1. Anatomy of kidney and ureterBy
Dr. Muslim Kandel
2015

2. 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)

3. Relationship of the Kidneys to Vertebra and Ribs

4. 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

5. 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

6. 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.

8. Coronal Section, Right Kidney

9. Relations of kidney
Anterior Posterior

10. Position of the KidneysA

11. 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

12. Fascial Coverings: Retrorenal Layer

13. 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)

15. 1- Renal Aplesia &Hypoplasia
Congenital anomalies …
1- Renal Aplesia &Hypoplasia

16. 2-Ectopic Kidney A- Pelvic Kidney

17. 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

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

20. 4-Abnormal Kidney Structures
Horseshoe Kidney
Pancake Kidney
5-cystic disease
A- polycystic kidney
B-solitery cyst
Malrotated Kidneys
Aberrent renal vessels

21. ureters
Its thick wall retroperitoneal muscular tube 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

22. 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. .

23. 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

24. intramural part

25. 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

26. After ESWL accumilation of fragment of stones

27. 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