Kidneys and Adrenal Glands Department of Regional Anatomy and Operative Surgery

Position, relation Structure Blood supply Lymphatic drainage Innervations

Position Retroperitoneal Upper poles T12 vertebra Lower poles L3 vertebra Right is lower than left

Cadaveric kidneys

Surface Projection of kidney

Renal Angle Tenderness or percussing pain caused by kidney disease is localized here

Neighbor of Kidney

Anterior Surface of the kidney

Posterior Surface

Costodiaphragmatic recess of the pleural cavity

Renal hilum, Renal sinus and Renal pedicle cortex Renal pyramid Renal column Renal sinus calyx Renal hilum papilla Renal pedicle

From anterior to posterior renal vein renal artery renal pelvis From above downwards the renal artery

Hydronephrosis

renal artery T11

Renal artery

Vascular renal segment Superior (apical) Anterior superior (upper) posterior Anterior inferior (middle) Inferior (lower)

variation of renal artery !

Variation of Renal Artery

Renal 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 Capsule Renal fascia Adipose capsule Fibrous capsule

Renal fascia

Fibrous capsule Adipose capsule Perirenal fat Pararenal fat

Fibrous Capsule

Ureter

Ureter is divided into 3 parts: ①abdominal part ②pelvis part ③intramural part

28 to 34 cm 3 narrowing sites the pelviureteric junction crossing the pelvic brim traversing the bladder wall

Horseshoe kidney

Suprarenal Gland

Endocrine gland T11 level Right is triangular Left is semi-lunar

tail of pancreas & spleen vessel Relation Left right anterior superior stomach liver inferior tail of pancreas & spleen vessel posterior diaphragm medial abdominal aorta Inferior vena cava

Artery of Adrenal Gland

Veins of adrenal gland Left suprarenal vein, into the left renal vein Right suprarenal vein, into the inferior vena cava

Anterior transperitoneal approach incision Posterior retroperitoneal approach Anterior transperitoneal approach

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

Question What causes the pain when a ureteral calculus is present? Why is the pain felt in such an extensive area? Where does one look for the course of the ureter in a radiograph? Where along the ureter is a calculus likely to be held up?

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

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

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

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

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

operation procedure of kidney transplant

nephrectomy For a nephrectomy, the kidney commonly is exposed in the loin. After an oblique incision midway between the twelfth rib and the iliac crest, the posterior free border of the external oblique is identified, and divided to reveal the peritoneum, which is pushed forward to reveal the renal fascia. The subcostal nerve and vessels are preserved; the renal fascia is opened; and the kidney exposed. Care must be taken not to damage the pleura, since it is separated from the upper pole of the kidney only by the diaphragm. Posterior surgical approach Since the kidneys lie in part above the twelfth rib, a direct posterior approach might pass first into the thorax, perforating the pleural cavity. A posterior approach to the kidney also puts at risk the subcostal and iliohypogastric nerves which pass laterally behind the kidney.