Anatomy of The

Kidney
 Location & Position of the kidneys
• The kidneys are retroperitoneal
paired organs
• Each kidney lies lateral to the
vertebral column, on the posterior
abdominal wall largely under cover
of the costal margin
• In the supine position, the kidneys
extend from approximately T12
vertebra superiorly to L3 vertebra
inferiorly
• 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)
Color, Shape & Dimensions of the kidneys
• The Kidneys are reddish brown bean-
shaped organs with the dimensions of
12 x 6 x 3cm
• Although they are similar in size and
shape, the left kidney is a longer and
more slender organ than the right
kidney, and nearer to the midline.
• Each kidneys has:
 Convex upper & lower ends
 A convex lateral border
 A medial border that has a vertical
slit called the hilum
• Internally the hilum extends into a
large cavity called the renal sinus.
 Renal Hilum & Renal sinus
• The hilum transmits, from
the front backward, the
renal vein, renal artery &
the ureter (VAU)
• Lymph vessels and
sympathetic fibers also
pass through the hilum.
• The renal sinus contains
the upper expanded part
of the ureter called the
Renal pelvis
• Perirenal fat continues into
the hilum and sinus and
surrounds all structures.
 Coverings
1. Fibrous capsule: Surrounds the
kidney and is closely applied to the
outer surface.
2. Perirenal fat: Covers the fibrous
capsule
3. Renal (Perirenal) fascia:
Condensation of connective tissue
that lies outside the perirenal fat
and encloses the kidney and the
suprarenal gland
4. Pararenal fat: Lies external to the
renal fascia, is part of the
retroperitoneal fat
Structures 2,3 & 4 support the
kidneys and hold them in position
on the posterior abdominal wall.
 Relations
The anterior surface of
the both kidneys are
related to numerous
structures, that are
different on both sides.
some of these structures
have an intervening layer
of peritoneum and some
lie directly against the
surface of the kidney.
kidney

The posterior surface of the right and left kidneys are

related to similar structures.
 Relations: Anterior
Left kidney
• a small part of the superior pole, on
its medial side, is covered by the left
suprarenal gland
• the rest of the superior pole is
covered by the stomach and spleen
• moving inferiorly, the
retroperitoneal pancreas covers the
middle part of the kidney;
• on its lateral side, the lower half of
the kidney is covered by the left
colic flexure and the beginning of
the descending colon, and, Note that peritoneum intervenes
between the kidney and the
• on its medial side, by the parts of
stomach, spleen and small intestine.
the small intestine.
 Relations: Anterior
Right kidney
• a small part of the superior pole is
covered by the right suprarenal
gland
• moving inferiorly, a large part of the
rest of the upper part of the
anterior surface is against the liver
• medially, the descending part of
the duodenum is retroperitoneal
and contacts the kidney;
• the inferior pole of the kidney, on
its lateral side, is directly associated
with the right colic flexure and, on Note that peritoneum intervenes
its medial side, is covered by a between the kidney and the liver
segment of the small intestine. and small intestine
 Relations: Posterior
• As the left kidney lies at higher
level than the right, it is related
to 11th & 12th ribs and the last
intercostal space.The right
kidney is related to 12th rib and
the last intercostal space.
• The diaphragm & the
costodiaphragmatic recess
intervene between the thoracic
wall & the kidney
• Psoas, quadratus lumborum,
transversus abdominis muscles
(from medial to lateral)
• Subcostal (T12), ilio-hypogastric
& ilio-inguinal nerves
 Vertebrocostal & Renal Angles
• Renal angle: The angle
between the last rib and the
lateral border of erector
spinae muscle, is occupied E
by kidney r
e
• Vertebrocostal angle: The c
t

angle between the last rib o

r

and the lateral border of s

vertebral column , is p
i

occupied by lower part of Vertebrocostal

angle
n
a
Renal angle

the pleural sac. e

 Internal structure
• Each kidney consists of an outer
renal cortex and an inner renal
medulla.
• The renal cortex is a continuous
band of pale tissue that
completely surrounds the renal
medulla.
• Extensions of the renal cortex,
the renal columns project into
the inner aspect of the kidney,
dividing the renal medulla into
discontinuous aggregations of
triangular-shaped tissue, the
renal pyramids.
• The bases of the renal
pyramids are directed
outward, toward the renal Base Apex
cortex, while the apex (called
the Renal papilla) of each renal
pyramid projects inward,
toward the renal sinus.
• The renal papilla is surrounded
by a cup shaped minor calyx
• In the renal sinus, several
minor calices unite to form a
major calyx, and two or three
major calices unite to form the
renal pelvis, which is the
funnel-shaped superior end of
the ureters.
 Arterial Supply
• The renal artery arises from the
Lobar
aorta at the level of the second arteries Interlobar
arteries
lumbar vertebra.
• Each renal artery divides into 5
segmental arteries that enter the
hilum of the kidney, 4 in front of
and one behind the renal pelvis.
They are distributed to the
different segments of the kidney.
Segmental
• Each segmental artery gives rise to arteries
number of lobar arteries, each
supplies a renal pyramid.
• Before entering the renal
substance, each lobar artery gives
off two or three interlobar arteries
• The interlobar arteries run Interlobar Arcuate
arteries
arteries
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 and
give off the afferent
glomerular arterioles.
arterioles Interlobular
arteries
Segmental branches &
vascular segments of 1
3
kidneys 5
4
• Each kidney has 5 2
segmental branches and
thus is divided into 5
vascular segments
named as:
1. Apical 1
2. Caudal 3
5
3. Anterior Superior 4
4. Anterior Inferior
2
5. Posterior
Blood Supply

Glomerulus
 Venous Drainage
Both renal veins drain to the inferior vena cava. The left renal vein enters the
inferior vena cava a little above the right vein.

The left renal vein:

• Is three times longer than the right (7.5 cm and
2.5 cm). So, for this reason the left kidney is the
preferred side for live donor nephrectomy.
• Course: Runs from its origin in the renal hilum:
• Posterior to the splenic vein and the body
of pancreas, and
• Then across the anterior aspect of the
aorta, just below the origin of the superior
mesenteric artery.
• Tributaries:
• Left gonadal vein enters it from below The right renal vein:
• Left suprarenal vein, usually receiving one • Lies behind the 2nd part of
of the left inferior phrenic veins, enters it the duodenum and
sometimes the lateral part of
above
the head of the pancreas
 Lymphatic Drainage & Nerve Supply
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 T10-12
nerves.

Lymphatic Drainage
The lymph vessels follow
the arteries. Lymph drains
to the lateral aortic
lymph nodes around the
origin of the renal artery.