KIDNEY

Anatomical
location
Size
Shape

Upper posterior part of abdominal cavity, on each side

* right kidney is lower than the left kidney about 1-2 inches
(presence of liver in the right side pushing right kidney lower down)
12 cm length x 6cm width x 3 cm thick (about the size of a clenched fist)
- bean-shaped
2 borders
- outer/lateral convex
- inner/medial with 3 convexities (upper & lower are more
convex)
* depression at the middle of inner border hilum
Structures present at the hilum
-renal Vein (most anterior )
-renal Artery (in the middle)
- renal Pelvis (most posterior)
2 poles
2 surfaces

Vertebral level
of the kidneys

- upper
- anterior

supine
position

erect position
full aspiration
Surface
anatomy of the
kidney

-lower
-posterior

URINARY BLADDER = hollow muscular organ acting as a reservoir for urine

infants & children up to 3 years
it is an abdominal organ (due to small pelvis)
children above 3 years up to adult age
the bladder starts to enter the pelvic cavity
adults
it is a pelvic organ
In infant: Fusiform shape

In adults:
(1) Distended bladder: it is spherical or ovoid in shape.
(2)Empty bladder: it has a shape of tri-sided pyramid.
4 surfaces
superior, two inferolateral, posterior (base
4 angles
anterior (apex), inferior (neck) and two posterosuperior
3 attached tubular structures two ureters, urethra
1 ligament
median umbilical ligament
*each surface is triangle in shape

- extend from T12 to L3

- hilum lies at L1
- upper pole
(left side) : reaches the lower border of 11th rib
(right side) : reaches upper border of the 12 rib
descend about 1 inch (2.5cm)
descend about 2-3 inches (5-8cm)

On the front of the abdomen

upper
5 cm from
midway between
pole
middle line
plane of the lower end of body of the
sternum + transpyloric plane
hilum
5 cm from
on the transpyloric plane
middle line
lower
7.5 cm from
midway between
pole
middle line
transpyloric plane + intertubercular planes
On the back of the abdomen
The rectangle of Morris is used:
2 vertical lines
2.5 cm and 9 cm from the midline respectively
2 horizontal lines drawn at spinous process of T11 and L3 respectively
The hilum is 5 cm from the middle line at the level of the spinous process of
the first lumbar vertebra (L1)

within the pelvic cavity, urinary bladder is situated in the following position;
1. apex, facing anteriorly, related to the upper border of symphysis pubis
2. base, facing posteriorly

Anterior
relation

(see diagram above)

above hilum
opposite
hilum
below hilum

Right
suprarenal, liver
second part of
doudenum
small intestine and
large intestine

Left
suprarenal, stomach
and spleen
splenic artery on top of
pancreas
small intestine and
large intestine

Posterior
relation

Superior surface
- covered by peritoneum and related to superior vesical artery and coils of ileum
- other relations differ between males and females
males
females
- rectovesical pouch of peritoneum
- uterovesical pouch of peritoneum,
- pelvic colon
- anterior wall of fundus and body of uterus.
Inferolateral surface
anteriorly
- pubic bone
- retropubic space [fat + ligament;
pubovesical (female) or puboprostatic (male)]
Posterior surface (base of bladder)
males
- rectum
- 2 ampulla of vas deferens
- 2 seminal vesicles
- Rectovesical pouches of peritoneum
(to the uppermost part of the base)

4 muscles
1. Diaphragm.
2. Psoas major.
3. Quadratus lumborum.
4. Transversus abdominis

4 structures
1. Subcostal vessels.
2. Subcostal nerve.
3. Iliohypogastric nerve.
4. Ilioinguinal nerve.

posteriorly
- obturator internus muscle
- obturator vessels and nerve
- levator ani muscle

females
- vagina
- anterior vaginal fornix
- cervix

Peritoneal
covering

The kidney is a retroperitoneal structure.

