Gross anatomy of the kidney and the ureter Ákos Lukást MD., Ph.D (lukats.akos@med.semmelweis-univ.hu)

Parts of the urinary system Two kidneys (production of urine) Two ureters (transport of urine) Urinary bladder (storage, urination) Urethra

Main functions of the kidneys Filtration of the blood and excretion of waste metabolic products, toxic materials, drugs etc. Regulation of water-, electrolyte- and acid-base balance Regulation of blood pressure (volume / electrolyte control and renin production) Endocrine functions: erythropoietin, renin production

Positioning Beam shaped Size cca. 11 cm x 6 cm x 3 cm (thickness) Retroperitoneal Hilus points medially and slightly anteriorly Th11 L3

Projection of kidney

„VAU”!! Right Left

Hilus of kidney: VAU glandula suprarenalis a. renalis pelvis renalis v. renalis glandula suprarenalis a. renalis pelvis renalis ureter papilla

Crossing of arteries and veins near the kidney Left renal vein anterior to aorta Rigth renal artery behind IVC

Longitudinal section Renal hilum – renal sinus: - v. renalis – anterior - a. renalis – intermed. - pelvis renalis – posterior adipose tissue, lymph vessels, nerves

Longitudinal section Lobes, with cortex and medulla (pyramid, tip: papilla, medullary rays in cortex) Cortex of adjacent lobes – renal columns (Bertini)

Calyces, renal pelvis infundibula Collecting ducts open to minor calyces at the papilla (cribriform plate) Adjacent minor calyces conflue to major calyces Upper and lower infundibulum pelvis renalis ureter

Renal artery and branches

Capsules of the kidney Fibrous capsule (dense irregular CT on the surface of the kidneys) Adipose capsule – perirenal fat, containing ureter, vessels, suprarenal (adrenal) gland, extends into renal sinus Renal fascia (open inferiorly!!!)

Renal fascia - anterior and posterior lamina - continuous with each other posteriorly, anteriorly and superiorly - open inferiorly (ureter) Descend of the kidney is only prevented by the perirenal fat (anorexia nervosa!, cahexia!) Descend of the kidneys may obstruct ureter or renal vessels

Kidneys, suprarenal glands, ureter in situ 3 arteries of adrenal gland: A. suprarenalis sup. (a. phrenica inf.) A. suprarenalis media (aorta) A. suprarenalis inf. (a. renalis)

Contacts of the anterior surface of kidney

Contacts of the posterior surface of kidney DIAPHRAGMA M. transv. abd. tendon

Ureter Location: posterior body wall Retroperitoneal Hilus to urinary bladder ~25 cm long 3 crossings -behind gonadal arteries -anterior to iliac arteries (near bifurcation) - behind/under uterine artery, above vaginal a. - behind deferent ducts in males

Ureter Three constrictions : - exit from renal pelvis - crossing with iliac vessels - entery to bladder Predilection sites for ureter stones to obstruct

Variations of blood supply Renal vein encircling aorta Accessory renal a.

Ureter stone

Irodalom Szentagothai J, Réthelyi M: Funkcionális anatómia, Medicina, 1989 Sobota - Atlas of Human Anatomy, 20th edition, Urban and Schwarzenberger, 1993 Netter - Atlas of Human Anatomy, Medi Media INC, New York, 1989 http://rad.usuhs.mil/medpix/index.html