Kidneys and Adrenal Kidneys and Adrenal GlandsGlands

Department of Regional Anatomy and

Operative Surgery

Position, relationPosition, relationStructure Structure Blood supply Blood supply Lymphatic Lymphatic drainagedrainage

InnervationsInnervations

PositionRetroperitoneal

Upper poles

T12 vertebra

Lower poles

L3 vertebra

Right is lower than left

Cadaveric kidneys

Surface Projection of kidneySurface Projection of kidney

Renal Angle

Tenderness or percussing pain caused by kidney disease is localized here

Neighbor of KidneyNeighbor of Kidney

Anterior Surface of the kidney

Posterior Surface

Costodiaphragmatic recess of the pleural

cavity

Renal hilum, Renal sinus and Renal pedicle

Renal hilum

Renal sinus

Renal pedicle

cortex

Renal column

Renal pyramid

calyx

papilla

renal veinrenal vein

renal artery renal artery

renal pelvisrenal pelvis

From above From above downwardsdownwards

the renal arterythe renal artery

renal vein renal vein

renal pelvisrenal pelvis

From anterior to From anterior to posteriorposterior

HydronephroHydronephrosissis

renal arteryrenal artery

T11

Renal artery

Vascular renal segmentVascular renal segmentSuperior (apical)

Anterior superior (upper)

Anterior inferior

(middle)

Inferior (lower)

posterior

variation of renal variation of renal arteryartery

!!

Variation of Renal Variation of Renal ArteryArtery

Renal veinsRenal veins

Aorta-renal artery-segmental artery-lobar artery-interlobar artery-arcuate artery-interlobulor artery-afferent arteriole-glomerulus (capillaries)-efferent arteriole-peritubular capillaries and vasa recta-interlobular vein-arcuate vein-interlobar vein-renal vein-interior vena cava

Renal CapsuleRenal Capsule

Renal fasciaRenal fascia Adipose capsuleAdipose capsule Fibrous capsuleFibrous capsule

Renal fascia

Fibrous capsule

Adipose capsule

Perirenal fat

Pararenal fat

FibrousFibrous

Capsule Capsule

Ureter

Ureter is divided into 3 parts:Ureter is divided into 3 parts:①①abdominal partabdominal part②②pelvis partpelvis part③③intramural part intramural part

28 to 34 cm 3 narrowing sites

•the pelviureteric junction

•crossing the pelvic brim

•traversing the bladder wall

Horseshoe kidneyHorseshoe kidney

Suprarenal Suprarenal GlandGland

•Endocrine gland

•T11 level

•Right is triangular

•Left is semi-lunar

LeftLeft rightright

anterioanteriorr

superisuperioror stomachstomach

liverliverinferiinferi

oror

tail of tail of pancreas & pancreas &

spleen vesselspleen vessel

posteriorposterior diaphragmdiaphragm diaphradiaphragmgm

medialmedial abdominal abdominal aortaaorta

Inferior Inferior vena vena cavacava

Relation

Artery of Adrenal Artery of Adrenal GlandGland

Veins of adrenal glandVeins of adrenal gland

Left suprarenal vein, into the

left renal vein

Right suprarenal vein, into the

inferior vena cava

incision

Anterior transperitoneal approach

Posterior retroperitoneal approach

A 55-year-old woman was found rolling on A 55-year-old woman was found rolling on her kitchen floor, crying out from agonizing her kitchen floor, crying out from agonizing pain in her abdomen. The pain came in pain in her abdomen. The pain came in waves and extended from the right loin to waves and extended from the right loin to the groin and to the front of the right thigh. the groin and to the front of the right thigh. An anteroposterior radiograph of the An anteroposterior radiograph of the abdomen revealed a calculus in the right abdomen revealed a calculus in the right ureter. ureter.

Case ACase A

a.a. What causes the pain when a ureteral What causes the pain when a ureteral calculus is present?calculus is present?

b.b. Why is the pain felt in such an extensive Why is the pain felt in such an extensive area?area?

c.c. Where does one look for the course of Where does one look for the course of the ureter in a radiograph?the ureter in a radiograph?

d.d. Where along the ureter is a calculus likely Where along the ureter is a calculus likely to be held up?to be held up?

QuestionQuestion

An explorer in the Amazon jungle was found An explorer in the Amazon jungle was found alive after having lost contact with the alive after having lost contact with the outside world for six months. On physical outside world for six months. On physical examination, he was found to be in an examination, he was found to be in an emaciated condition. On palpation of the emaciated condition. On palpation of the abdomen, a rounded, smooth swelling abdomen, a rounded, smooth swelling appeared in the right loin at the end of appeared in the right loin at the end of inspiration. On expiration, the swelling inspiration. On expiration, the swelling moved upward and could no longer be felt. moved upward and could no longer be felt. What anatomical structure could produce What anatomical structure could produce such a swelling?such a swelling?

Case BCase B

An intravenous pyelogram revealed that a An intravenous pyelogram revealed that a patient’s left kidney was in its normal patient’s left kidney was in its normal position, but the right kidney was situated in position, but the right kidney was situated in front of the right sacroiliac joint. Can you front of the right sacroiliac joint. Can you explain this on embryological grounds?explain this on embryological grounds?

Case CCase C

An examination of a patient revealed that An examination of a patient revealed that she had a horseshoe kidney. What she had a horseshoe kidney. What anatomical structure prevents a horseshoe anatomical structure prevents a horseshoe kidney from ascending to a level above the kidney from ascending to a level above the umbilicus?umbilicus?

Case DCase D

An intravenous pyelogram revealed that the An intravenous pyelogram revealed that the calyces and pelvis of a patient’s right kidney calyces and pelvis of a patient’s right kidney were grossly dilated (a condition known as were grossly dilated (a condition known as hydronephrosis). What embryological hydronephrosis). What embryological anomaly may be responsible for this anomaly may be responsible for this condition?condition?

Case ECase E

Which congenital anomaly of the ureter is Which congenital anomaly of the ureter is likely to present as a case of urinary likely to present as a case of urinary incontinence?incontinence?

Case FCase F

operation procedure of kidney transplant

nephrectomynephrectomy

For a nephrectomy, the kidney commonly is For a nephrectomy, the kidney commonly is exposed in the loin. After an oblique incision exposed in the loin. After an oblique incision midway between the twelfth rib and the iliac crest, midway between the twelfth rib and the iliac crest, the posterior free border of the external oblique is the posterior free border of the external oblique is identified, and divided to reveal the peritoneum, identified, and divided to reveal the peritoneum, which is pushed forward to reveal the renal fascia. which is pushed forward to reveal the renal fascia. The subcostal nerve and vessels are preserved; the The subcostal nerve and vessels are preserved; the renal fascia is opened; and the kidney exposed. renal fascia is opened; and the kidney exposed. Care must be taken not to damage the pleura, Care must be taken not to damage the pleura, since it is separated from the upper pole of the since it is separated from the upper pole of the kidney only by the diaphragm.kidney only by the diaphragm.