Kidney Diseases

Published on 16/04/2015 by admin

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Last modified 16/04/2015

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12 Kidney Diseases

Anatomy of the Kidneys

Position of the Kidneys

• Retroperitoneal, posterior to upper GI organs

• Lying on lateral borders of upper psoas muscles

• Kidneys and adrenals lie within perirenal (perinephric) fat that is enclosed by fibrous renal fascia (Gerota’s).

• Retroperitoneal pararenal fat surrounds renal fascia.

• Parts of right kidney lie posterior to liver, duodenum, and right colic (hepatic) flexure.

• Right-dominant liver forces right kidney to lie lower than the left.

• Parts of left kidney lie posterior to stomach, tail of pancreas, spleen, and left colic (splenic) flexure.

• Upper parts of both kidneys overlie posterior inferior diaphragm.

• Right kidney also typically overlies quadratus lumborum, 12th rib, and transversus abdominis.

• Left kidney overlies quadratus lumborum, 11th and 12th ribs, and transversus abdominis.

Gross Structure of Kidney

Internal Renal Structure

• Renal capsule: fibrous, invests cortex, terminates around the rim of minor calyces in renal sinus

• Cortex: contains Bowman’s capsules and glomeruli (renal corpuscles), proximal and distal convoluted tubules, proximal collecting ducts, arcuate arteries and veins, cortical capillary plexus

• Medulla, pyramids: contain loops of Henle, distal collecting ducts, vasa rectae, medullary capillary plexus

• Renal (cortical) columns (Bertini): lie between pyramids, like cortex, contain renal corpuscles, tubules, and vessels

• Renal papilla: apex of pyramid, contains collecting tubule openings, drains into minor calyx

Collecting System

• Minor calyces: collect urine from papillary tubules

• Major calyces: formed by union of 8-10 minor calyces

• Renal pelvis: formed by union of 2-4 major calyces, connects in turn to ureter

Ureter

• Fibromuscular tube with mucosa

• Upper: renal pelvis to upper border of sacrum

• Middle: overlies sacrum

• Lower: border of sacrum to bladder

• Blood supply: upper from renal arteries, middle from ovarian or testicular arteries, lower from vesical arteries

Nerves of Kidneys, Ureters, and Urinary Bladder

Innervation of Kidneys and Ureters

• Parasympathetic

Preganglionic: vagal fibers run through celiac and superior mesenteric plexuses, joining renal nerve plexus for distribution to ganglion cells in renal parenchyma, pelvis, and ureter

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