KIDNEYS, OF KIDNEYS, URETERS URETERS

& & SUPRARENAL SUPRARENAL

GLANDSGLANDS

By Prof. Saeed Abuel Makarem

KIDNEYSKIDNEYS Its main function is to excrete

most of the waste products of metabolism

It control the water and electrolyte balance of the body body

It maintain acid-base balance of the bloodblood

The waste products leave the kidneys as urine, which passes down the ureters to the urinary bladder

The urine leaves the body through the urethra

Kidneys are reddish brown Kidneys are reddish brown in colorin color

Lie behind the peritoneum Lie behind the peritoneum of the posterior abdominal of the posterior abdominal wallwall

It lie high up on either It lie high up on either side of the vertebral side of the vertebral columncolumn

Are largely under cover of Are largely under cover of the costal marginthe costal margin

The right kidney lies The right kidney lies slightly lower than the left slightly lower than the left due to the large size of due to the large size of right lobe of the liverright lobe of the liver

KIDNEYSKIDNEYS With contraction of the With contraction of the diaphragm during diaphragm during respiration, both kidneys respiration, both kidneys move downward in a move downward in a vertical direction as much vertical direction as much as 2.5 cmas 2.5 cm

On the medial border of On the medial border of each kidney is a vertical each kidney is a vertical slit called the hilumslit called the hilum

The hilum extends into a The hilum extends into a large cavity called the large cavity called the renal sinusrenal sinus

The hilum transmits the The hilum transmits the renal vein, two branches renal vein, two branches of renal artery, ureter, of renal artery, ureter, and the third branch of and the third branch of renal artery from the front renal artery from the front backward (V.A.U.Abackward (V.A.U.A.).)

COVERINGSCOVERINGS 1- Fibrous capsuleFibrous capsule: It surrounds the kidney 2- Perirenal fatPerirenal fat: It covers the fibrous

capsule

3- Renal fasciaRenal fascia: it is a condensation of

connective tissue that encloses the kidneys and suprarenal glands,

it is continuous laterally with the fascia transversalis

4- Pararenal fatPararenal fat: it lies external to the renal

fascia, and forms part of the retroperitoneal fat

Each kidney has a dark brown outer cortex and a light brown inner medulla

Medulla is composed of about a dozen renal pyramids

Each pyramid having its base directed laterally toward the cortex, and its apex, (the renal papilla), projecting medially

The cortex extends into the medulla between adjacent pyramids as the renal column

RENAL RENAL STRUCTURESTRUCTURE

Extending from the bases of the renal pyramids into the cortex are striations known as medullary rays

The renal sinus within the hilum, contains the upper expanded end of the ureter, the renal pelvis

Renal pelvis divides into twotwo or threethree major major calycescalyces, which divides into two or three minor minor calycescalyces

RIGHT KIDNEYRIGHT KIDNEY Suprarenal glandSuprarenal gland LiverLiver,, Second part of the Second part of the

duodenum,duodenum, Right colic flexureRight colic flexure Coils of small intestineCoils of small intestine

LEFT KIDNEYLEFT KIDNEY Suprarenal gland,Suprarenal gland, SpleenSpleen,, StomachStomach, , Pancreas (body), Pancreas (body), Left colic flexure,Left colic flexure, Descending colon Descending colon Coils of jejunumCoils of jejunum

.

RIGHT KIDNEYRIGHT KIDNEYDiaphragm,Costodiaphragmatic recess of the pleura,Twelfth rib & last intercostal space,Psoas majorQuadratus lumborum, Transversus abdominis muscleSubcostal nerve (T12) Iliohypogastric nerve (L1)Ilioinguinal nerve (L1)

LEFT KIDNEY Same as the right except it Same as the right except it is higher it reaches up to the is higher it reaches up to the 1111thth rib. rib.

