Anatomy of kidney.pptx
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The kidneys are paired retroperitoneal organs located in the posterior abdominal cavity. Each kidney is reddish-brown and ovoid in shape, measuring approximately 10-12 cm long. The kidneys receive blood supply from the renal arteries and drain into the renal veins. The internal anatomy of the kidneys includes the renal cortex, medulla, pyramids, calyces and pelvis which collect urine drained from nephrons. Variations can occur in the number and branching pattern of renal vessels.
Anatomy of kidney.pptx
- 1. ANATOMY OF KIDNEY 1 DR.MANOJ ARYAL DM RESIDENT NEPHROLOGY NAMS BIR HOSPITAL
- 2. 2 ANATOMY OF KIDNEY • Paired ovoid, reddish-brown retroperitoneal organs situated in the posterior part of the abdomen on each side of the vertebral coloumn • Lie on the psoas muscles; thus the longitudinal axes of the kidneys are oblique . • The upper poles more medial and posterior than the inferior poles. • The medial aspect of each kidney is rotated anteriorly at an angle of approximately 30 degrees.
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- 4. 4 • The exact position of the kidney within the retroperitoneum varies The kidneys move inferiorly approximately 3 cm (one vertebral body) during inspiration and during changing body position from supine to the erect.
- 5. 5 DIMENSIO NS • Length- 10 to 12 cm • Width- 5.0 to 7.5 cm • Thickness- 2.5 to 3.0 cm. Weight of kidney = approx. 125-170 gm. ( 10- 15 gm lighter in females).
- 6. 6 Right kidney vs left kidney Right kidney Left kidney • Reside betweenthe top of the 1st lumbar vertebra to the bottom of the 3rd lumbar vertebra. • The right kidney is slightly shorter and wider because of downward compression by the liver. • The right kidney is related to the 12th • Between the 12th thoracic vertebra and the 3rd lumbar vertebra. • Left kidney is related to the 11th and 12th ribs
- 7. 7 RELATIO NS • Surfaces of kidney are - anterior and posterior. • Borders are - medial and lateral. • Poles of kidney are – superior and inferior. • Anteriorly kidney is related - abdominal viscera • Posteriorly - osteomuscular area
- 8. 8 ANTERIOR RELATIONS RIGHT KIDNEY LEFT KIDNEY • right adrenal gland • liver • second part of duodenum • ascending colon • hepatic flexure of colon. • Left adrenal • Pancreas • splenic vessels • Stomach • Spleen • Dj flexure • Ligament of trietz • Descending colon • Splenic flexure of colon • Loops of jejunum.
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- 10. 10 POSTERIOR RELATIONS OF KIDNEY LEFT KIDNEY RIGHT KIDNEY • Projection of 11th rib • Area for diaphragm • Projection of 12th rib • Area for aponeurosis of transversus abdominis muscle • Area for quadratus lumborum muscle • Area for psoas major • Area for diaphragm • Projection of 12th rib • Area for aponeurosis of transversus abdominis muscle • Area for quadratus lumborum muscle • Area for psoas major muscle
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- 13. 13 APPLIED ANATOMY • Posterior reflection of the pleura extends inferiorly to the 12th rib • Lung edge lies above the 11th rib (at the 10th intercostal space) • Risk of injury to the lung from a 10th intercostal percutaneous approach to the kidney
- 14. Relationship to ribs and pleura 14
- 15. 15 MEDIALBORD ER » In medial border of each kidney there is a vertical fissure called renal hilum/porta • Renal vessels, nerves, lymphatics, enter and exit through through hilum • Concavity of hilum is continous with deep declivityin medial border of kidney called renal sinus • Within renal sinus is renal pelvis, a funnel shaped sac formed by widely expanded portion of proximal ureter and by junction of major calices
- 16. 16 • Intra renal pelvis denotes the pelvis that is almost covered by renal parenchyma. • Renal pelvis almost bifurcates or trifurcates within the sinus producing 2/3 major calyx. • Each major calyx again divide into 5-14 minor calyxes receiving collecting ducts ( 500). • Renal pelvis commonly lies posterior to renal vessels.
- 17. 17 • LATERALBORDER : Related to perirenal fascia, gerota’s fascia, para renal fascia.
- 18. 18 GEROTA’S FASCIA • Encloses the kidney & perirenal fat and adrenals. • Anatomic barrier to spread of malignancy • Superiorly and laterally it is closed • Medially it crosses the midline to fuse with the fellow of opposite Side • Inferiorly it remains open- perinephric fluid can track into pelvis
- 19. RENAL FASCIA 19
- 20. 20 • Two distinct regions :- Cortex - pale outer region Medulla - darker inner region • Renal medulla - 8 to 18 striated, distinct, conically shaped areas called renal pyramids. • The apex of the pyramids forms the renal papilla, and each papilla is cupped by an individual minor calyx. • The base of the pyramids is positioned at the corticomedullary boundary. • Renal cortex is approximately 1 cm in thickness and covers the base of each renal pyramid peripherally and extends downward between the individual pyramids to form the columns of Bertin .
- 21. 21 • Interlobar arteries traverse these columns of Bertin • Therefore percutaneous access to the collecting system is usually performed through a renal pyramid into a calyx to avoid these columns of Bertin containing larger blood vessels • The functional unit of the kidney is the nephron. Approximately 0.4 to 1.2 million nephrons are found in each adult kidney.
