GROSS ANATOMY OF THE HUMAN KIDNEY

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GROSS ANATOMY OF THE HUMAN KIDNEY
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Introduction

• Most humans have a pair of kidneys which are
• located within the abdomen behind the peritoneum
• on either sides of the vertebrae column. They are
• reddish brown and are covered by its capsule
• which is further surrounded by adipose connective
  
• tissue. The surfaces are convex with the anterior
  
• facing anterolaterally while the posterior
  surfaces
• are directed posteriomedially. Traces of fetal
• lobulations may be present in adult kidneys.

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• The hilium is a vertical depression at the
• medial border transmitting the renal vessels,
• nerves and renal pelvis. The right hilium is
  located
• just below the transpyloric plane while the left
  is just
• above it about 5cm from midline. The upper poles
• overlies the 11th rib (left) and the12th rib
  (right). The
• weight of the liver accounts for the lower
  position of
• the right kidney.
• Normal - 12cm x 6cm x 3cm and weighs 130g.
• Generally located between T12 L3. The emerging
• pelvis from the hilium continues downwards as the
  
• ureter. The kidneys are usually impalpable but
  for
• the lower pole in slim individuals at deep
  inspiration.

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Relations from greys pics
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• Relations
• Anterior
• Right kidney suprarenal gland superomedially,
  right hepatic lobe laterally, descending duodenum
  medially and the right colic flexure. The areas
  in contact with the suprarenal, duodenum and
  colon are devoid of peritoneum.
• Left kidney suprarenal gland superomedially,
  the spleen superolaterally, body of pancreas,
  splenic vessels and stomach at the mid anterior
  surface. It is related to the colon
  inferolaterally and the jejunum medially. The
  areas in contact with the suprarenal, pancreas
  and colon are devoid of peritoneum.

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• diaphragm, quadratus, lumborum muscle, the
• psoas, transversus abdominis, subcostal vessels
• the last thoracic, iliohypogastric and
  ilioinguinal
• nerves. The right kidney rests on the 12th rib
  and
• the left on the 11th and 12th ribs. The diaphragm
  
• separates the kidneys from the pleura i.e. the
• Posterior
• It is embedded in fat and devoid of peritoneum.
• Relations are similar on both sides with the
• costodiaphragmatic recess.
• Superior
• Suprarenal glands and the peritoneum of the
  hepatorenal pouch (greater sac) in the right and
  that of the stomach bed(lesser sac) on the left.

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• Lateral border
• It is convex, on the right it is separated from
  the
• right lobe of liver by peritoneum of the greater
  sac
• while on the left it is separated from the spleen
  and
• descending colon by the peritoneum of the greater
  
• sac.
• Medial border
• Also convex at the poles but concave between the
• poles. The hilium located centrally transmits the
  renal
• vein, renal artery and renal pelvis in
  anteroposterior
• order.
• The perinephric/perirenal fat
• The kidney and its vessels are embedded in this

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• thick adipose CT which helps maintain it in
• position. The fat is surrounded by a condensed
• fibroareolar sheath called the renal fascia.
• Blood supply
• Arterial renal aa from the abdominal aorta
  enters
• the kidney behind the renal vein it supplies the
  
• kidney in 5 segments.
• Posterior division post segment
• Anterior division apical, upper, middle and
  lower segments.
• There are no collaterals between these vessels.

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Segmental blood supply
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• Venous drainage group of veins drain the
• segments with communications. The
• resultant 5 vessels drain into the renal vein
• at the hilium.
• Lymphatic drainage Lymphatic channels form a
• plexus which drains into the para-ortic nodes at
  L2.
• Innervation
• Through both sympathetic and parasympathetic
• parts of the ANS.
• Sympathetic preganglionic of T2 L2 via the
• thoracic and lumbar splanchnic and postganglionic
  
• cells in coeliac and renal ganglion
• Parasympathetic Vagal fibres

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• Function excretion of end products of metabolic
  activities and excess water through urine
  formation.
• Development
• Successive development of the pronephros,
• meronephros and the metamorphosis occur
• from the inter mediate cell mass of the
• mesoderm.
• Pronephros disappears leaving its duct
• Mesonephros Wolffian duct ie epidydimis etc
• Metanephos Formed by million of new tubules. It
  induces the formation of the ureteric bud from
  the mesonephric duct.

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• The bud divides into the pelvis calyces and
• collecting tubules of the pyramid to which the
  DCT
• of metanephros drain. Metanephros tissue overlie
• the tubular budding the lobulated appearance of
• the fetal/neonatal kidneys is a reflection of
  this.
• The development of the metanephros occurs
• within the pelvis and is supplied by the internal
  iliac
• Arteries. Migration into adult position occurs
  via
• successive arterial supply from the common iliac
• aa and the aorta. Finally the aortic supply
  through
• the renal aa remains while the older and lower
• vessels degenerates.

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• Clinicals
• (1) Congenital anomalies
• persistance of fetal aa
• horseshoe kidney ie fusion of lower poles
• polycystic kidney disease
• renal agenesis
• (2) Pain referred to the ant abd wall back,
  lumbar and external genitalia. nausea
  and vomiting
• (3) Nephroptosis floating kidneys
• Investigation - abdominal USS
• -Renal biopsy lower pole below
  12th rib
• -Intraveous pyelogragh

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Intravenous pyelogram