Posterior Relations of the Posterior Relations of the KidneysKidneys

BLOOD SUPPLYBLOOD SUPPLY

The renal artery arises The renal artery arises from the aorta at the from the aorta at the level of the level of the second second lumbar vertebralumbar vertebra

Each renal artery divides Each renal artery divides into into five five segmental segmental arteries that enter the arteries that enter the hilum of the kidney, four hilum of the kidney, four infront and one behind infront and one behind the renal pelvisthe renal pelvis

Lobar artery arise from Lobar artery arise from each segmental artery, each segmental artery, one for each renal one for each renal pyramidpyramid

Each lobar artery gives two or three interlobar arteries

The interlobar arteries run toward the cortex on each side of the renal pyramid

Interlobar arteries give the arcuate arteries at the junction of the cortex and medulla

The arcuate arteries give several interlobular arteries

Afferent glomerular arterioles arise as branches of interlobular arteries

Renal vein emerges from the hilum in front of the renal artery and drains into the IVC

Left renal vein is longer than the right renal vein

Lateral aortic lymph nodes lie around the origin of the renal artery

Renal sympathetic plexus: afferent fibers that travel through the renal plexus enter the spinal cord in the 10th, 11th, and 12th thoracic nerves

URETERSURETERS The two ureters are

muscular tubes that extend from the kidneys to the posterior surface of the urinary bladder

The urine is propelled along the ureter by peristaltic contractions

Each ureter measures about 25 cm long

Each ureter has three constrictions along its course,

1- Where the renal pelvis joins the ureter,

2- As it crosses the pelvic brim,

3- Where it pierces the bladder wall ( intra-mural part)

The renal pelvis is the funnel-shaped expanded upper end of the ureter

It lies within the hilum of the kidney and receives the major calyces

It enters the pelvis by crossing the bifurcation of the common iliac artery in front of the sacroiliac joint

It runs downward & forward on the lateral wall of the pelvis to enter the lateral angle of the bladder

RELATIONS, RIGHT RELATIONS, RIGHT URETERURETER

AnteriorAnterior: Duodenum, Terminal part of the

ileum, Right colic vessels, Iliocolic vessels, Right testicular or

ovarian vessels, and the

Root of the mesentery. PosteriorPosterior: Right psoas muscle, Bifurcation of the right

common iliac artery

RELATIONS, LEFT RELATIONS, LEFT URETERURETER

AnteriorAnterior: : Sigmoid colon, Sigmoid

mesocolon, Left colic vessels, Left testicular or

ovarian vessels

PosteriorPosterior: Left psoas muscle, Bifurcation of left

common iliac artery

Upper end is supplied by the renal artery

Middle portion by (gonadal) (gonadal) testicular or ovarian artery

In the pelvis is supplied by the superior vesical artery

The lymph drains to the lateral aortic nodes and the iliac nodes

Renal, testicular (or ovarian), and hypogastric plexus (in the pelvis)

Afferent fibers travel with the sympathetic nerves and enter the spinal cord in the first first and second and second lumbar segments

The two suprarenal glands are yellowish retroperitoneal organs that lie on the upper poles of the kidneys

They are surrounded by the renal fascia

Separated from the kidneys by the perirenal fat

Each gland has a yellow cortex and a dark brown medulla

SUPRARENAL SUPRARENAL GLANDSGLANDS

The cortex secretes hormones include:

Mineral corticoidsMineral corticoids, which control fluid and electrolyte balance.

GlucocorticoidsGlucocorticoids, which control carbohydrates, fats, and proteins.

Sex hormonesSex hormones, which probably play a role in the prepubertal development of the sex organs

The medulla secretes the catecholamine, catecholamine, epinephrine and epinephrine and norepinephrinenorepinephrine

LEFT SUPRARENAL LEFT SUPRARENAL GLANDSGLANDS

Left suprarenal gland is crescentic in shape

Extends along the medial border of the left kidney from the upper pole to the hilum

It lies behind the: The pancreas, The lesser sac, The stomach It rests posteriorly on

the diaphragm

The right suprarenal gland is pyramidal in shap and caps the upper pole of the right kidney

It lies behind the right lobe of the liver and extends medially behind the IVC

It rests posteriorly on the diaphragm

Arteries:Arteries: Three arteries supplying

each gland, 1- Superior suprarenal artery:

from inferior phrenic artery 2- Middle suprarenal from

aorta. 3- Inferior suprarenal from

renal. VeinsVeins:: A single vein emerges from

the hilum of each gland: The right suprarenal vein right suprarenal vein

drains into the IVCIVC . The left suprarenal vein left suprarenal vein

drains into the left renalleft renal

Dr. L. Tchakarov 25

The suprarenal glands of the human fetus are 10 to 20 times larger than the adult glands relative to body weight, and are large compared with the kidneys.

These large glands result from the extensive size of the fetal cortex.