1. Kidney and ureter anatomy

Question 1

How are the kidneys located in relation to peritoneum?

Answer 1

retroperitoneally

Question 2

which vertebral levels are kidneys located?

Answer 2

L kidney: T12-L2 R kidney: slightly lower as displaced by liver

Question 3

which structure lies superior to kidneys?

Answer 3

adrenal (suprarenal) glands

Question 4

what are the 3 layers covering the kidney?

Answer 4

1. renal capsule (fibrous)
2. perirenal fat
3. renal fascia (also encloses adrenal glands)

+ pararenal fat

Question 5

label this diagram

Answer 5

Question 6

which vessels provide arterial supply and venous drainage of the kidneys and where do these vessels arise/drain?

Answer 6

• renal arteries - arise from abdominal aorta immediately distal to origin of SMA
• renal veins - drain into IVC

Question 7

name the structures entering kidney at kidney hilum and their order

Answer 7

anterior to posterior:

• renal vein
• renal artery
• ureter

(+ nerves and lymphatics)

Question 8

what are extrahilar renal arteries, where do they arise and why might they cause problems?

Answer 8

• accessory terminal renal arteries present in 25% of pop, supplying small parts of kidney, esp. inferior pole
• arise from abdominal aorta (persistence of embryonic vessels that form during ascent of kidneys)
• narrow so are at greater risk of blockage causing avascular necrosis, and can cause hazard during surgery

Question 9

where does lymph from the kidneys drain?

Answer 9

lateral aortic nodes (at origin of renal kidneys)

Question 10

label this image

Answer 10

Question 11

what are the ureteric walls composed of?

Answer 11

smooth muscle - contract to produce peristaltic waves

Question 12

describe the course of the ureters from the kidneys to the bladder

Answer 12

i. arise from renal pelvis at ureteropelvic junction…
ii. descend down abdomen along anterior surface of psoas major (retroperitoneal) - course defined by tips of transverse processes
iii. cross pelvic brim to enter pelvic cavity (forms bend in ureter), anteriorly to bifurcation of common iliac arteries
iv. in pelvic cavity, run down lateral pelvic walls and turn anteromedially
v. enter lateral aspect of bladder in oblique manner (creating one way valve) at vesicoureteric junction

Question 13

what are the important anatomical relations of the ureters with structures of reproductive system in males and females

Answer 13

females: ureters descend posterior to ovary, into base of broad ligament and passes under uterine arteries (approx. 2cm superiorly to ischial spine)
males: ureters pass under vas deferens, superior to seminal vesicles

Question 14

name 3 common sites of relative ureter lumen constriction where renal stones can lodge

Answer 14

1. ureteropelvic junction
2. vesicoureteric junction
3. bifurcation of common iliac arteries (at pelvic prim)

Question 15

describe the blood supply to the ureters

Answer 15

segmental arteries from renal, gonadal, vesicle and uterine arteries

Question 16

Explain why a renal calculus passing through the ureter may give sever pain radiating from loin to groin and onto the proximal anterior aspect of the thigh?

Answer 16

sensory fibres from the ureters enter spinal cord at T11-L2 with ureteric pain referred to those dermatomal areas

Question 17

describe the normal size of the kidney

Answer 17

• height: 11-12cm
• width: 5-7.5cm
• depth: 2.5-3cm