- 22. 22 • The cortex made up of the glomeruli with PCT & DCT. • The renal pyramids are made up of loops of Henle and collecting ducts. • Ducts join to form the papillary ducts (about 20), which open at the papillary surface (area cribosa) and drain urine into the collecting system(into the fornix of a minor calyx).
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- 24. 24 MINOR CALYX • The renal papillae drain into the minor calyces, (the most peripheral portions of the intrarenal collecting system). • Range in number from 5 to 14 (mean- 8) • Simple (drains one papilla) • Compound (drains two or three papillae)
- 25. 25 • Three calyceal groups: upper, middle, and lower. • Minor calyces, either directly or after coalescing into major calyces, drain by infundibula into the renal pelvis • Compound calyces of the poles of the kidney are oriented facing their respective poles. • Simple calyces usually come in pairs, with one facing anteriorly and one facing posteriorly
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- 27. 27 • Drainage of the upper pole into the renal pelvis is by a single midline infundibulum in the majority of kidneys. • Drainage from the lower pole is via a single infundibulum in about half of human kidneys. • The middle calyces are typically arranged in a series of paired anterior and posterior calyces. • In about two thirds of kidneys, there are two major calyceal systems—an upper one and lower one—and the middle calyces drain into either or both systems
- 28. 28 RENAL VASCULATURE • The renal arteries arise from the aorta at the level of the intervertebral disk between the L1 and L2 vertebrae. • Each artery divides into five segmental end arteries that do not anastomose significantly with other segmental arteries. • The renal artery usually divides to form anterior and posterior divisions. • The anterior division supplies anterior two thirds of the kidney, and the posterior division supplies the posterior one third of the kidney. • Typically, the anterior division divides into four anterior segmental branches: apical, upper, middle, and lower. • The posterior segmental artery - first and most constant branch, which separates from the renal artery before it enters the renal hilum
- 29. 29 SEGMENTAL BRANCHES • End arteries- so injury lead to segmental infarction. • First and most constant branch POSTERIOR SEGMENTAL BRANCH • Four anterior branches • APICAL • UPPER • MIDDLE • LOWER • Posterior segmental artery passes posterior to renal pelvis
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- 32. 32 • In the renal sinus, the segmental arteries branch into lobar arteries, which further subdivide in the parenchyma to form interlobar arteries. • The interlobar arteries progress peripherally within the cortical columns of Bertin, avoiding the renal pyramids but in a close association with the minor calyceal infundibula. • At the base (peripheral edge) of the renal pyramids, the interlobar arteries branch into arcuate arteries. • Instead of moving peripherally, the arcuate arteries parallel the edge of the corticomedullary junction and move radially, where they eventually divide to form the afferent arteries to the glomerulus.
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- 35. 35 ANOMALIES OF RENAL ARTERY • Multiple renal arteries- kidney supplied by more than one artery. MC on left side. • Accessory renal artery – 2 or more branch supply the same renal segment. MC on left side 30 to 35% • They enter either in upper pole/ lower pole of kidney. • Such accessory artery can cause ureteric obstruction lead to secondary HUN.. • But ligation of accessory renal artery result in a portion of infarction • Arterial anomalies are more common on left and venous anomalies are more common on right.
- 36. 36 COMMON ANATOMIC VARIANTS OF VESSEL • Occurs in 25- 40% • M.C is supernumery arteries- More common on Left side. • Lower pole arteries can cross ant to collection system and cause PUJ obstruction
- 37. 37 RENAL VEIN • The vein is located directly anterior to the renal artery. • This position can vary up to 1-2 cm cranially or caudally relative to the artery
- 38. 38 LEFT RENAL VEIN • The left renal vein - 6 to 10 cm in length and drains into IVC after passing posterior to the superior mesenteric artery and anterior to the aorta • Left renal vein enters the IVC at a slightly more cranial level and a more anterolateral location • The left renal vein receives the left adrenal vein superiorly, lumbar vein posteriorly, and left gonadal vein inferiorly
- 39. 39 RIGHT RENAL VEIN • The right renal vein is generally 2 to 4 cm in length and enters the right lateral to posterolateral edge of the IVC • Right renal vein enters the IVC at a slightly more caudal level. • The right renal vein typically do not receive any branches
- 40. 40 • Unlike the arterial supply, the venous drainage communicates freely through “Venous Collars” around the infundibula, • Extensive collateral circulation is present in the venous drainage of the kidney. • Surgically, this is important, because unlike the arterial supply, occlusion of a segmental venous branch has little effect on venous outflow
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- 43. 43 BRODEL’SLINE/AVASCULAR PLANE • Slightly behind the convex border at the posterior half of kidney (approximately 2/3 rd way from lateral border ). • Incision in this area will permit to remove stone within renal calices with minimal damage.
- 44. 44 LYMPHATI CS • Largely follow blood vessels through the column of bertin. • Lymphatics empty to LN near renal hilum • L KIDNEY:- -Lt lateral para- aortic LN • R KIDNEY:- -Rt inter aortocaval and Rt lateral para caval LN and anterior and posterior inferior venacaval nodes.
- 47. 47 NERVE SUPPLY • SYMPATHETIC - From T8 to L1 through celiac and aortico renal ganglion - Vasoconstriction • PARA SYMPATHETIC- From vagus - vasodilatation
- 48. 48 THANK YOU