dr. mahmud abuauba
TRANSCRIPT
The Anatomical Aspects
of the Renal System
Dr. Mahmud Abuauba MBChB, DCH, MD, PhD
Consultant Pediatrician & pediatric Nephrologist
Assistant Professor of Pediatrician
Zawia Kidney Center
28th
Apr. 2018
برعاية
الزاوية-ركز علاج أمراض الكلىم
BODY ORGANIZATION
THE RENAL SYSTEM
OR
URINARY SYSTEM
Nephrologists usually say
the RENAL SYSTEM
and
Urologists usually say
the URINARY SYSTEM
THE URINARY SYSTEM
Paired kidneys (2)
Paired ureters (2)
Unpaired urinary bladder (1)
Unpaired urethra (1)
SIX ORGANS
THE URINARY SYSTEM
FUNCTIONS
Mainly to maintain internal body homeostasis through filtration, reabsorption & secretion to form urine
Regulation of body fluid osmolarity
Maintain acid-base balance
Excretion of metabolic waste products (BUN, Cr, UA)
Excretion of toxic substances
Arterial blood pressure regulation
Endocrine function (epo, VitD, Renin)
THE KIDNEY I
Normally, There are two kidneys
1 in 500-1000, has a single kidney
(unilateral renal agenesis)
1/10,000 has no kidneys Potter’s
(bilateral renal agenesis) syndrome
THE KIDNEY II
It is a bean-shaped organ
Reddish to brown in color
Size of a fist
Lies high up on the posterior
abdominal wall
It is a retroperitoneal organ
THE KIDNEY III
On anterior abdominal wall, the
hilum of each kidney lies on the
transpyloric plane about 3 finger
breath from the midline
On the back, the kidneys extend
from T12 to L3 spines, slightly above
the umbilicus
The hilli lie opposite L1 vertebra
T12
L3
The renal angle overlies the lower part of the
kidney, tenderness in this area may indicate
perinephric abscess, infection or hemorrhage
THE KIDNEY III
Two borders
Hilum at medial border
Two poles
Two surfaces
Lies obliquely
THE HILUM
It is vertical slit-like depression
Located on medial concave border
Contains the vascular bundle:
⚫Renal vein, exits (V.A.U.A)
⚫Renal artery, enters
⚫Renal nerves, enter
⚫Renal lymphatics, exit
⚫Renal pelvis, exits
Transpyloric plane
RENAL SINUS
Hilum leads into renal sinus
It is a central cavity within the
kidney
Contains
⚫Renal pelvis
⚫Renal vessels
⚫Renal nerves & lymphatics
⚫Perirenal fat
Surrounded by renal capsule
THE KIDNEY IV
Lies obliquely
⚫Upper pole ~ 2.5 cm
⚫Hilum ~ 5.0 cm
⚫Lower pole ~ 7.5 cm
Lower pole 2.5 cm from iliac rest
Lower in standing position ~2.5cm
Move with respiration ~ 2 cm
Rt is lower than the Lt ~ 1.25 cm
THE KIDNEY V
The left kidney is:
Higher
Larger
Longer
Thinner
Narrower
Nearer to the midline
Than the right kidney
CAN BE PALPABLE
Right kidney
Tall
Thin
Female
Standing
Full inspiration
SUPRARENAL GLANDS
Adrenals, yellow in color
Two (Rt & Lt)
Upper pole of the kidney
Right is pyrimdal in shape
Left is crescent in shape
MEASUREMENTS
Length
In adult
⚫11-12 cm in length
⚫5-6 cm in width
⚫2-3 cm in thickness
In FT newborn 5 cm (4.5 to 6 cm)
with age
MEASUREMENTS
Weight
In adults:
⚫Female 135 g ( 115-155 g)
⚫Male 150 g (125-175 g)
⚫1/240 of body weight
⚫In FT newborn 24 g
⚫1/80 of body weight
with age
2175 g
RENAL COVERING
Renal fibrous capsule
Perirenal or perinephric fat
Renal fascia
Pararenal fat
RENAL CAPSULE
Surface of the kidney is smooth
It is lobulated in fetus
Covered by thin glisting, tight,
rough capsule
Easily removable normally
Adherent in diseased kidney
Covers the surfaces, renal sinus &
vascular bundle
PERINEPHIC FAT
It is perirenal
A mass of adipose CT
Surrounding the renal capsule
Maintain position of the kidneys
Prevent trauma
RENAL FASCIA
Surrounding perinephric fat
It is fibro-aleolar CT
Encloses kidney & adrenal gland
Has two layers
l Anterior
l Posterior
Behind it, paranephric or pararenalbody (fat)
POSITION
The kidneys held in position by:
Perirenal fat
Renal fascia
Pararenal fat
Surrounding neighbour structures
Vascular bundle
RENAL PELVIS
It is the funnel-shaped expanded
upper end of ureter
Formed by 2-3 major calyces
Each major calyx formed by 2-3
minor calyces
Each minor calyx is indented by 1-3
renal papillae, apex of renal pyramid
& acts as a pacemaker
Average capicty < 5 ml
Abdominal
Examination
