Anatomy of kidney and ureter By Dr. Muslim Kandel 2015

Kidney The kidneys are bean-shaped solid organs , are located in the abdominal cavity, one on each side of the spine, and lie in a retroperitoneal position at a slightly oblique angle. size 12 cm long 6 cm width &3 cm thick position The right kidney being slightly lower and smaller than the left, because of the position of the liver, The left kidney is at the level T12 to L3 and the right is slightly lower. Features 2 ends upper and lower 2 borders –medial (concave ) & lateral (convex) 2 surfaces –ant.(irregular) & post (flat)

Relationship of the Kidneys to Vertebra and Ribs

Hilum of kidney Its lead to a wide space inside the kidney called renal sinus Its give passage of following (from ant to post.)VAP 1- renal vein 2-renal art. 3-pelvis of ureter

Structure of Kidney The kidney is divided into two major structures: 1- the outer renal cortex 2-the inner renal medulla. These structures take the shape of 8 to 18 cone-shaped renal lobes, each containing renal cortex surrounding a portion of medulla called a renal pyramid. Between the renal pyramids are projections of cortex called renal columns

Nephron Is the basic structural and functional unit of the kidney . normal kidney contains 800,000 to 1.5 million nephrons. function :- to regulate the concentration of water and electrolyte by filtering the blood, reabsorbing and what is needed then excreting the rest as urine. Composition glomerulus(in the cortex.) tubule (pyramids)medullary ray is a collection of tubules that drain into a single collecting ductThe tip, or papilla, of each pyramid minor calyx; major calyces pelvis. the ureter.

Coronal Section, Right Kidney

Relations of kidney Anterior Posterior

Position of the Kidneys A

Capsules of kidney 3F fibrous capsule (inner true cap)extend to Renal. sinus, Not adherant fatty capsule (peri renal fat) , surround kid& adrinal gl * rapid depletion of this layer-ptosis of kidney fascial capsule (Zuker Candle f) from F. transversalis its divided into 2 layers: ant. infront of kid. Fuse with CT of aorta & IVC postbehind kid. Fuse with vertebral column both layers fuse superiorly above suprarenal glang but inferiorly remain seperated

Fascial Coverings: Retrorenal Layer

Arterial supply of kidney 1- Renal art. aorta (L2) Lt a shorter , behind renal v Rt longer ,behind renal v & IVC Each art. Divided into 5 br(5 segments){apical, upper, middel, lower, and post) 2- Accessory renal art. --(30% ) aorta Venous drainage Renal vein  IVC Rt shorter, Lt longer and pass infront aorta Lymphatics Paraaortic LN Nerve supply— symp renal plexus  Caeliac plexus(T10-L1)

1- Renal Aplesia &Hypoplasia Congenital anomalies … 1- Renal Aplesia &Hypoplasia

2-Ectopic Kidney A- Pelvic Kidney

a. Most common fusion anomaly b-Horseshoe Kidney a. Most common fusion anomaly b. Usually fused at inferior pole c. The isthmus may simulate a retroperitoneal mass d. May be confused with para-aortic lymph nodes e. Look for malrotated pelvis C-unilatral S-fusion the upper pole of one kidney fused with the lower pole other kidney form S- shape deformity

Duplex kidney, Duplex renal pelvis, Duplex kidney &ureter 3-Duplication Duplex kidney, Duplex renal pelvis, Duplex kidney &ureter

4-Abnormal Kidney Structures Horseshoe Kidney Pancake Kidney 5-cystic disease A- polycystic kidney B-solitery cyst Malrotated Kidneys Aberrent renal vessels

ureters Its thick wall retroperitoneal muscular tube 25-30 cm long 6 mm width , Start infront of transverse process of L1(renal pelvis), End postero-superior angle of urinary bladder Its course divided into 3 parts 1-Abdominal part 2-Pelvic part3-Intramural part 1-Abdominal part (Ant . course different between Rt. & Lt ) Lt Rt 1-3 aa(gonadal a, upper Lt colic,lower Lt colic) 2-Segmoid mesocolon & sigmoid colon 1- 3 aa(gonadal a, upper Rt colic, iliocolic) 2- 3rd part of doudenum 3-Mesentry root+sup mesenteric A&V

Post. course of abd. part ureters arise from the pelvis of each kidney, and descend on top of the psoas major muscle, genitofemoral N , tips transvers process of L2,3,4,5 to reach the brim of the pelvis. Here, they cross in front of the common iliac arteries. .

2-Pelvic part 3- intramural part : pass down along the sides of the pelvis, and finally curve forwards and enter the bladder postero-sup. angle In females, the ureters pass through the mesometrium and under the uterine arteries on the way to the urinary bladder. "water (ureters) under the bridge (uterine arteries or vas deferens in male) Therfore the ureter s may be injured during hysterectomy(remove uterus) 3- intramural part : At the entrance to the bladder, run very oblique course through its wall for 2cm before opening, which prevent the backflow of urine

intramural part

Constrictors of the ureter 1-at the ureteric junction of renal pelvis; 2-as the ureter passes over the iliac vessels; 3- opposite ischial spine 4-where the ureter enters into the urinary bladder (vesicoureteric junction) A kidney stone can move from the kidney and become lodged inside the ureter usually at this contractures which can block the flow of urine

After ESWL accumilation of fragment of stones

Blood supply Nerve supply The ureters receive a segmental arterial supply, which varies along its course 1-aorta 2-renal a 3-testicular a 4-inf. Vescical a 5-common iliac a Nerve supply Sympathetic T11L1 Parasympathetic 2nd ,3rd 74th sacral