Course Code: ANA 221

Course Title: Gross Anatomy II

Developer: Dr. Bassey Monday
Phone: 08063079296
Topic Kidney, Ureter and Suprarenal gland

LEARNING OBJECTIVES

By the end of this week you should be able to;

Describe the gross features of the kidney, ureter and suprarenal gland

Describe the nerve supply, blood supply and lymphatic drainage

Kidneys
The two kidneys function to excrete most of the waste products of metabolism. They play a
major role in controlling the water and electrolyte balance within the body and in maintaining
the acid–base balance of the blood. The waste products leave the kidneys as urine, which passes
down the ureters to the urinary bladder, located within the pelvis. The urine leaves
the body in the urethra.
Location and Description
The kidneys are reddish brown and lie behind the peritoneum high up on the posterior abdominal
wall on either side of the vertebral column; they are largely under cover of the costal margin.
The right kidney lies slightly lower than the left kidney because of the large size of the right lobe
of the liver. With contraction of the diaphragm during respiration, both kidneys move downward
in a vertical direction by as much as 1 in. (2.5 cm).

The hilum is a vertical slit in the medial concave border of each kidney that is bounded by thick
lips of renal substance. The hilum extends into a large cavity called the renal sinus. The hilum
transmits, from the front backward, the renal vein, two branches of the renal artery, the ureter,
and the third branch of the renal artery (VAUA). Lymph vessels and sympathetic fibers also
pass through the hilum.
Coverings
The kidneys have the following coverings:
Fibrous capsule: This surrounds the kidney and is closely applied to its outer surface.
Perirenal fat: This covers the fibrous capsule.
Renal fascia: This is a condensation of connective tissue that lies outside the perirenal fat and
encloses the kidneys and suprarenal glands; it is continuous laterally with the transversalis
fascia.
Pararenal fat: This lies external to the renal fascia and is often in large quantity. It forms part
of the retroperitoneal fat.
The perirenal fat, renal fascia, and pararenal fat support the kidneys and hold
them in position on the posterior abdominal wall.
Renal Structure
Each kidney has a dark brown outer cortex and a light brown inner medulla. The medulla is
composed of about a dozen renal pyramids, each having its base oriented toward the cortex
and its apex, the renal papilla, projecting medially. The cortex extends into the medulla between
adjacent pyramids as the renal columns. Extending from the bases of the renal pyramids into
the cortex are striations known as medullary rays. The renal sinus, which is the space within
the hilum, contains the upper expanded end of the ureter, the renal pelvis. This divides into two
or three major calyces, each of which divides into two or three minor calyces. The apex of the
renal pyramid, the renal papilla, indents each minor calyx.

Important Relations, Right Kidney

Note that many related structures are directly in contact with the kidneys, whereas visceral layers
of peritoneum separate others.
Anteriorly: The suprarenal gland, the liver, the second part of the duodenum, and the right colic
flexure.
Posteriorly: The diaphragm, the costodiaphragmatic recess of the pleura, the 12th rib, and the
psoas, quadratus lumborum, and transversus abdominis muscles. The subcostal (T12),
iliohypogastric, and ilioinguinal nerves (L1) run downward and laterally.

Important Relations, Left Kidney

Anteriorly: The suprarenal gland, the spleen, the stomach, the pancreas, the left colic flexure,
and coils of the jejunum.
Posteriorly: The diaphragm, the costodiaphragmatic recess of the pleura, the 11th (the left
kidney is higher) and 12th ribs, and the psoas, quadratus lumborum, and transversus abdominis
muscles. The subcostal (T12), iliohypogastric, and ilioinguinal nerves (L1) run downward and
Laterally

Blood Supply
The renal artery arises from the aorta at the level of the second lumbar vertebra. Each renal
artery usually divides into five segmental arteries that enter the hilum of the kidney. They are
distributed to different segments or areas of the kidney. Lobar arteries arise from each
segmental artery, one for each renal pyramid. Before entering the renal substance, each lobar
artery gives off two or three interlobar arteries. The interlobar arteries run toward the cortex
on each side of the renal pyramid. At the junction of the cortex and the medulla, the interlobar
arteries give off the arcuate arteries, which arch over the bases of the pyramids. The arcuate
arteries give off several interlobular arteries that ascend in the cortex. The afferent
glomerular arterioles arise as branches of the interlobular arteries.

The renal vein emerges from the hilum in front of the renal artery and
drains into the inferior vena cava.
Lymph Drainage
Lymph drains to the lateral aortic lymph nodes around the origin of the renal artery.

Nerve Supply
The nerve supply is the renal sympathetic plexus. The afferent fibers that travel through the renal
plexus enter the spinal cord in the 10th, 11th, and 12th thoracic nerves.

