Kidneys Flashcards by John Jonah Jameson Jr.

What are the kidneys?

Pair of excretory, retroperitoneal organs

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Location of the kidneys

Situated on the posterior abdominal wall, one on each side of the vertebral column, behind the peritoneum
Occupy the epigastric, hypochondriac, lumbar and umbilical regions
Extend from T12 vertebra to L3

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Difference in location between right and left kidneys

Right kidney is slightly lower than the left
Left kidney is a little nearer to the median plane than the right

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Dimensions of the kidneys

11cm long
6 cm broad
3 cm thick

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Weight of kidneys

150g in males
135g in females

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Direction of the kidneys

Long axis of the kidney is directed downwards and laterally so the upper poles are nearer to the median plane than the lower poles

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What are the poles of the kidneys?

Upper pole: Broad and in close contact with the corresponding suprarenal gland
Lower pole: Pointed

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What are the surfaces of the kidneys?

Anterior surface: Irregular
Posterior surface: Flat

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What are the borders of the kidneys?

Lateral border: Convex
Medial border: Concave (the middle part has the hilus/hilum)

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Constituents of the hilum of the kidney

Anterior to posterior:
Renal Vein
Renal Artery
Renal Pelvis (expanded upper end of the ureter)

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Anterior relations of the right kidney

Right suprarenal gland
Liver
Second part of duodenum
Hepatic flexure of colon
Small intestine

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Which of the anterior relations of the right kidney are covered by peritoneum?

Hepatic
Intestinal

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What are lateral relations of the right kidney?

Right lobe of the liver
Hepatic flexure of the colon

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What are the anterior relations of the left kidney?

Left suprarenal gland
Spleen
Stomach
Pancreas
Splenic vessels
Splenic flexure and descending colon
Jejunum

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Which of the anterior relations of the left kidney are covered by peritoneum?

Gastric
Splenic
Jejunal

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Lateral relations of the left kidney

Spleen
Descending colon

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What relations are common to both kidneys?

Upper pole: Suprarenal gland.
Lower poles lie about 2.5 cm above the iliac crests

Medial border of each kidney is related to:
1. Suprarenal gland above the hilus
2. Ureter below the hilus

Most posterior relations are common between both kidneys

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What are the posterior relations of the kidneys?

Diaphragm
Medial and lateral arcuate ligaments
Psoas major
Quadratus lumborum
Transversus abdominis
Subcostal vessels
Subcostal, iliohypogastric and ilioinguinal nerves

What additional posterior relations does each kidney have (which aren’t shared between both)?

Right Kidney: Twelfth rib
Left Kidney: Eleventh and Twelfth ribs

What are the coverings of the kidney?

Fibrous Capsule
Perirenal/Perinephric Fat
Renal Fascia
Pararenal/Paranephric Body (Fat)

What is the fibrous capsule?

Thin membrane which covers the kidney and lines the renal sinus
Can generally be removed easily except in certain diseases

What is perirenal/perinephric fat?

Layer of adipose tissue
Lies outside the fibrous capsule
Thickest at the borders of the kidney and fills up the extra space in the renal sinus

What are the layers of the renal fascia?

Posterior Layer: Fascia of Zuckerkandal
Anterior Layer: Fascia of Gerota

Describe how the renal fascia changes across the kidney

Right side at the level of upper pole of kidney, anterior fascia blends with inferior coronary layer and bare area of liver
Posterior layer on both right and left sides fuses with fasciae of muscles of posterior abdominal wall
Medially, the anterior layer is continuous from one to the other kidney and the posterior layer is attached either side of vertebra
Below, both the layers extend along the ureter and fuse with iliac fascia

What is the pararenal/paranephric body?

Fat lying outside the renal fascia

Where is pararenal fat most common?

Posteriorlty and twoards the lower pole of the kidney Fills up the paravertebral gutter and forms cushion for kidney

What is the internal structure of the kidney?

Outer-reddish brown cortex Inner-pale medulla A space called the renal sinus

What is the structure of the renal medulla?

10 renal pyramids Apices form the renal papillae which indent the minor calyces

What are the sections of the renal cortex?

**Cortical arches or cortical lobules** which form caps over the bases of the pyramids **Renal columns** which dip in between the pyramids

What structures form a kidney lobe?

Each pyramid and its overlying cortical arch

What is a renal sinus?

Space that extends into the kidney from the hilus

Contents of a renal sinus

Branches of the renal artery Tributaries of the renal vein Renal pelvis (which divides into 2-3 major calyces)

Describe the divisions of the renal pelvis

Pelvis divides into 2-3 major calyces Each major calyx divides into 7-13 minor calyces Each minor calyx ends in an expansion which is indented by one to three renal papillae

What is the blood supply of the kidney?

Renal artery and its branches

Lymphatic drainage of the kidney

Kidney lymphatics drain into the lateral aortic nodes ## Footnote Located at level of origin of renal arteries (L2)

Nerve supply of the kidney

Suplied by the renal plexus (an offshoot of the coeliac plexus) Contains sympathetic (T10–L1) fibres which are chiefly vasomotor The afferent nerves of the kidney belong to segments T10 to T12

How is exposure of the kidney prepared for?

Resection of 12th rib

What is the risk when resecting the 12th rib?

Danger of opening the pleural cavity (the lower border of the pleura lies between 12th rib and diaphragm) ## Footnote **Anterior to Posterior**: Diaphragm, Pleura, Ribs

Where can tenderness of the kidney be elicited?

Applying pressure over the renal angle

What is the renal angle?

Angle between the lower border of the 12th rib and the outer border of the erector spinae

Where can the kidney be palpated?

Can be palpated bimanually with one hand over the front and the other hand behind

When can the kidney be palpated?

When it is enlarged, it can be felt upon deep inspiration

Where does blood/pus from the kidney go?

Blood from a ruptured kidney or pus in a perinephric abscess first distends the renal fascia It forces its way within the renal fascia downwards into the pelvis It cannot cross to opposite side because of the fascial septum and midline attachment of the renal fascia