Angles of Urinary Bladder

anterior (apex)

inferior (neck)

2 posterosuperior

Bare areas of the kidneys

= (areas not covered by the peritoneum) are the white areas in diagram.
areas related to
are covered by
-liver
peritoneum of the greater sac
-small intestine on both sides
-stomach
on left side
peritoneum of the lesser sac
-spleen
Renal Capsule

Fibrous (true)
Fatty (perinephric fat)
Fascial (Renal fascia)

intimately adherent to the kidney tissue

fat surrounding the fibrous capsule
- It is a condensation of the areolar tissue
between the peritoneum and the posterior
abdominal wall
-surrounds the perinephric fat

attached to the median umbilical ligament (obliterated urachus which is a

tubular structure present during development of the bladder and become
fibrosed in adult age)
* other end of median umbilical ligament is attached to umbilicus
- lies 1 inch behind the lower border of symphysis pubis
- urethra gets exit from this point.
- surrounded by the base of the prostate in males and pelvic fascia in
females
ureters enter the baldder at these angles

Ligaments attached to bladder

to apex
median umbilical ligament
to neck
ligament
anterior attachment
posterior attachment
pubovesical
posterior surface of
- neck of bladder
(female)
body of pubic bone,
- upper urethra
near the midline
puboprostatic
- neck of bladder
(male)
- base of prostate
tp posterosuperior angle
lateral ligament of the urinary bladder
* is a dense pelvic fascia, extending from lateral pelvic wall to the
two posterosuperior angles
Fascia surrounding the bladder
vesical fascia
- loose areolar CT surrounding the bladder
- allow bladder distension
- a part of pelvic fascia

Attachments of renal fascia

Peritoneal relation of bladder
superiorly
inferiorly
medially
laterally

blends with subdiaphragmatic fascia

anterior and posterior layers joins together to close the space
blends with the fascia over the renal vessels
blends with fascia transversalis

Clinical importance of renal fascia:

1) Sudden loss of weight may cause
descent (ptosis) of the kidney.
2) Pus spread does not occur downward
due to obliteration of the space inferiorly.

1. In empty bladder :
- peritoneum covers the superior surface
- in males it covers additionally the upper 1/2 inch of the base of the bladder
2. in full bladder :
* urinary bladder ascends upwards towards abdominal cavity, peeling off the peritoneum from
anterior abdominal wall and the side wall of pelvis
uribary bladder will be in direct relation to anterior abdominal wall

Arterial supply

renal artery (from abdominal aorta at the level of L2)

Venous drainage

renal vein drains to the IVC

Lymph drainage
Nerve supply

para-aortic lymph nodes at L2 (origin of the renal artery)

Sympathetic
plexus surrounding renal artey from T12 and L1
Parasympathetic
from vagus nerve and reach the kidney
*renal pain is referred to the dermatomes of the T12 and L1 segments
(lumbar region and radiating to the anterior abdominal wall and external
genitalia)

Kidney
segmentation

- segmentation of the kidney according to its blood supply.

- 5 segments:
apical, anterior superior, anterior inferior, posterior and inferior segments

1. superior vesical the superior surface.

2. inferior vesical (in males) or vaginal (in females), the base and trigone.
3. middle rectal (in males)
4. obturator
5. inferior gluteal
vesical venous plexus (surrounding the bladder) drains to the vesicoprostatic venous plexus
(surrounding the vesicoprostatic groove) drain to the internal iliac vein
lymphatic vessels travel with BVs internal iliac lymph nodes para-aortic lymph nodes
1. motor supply:
Sympathetic
preganglionic nerve cells lie in the L1,2 spinal cord segments
Parasympathetic from S2,3,4 nerves and reach the ureter through pelvic splanchnic nerves
2. sensory supply: urinary bladder pain is carried by afferent pain nerve fibers, which ascends with
the sympathetic system
* referred pain is felt in the dermatome of L1,2
(pubic region, groin, anterior external genital area and anterior thigh)
The Interior of bladder
In empty bladder, the mucosa is thick and has folds (rugae)
In full bladder, it is thin and smooth
Trigone:
- a triangular area, can be seen in the mucosa of the posterior wall of the bladder, between
three openings; 2 ureters and internal urethral meatus
- has smooth surface even in empty bladder, due to its embryonic origin (mesoderm not
endoderm like other mucosa)
- more vascular, sensitive and elastic than other mucosa
- contains special smooth muscle called superficial trigonal muscle that:
may help in closure of ureteric orifice during bladder contraction
extends to the proximal part of urethra in both sexes
Factors preventing urine reflux to the ureter during bladder contraction:
- Very oblique course of the intramural part of the ureter.
- Valve like flap of mucosa at ureteric orifice.
Interureteric bar:
- it is raised transverse ridge between the two ureteric orifices
Uvula vesicae:
- it is a small rounded elevation that lies immediately behind internal urethral opening
- caused by protrusion of underlying middle lobe of the prostate