URETER

The ureters are a pair of thick walled narrow muscular tubes that drain urine from the kidney to the
urinary bladder by peristaltic contractions of the smooth muscle in their wall. It is about 25cm long and
3mm wide. The ureter is divided into three parts – pelvis part, abdominal part and pelvic part.

Pelvis part: This is the funnel-shaped dilatation at the superior end of the ureter which is formed within
the renal sinus by the joining of the major calyx. It leaves the kidney by passing through the hilum
posterior to the renal vessels and descends downwards as the abdominal part. The point at which the
renal pelvis narrows to form the ureter is known as the ureteropelvic junction.

Abdominal part: The abdominal part extends from the lower end of the kidney to the bifurcation of
the common iliac vessels or pelvic brim. It passes downwards and slightly
medially deep to the peritoneum of the posterior abdominal wall on the anterior surface of the psoas
major muscle.

Pelvic part: This part extends from the bifurcation of the common iliac vessels to the base of the urinary
bladder. It enters the pelvic cavity by passing in front of the bifurcation of the common iliac artery; it
runs downwards, backwards and laterally along the anterior margin of the greater sciatic notch to the
level of the ischial spine. From the level of the ischial spine, it turns anteromedially to reach the
superolateral angle of the base of the urinary bladder, where it pierces the wall of the urinary bladder in
an oblique manner. This creates a one way valve where high intramural pressure collapses the ureters
thereby preventing backflow of urine.

Blood supply: The ureter is supplied by branches of the following arteries – renal, gonadal, abdominal,
common iliac, auperior and inferior vesical, middle rectal and uterine. Venous drainage: Drained by
corresponding veins

Lymphatic drainage: lymphatics from the abdominal part drains into the para-aortic lymph nodes
while the pelvic part drains into the common iliac and internal iliac lymph nodes.

Nerve supply: Sympathetic fibres are from T10 – L1 spinal segments which reach the ureter through
the coeliac and hypogastric plexuses. Parasympathetic fibres are from S2 – S4 spinal segments through
the splanchnic nerves.

Clinical correlation

Ureteric calculus: This is also known as kidney stone. It is the presence of solid stone in the urinary
tract which are formed from minerals in the urine. these stones mostly get lodged at the sites of ureteric
constriction. These stones obstruct urinary flow resulting to renal colic (pain in the groin) or haematuria
(blood in the urine).

Injury to the ureter: The ureter may get inured if care is not taken during surgery as they travel close
to other structures in the pelvis. The structures must be identified during pelvic surgery to ensure that
they are not damaged.
Fig. showing congenital anomalies of the ureter

SUPRARENAL GLAND

Suprarenal gland or adrenal glands are endocrine glands that produce a variety of hormones such as
adrenaline, aldosterone and cortisols.

Location: They are located on both sides on the superomedial part of the kidney in the posterior
abdominal wall.

Morphology: they are retroperitoneal in which the peritoneum covers the anterior surface only. They
are yellowish in colour and are enclosed by the renal fascia which attaches the gland to the crura of the
diaphragm. The right suprarenal gland is pyramidal in shape while the left is crescent-shaped. Each
suprarenal gland has two parts – outer cortex and inner medulla.

Cortex

The cortex is derived from the mesoderm and secretes corticosteroids and androgen which cause the
kidneys to retain sodium and water in response to stress, increasing the blood volume and blood
pressure. The cortex consists of three layers or zones from superior to deep - the zona glomerulosa, the
zona fasciculata and the zona reticularis. Zona glomerulosa secretes mineralocorticoids (e.g.
aldosterone), zona fasciculata secretes corticosteroids (e.g. cortisol) while zona reticularis secretes
androgen (e.g. dehydroepiandrosterone).

Medulla

The medulla lies centrally in the gland and has large chromaffin cells secreting cathecholamines such
as adrenaline (80%) and noradrenaline (20%) which is responsible for the flight, fright and fight
response.

Relations

Right suprarenal gland

Anteriorly – inferior vena cava, right lobe of the liver

Posteriorly – right crus of the diaphragm

Left suprarenal gland

Anteriorly – pancreas, spleen and stomach

Posteriorly – left crus of the diaphragm

Blood supply: Blood supply to the gland arises from three sources – Superior suprarenal artery which
is a branch of inferior phrenic artery; middle suprarenal artery which is a branch of abdominal aorta and
inferior suprarenal artery, a branch of renal artery.
Venous drainage: Drained by the suprarenal veins. The right drains into the IVC while the left drains
into the inferior phrenic vein which in turn drains into the left renal vein.

Lymphatic drainage: Lymphatics from the gland drain into the lumbar group of lymph nodes (para-
aortic lymph nodes). Efferent lymphatics then drain into the cisterna chyli through the lumbar lymphatic
trunks.

Nerve supply: Supplied by the coeliac plexus and greater splanchnic nerves

Fig. showing the kidneys and suprarenal glands