THE 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 supine position - upper - anterior -lower -posterior

Peritoneal covering

The kidney is a retroperitoneal structure.

erect position full aspiration Surface anatomy of the kidney

- 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)

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 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

Arterial supply
Venous drainage

Kidney segmentation

renal artery (from abdominal aorta at the level of L2) renal vein drains to the IVC - segmentation of the kidney according to its blood supply. - 5 segments: apical, anterior superior, anterior inferior, posterior and inferior segments

4 muscles 1. Diaphragm. 2. Psoas major. 3. Quadratus lumborum. 4. Transversus abdominis Renal Capsule Fibrous (true) Fatty (perinephric fat) Fascial (Renal fascia)

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

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

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)

Attachments of renal fascia 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.