Methods
Inspection
Palpation:
❖Superficial
❖Deep
❖Bimanual or ballottement
Percussion
Auscultation
Abdomen
Two imaginary
lines separate
abdominal region
into four quadrants
•Palpation for kidneys:
•Should use bimanual palpation, lie patient flat
with abd muscles relaxed, place your left hand
posteriorly in right renal angle & your right hand
over the anterior abdominal wall 5 cm away from
the midline, upper quadrant
•Push both hands towards each other as the patient
breaths out then feel for lower pole moving down as
patient breaths in, if palpable, push kidney
backwards & forwards between both hands
(ballotting), this confirms that it is the kidney
•Palpate for full distended urinary bladder in
suprapubic area
THE URETERS 1
Two ureters (Rt & Lt)
A muscular tube, 25-30 cm lenght
As a continuation of renal pelvis
Ends in posteior wall, base of UB
Has an oblique course, lies on
anterior surface of psoas major
Has three layers, mucosa,
muscularis & adventitia
THE URINARY SYSTEM
THE URETERS 2
The most common sites of ureteral
constrictions that are susceptible to blockage
by renal calculi:
❖Ureteropelvic junction
❖When ureter crosses the pelvic inlet
❖Ureterovesical junction
THE URINARY BLADDER I
A muscular sac-like organ
Temporary store urine at low
pressure
Is an abdominal organ in infancy
Shape, size & position vary
Has a base, neck, body, apex, sup
surface & two inferiolaterally surface
THE URINARY BLADDER II
Internal surface is folded, except
trigone is smooth
❖Trigone is smooth triangular area at
the base of UB
❖Its base is superior & bounded by
two opening of ureters
❖Apex points inferiorly & joins urethra
Has three layers, mucosa,
muscularis & advetitia
Ureterovesical junction
Both ureters enter UB posteriorly at
UVJ through an oblique course for 2
cm then through submucosal tunnel
to open at lateral angle of the trigone
Acts as a valve-like mechanism to
prevent VUR
Histologically I
the mucosa of calyces, renal pelvis,
ureter & UB consists of transitional
epithelium & lamina propria of CT
Underneath is smooth muscle
sheath then adventitia
Muscle fibers of UB run in any
direction but at bladder neck
arranged into 3 layers
Histologically II
Internal longitudinal layer becomes
circular around prostatic urethra in
♂ & to external meatus in ♀ & forms
true involuntary urethral sphincter
Middle layers ends in bladder neck
Outer longitudinal continues to end
of prostate in♂ & external meatus ♀
THE URETHRA
It is a tube for excretion of urineIn female 4-5 cm
In male 15-20 cm
Prostatic, membranous, penile
Has two sphincters:
⚫ Internal urethral sphincter (involuntary)
⚫ External urethral sphincter (voluntary)
around membranous part
⚫In ♀external voluntary sphincter
surrounds mid urethra
Parasympathetic from
vagus nerve of unknown
role, but may cause nausea
& vomiting with renal colic
Sympathetic innervations cause:
•Vasoconstriction of renal
vessels
•Stimulation of renin secretion
•Stimulation of Na & Cl
reabsorption from renal tubules
LYMPHATIC SUPPLY
Has rich lymphatic supply
Follow the blood vessels & join at
hilum to form large lymphatic trunks
Drain into para-aortic lymph nodes
Arranged into superficial & deep
RENAL BLOOD SUPPLY
Both kidneys receive approx. 21%
(20–25%) of cardiac output, at rest
High blood supply ~ 4 ml/g/min of
kidney tissue; why?
High O2 consumption
RENAL ARTERY
Each kidney receives a single
main renal artery (Rt &Lt)
From abd. aorta at Rt angle, at L2
Lt RA is shorter
In about 30%, accessory RA or
abberent RA, lower pole
BRANCHES
Each main RA upon or just arrivalto hilum divides into twodivisions; anterior & posterior
Supplying five vascular segments
Primary branches are segmentalarteries (5)
Pos. division supplies only pos.segment
No anastomoses be segmental As
HeartAbdominl aorta
Renal artery (Lt&Rt) IVC
Segmental arteries Renal veins
Lobar arteries Interlobar veins
Interlobar arteries Arcuate veins
Arcuate arteries Interlobular veins
Interlobular arteries Peritubular capillaries
AGA Glomerulus EGA
THANKS FOR
ATTENTION