172 25.

3 Gross Anatomy of the Kidney

Learning Objectives
By the end of this section, you will be able to:

 Describe the external structure of the kidney, including its location, support
structures, and covering
 Identify the major internal divisions and structures of the kidney
 Identify the major blood vessels associated with the kidney and trace the path of blood
through the kidney
 Compare and contrast the cortical and juxtamedullary nephrons
 Name structures found in the cortex and medulla
 Describe the physiological characteristics of the cortex and medulla

The kidneys lie on either side of the spine in the retroperitoneal space between the
parietal peritoneum and the posterior abdominal wall, well protected by muscle, fat, and
ribs. They are roughly the size of your fist, and the male kidney is typically a bit larger
than the female kidney. The kidneys are well vascularized, receiving about 25 percent of
the cardiac output at rest.
Conference held in March 2011.

There have never been sufficient kidney donations to provide a kidney to each person
needing one. Watch this video to learn about the TED (Technology, Entertainment,
Design) Conference held in March 2011. In this video, Dr. Anthony Atala discusses a
cutting-edge technique in which a new kidney is “printed.” The successful utilization of
this technology is still several years in the future, but imagine a time when you can print
a replacement organ or tissue on demand.

External Anatomy
The left kidney is located at about the T12 to L3 vertebrae, whereas the right is lower due to
slight displacement by the liver. Upper portions of the kidneys are somewhat protected by the
eleventh and twelfth ribs (Figure 1). Each kidney weighs about 125–175 g in males and 115–155
g in females. They are about 11–14 cm in length, 6 cm wide, and 4 cm thick, and are directly
covered by a fibrous capsule composed of dense, irregular connective tissue that helps to hold
their shape and protect them. This capsule is covered by a shock-absorbing layer of adipose
tissue called the renal fat pad, which in turn is encompassed by a tough renal fascia. The fascia
and, to a lesser extent, the overlying peritoneum serve to firmly anchor the kidneys to the
posterior abdominal wall in a retroperitoneal position.
kidneys are slightly protected by the ribs and are surrounded by fat for protection (not shown).

On the superior aspect of each kidney is the adrenal gland. The adrenal cortex directly influences
renal function through the production of the hormone aldosterone to stimulate sodium
reabsorption.

Internal Anatomy
A frontal section through the kidney reveals an outer region called the renal cortex and an inner
region called the medulla (Figure 2). The renal columns are connective tissue extensions that
radiate downward from the cortex through the medulla to separate the most characteristic
features of the medulla, the renal pyramids and renal papillae. The papillae are bundles of
collecting ducts that transport urine made by nephrons to the calyces of the kidney for excretion.
The renal columns also serve to divide the kidney into 6–8 lobes and provide a supportive
framework for vessels that enter and exit the cortex. The pyramids and renal columns taken
together constitute the kidney lobes.
Renal Hilum
The renal hilum is the entry and exit site for structures servicing the kidneys: vessels, nerves,
lymphatics, and ureters. The medial-facing hila are tucked into the sweeping convex outline of
the cortex. Emerging from the hilum is the renal pelvis, which is formed from the major and
minor calyxes in the kidney. The smooth muscle in the renal pelvis funnels urine via peristalsis
into the ureter. The renal arteries form directly from the descending aorta, whereas the renal
veins return cleansed blood directly to the inferior vena cava. The artery, vein, and renal pelvis
are arranged in an anterior-to-posterior order.

Nephrons and Vessels

The renal artery first divides into segmental arteries, followed by further branching to form
interlobar arteries that pass through the renal columns to reach the cortex (Figure 3). The
interlobar arteries, in turn, branch into arcuate arteries, cortical radiate arteries, and then into
afferent arterioles. The afferent arterioles service about 1.3 million nephrons in each kidney.
in the Kidney.

Nephrons are the “functional units” of the kidney; they cleanse the blood and balance the
constituents of the circulation. The afferent arterioles form a tuft of high-pressure capillaries
about 200 µm in diameter, the glomerulus. The rest of the nephron consists of a continuous
sophisticated tubule whose proximal end surrounds the glomerulus in an intimate embrace—this
is Bowman’s capsule. The glomerulus and Bowman’s capsule together form the renal
corpuscle. As mentioned earlier, these glomerular capillaries filter the blood based on particle
size. After passing through the renal corpuscle, the capillaries form a second arteriole,
the efferent arteriole (Figure 4). These will next form a capillary network around the more
distal portions of the nephron tubule, the peritubular capillaries and vasa recta, before
returning to the venous system. As the glomerular filtrate progresses through the nephron, these
capillary networks recover most of the solutes and water, and return them to the circulation.
Since a capillary bed (the glomerulus) drains into a vessel that in turn forms a second capillary
bed, the definition of a portal system is met. This is the only portal system in which an arteriole
is found between the first and second capillary beds. (Portal systems also link the hypothalamus
to the anterior pituitary, and the blood vessels of the digestive viscera to the liver.)
The two capillary beds are clearly shown in this figure. The efferent arteriole is the connecting
vessel between the glomerulus and the peritubular capillaries and vasa recta.
 kidney.

Visit this link to view an interactive tutorial of the flow of blood through the kidney.

Cortex
In a dissected kidney, it is easy to identify the cortex; it appears lighter in color compared to the
rest of the kidney. All of the renal corpuscles as well as both the proximal convoluted tubules
(PCTs) and distal convoluted tubules are found here. Some nephrons have a short loop of
Henle that does not dip beyond the cortex. These nephrons are called cortical nephrons. About
15 percent of nephrons have long loops of Henle that extend deep into the medulla and are
called juxtamedullary nephrons.

Chapter Review
As noted previously, the structure of the kidney is divided into two principle regions—the
peripheral rim of cortex and the central medulla. The two kidneys receive about 25 percent of
cardiac output. They are protected in the retroperitoneal space by the renal fat pad and overlying
ribs and muscle. Ureters, blood vessels, lymph vessels, and nerves enter and leave at the renal
hilum. The renal arteries arise directly from the aorta, and the renal veins drain directly into the
inferior vena cava. Kidney function is derived from the actions of about 1.3 million nephrons per
kidney; these are the “functional units.” A capillary bed, the glomerulus, filters blood and the
filtrate is captured by Bowman’s capsule. A portal system is formed when the blood flows
through a second capillary bed surrounding the proximal and distal convoluted tubules and the
loop of Henle. Most water and solutes are recovered by this second capillary bed. This filtrate is
processed and finally gathered by collecting ducts that drain into the minor calyces, which merge
to form major calyces; the filtrate then proceeds to the renal pelvis and finally the ureters.

Review Questions
1. The renal pyramids are separated from each other by extensions of the renal cortex
called ________.

A. renal medulla
B. minor calyces
C. medullary cortices
D. renal columns

2. The primary structure found within the medulla is the ________.

A. loop of Henle
B. minor calyces
C. portal system
D. ureter

3. The right kidney is slightly lower because ________.

A. it is displaced by the liver

B. it is displace by the heart
C. it is slightly smaller
D. it needs protection of the lower ribs

Critical Thinking Questions

1. What anatomical structures provide protection to the kidney?

2. How does the renal portal system differ from the hypothalamo–hypophyseal and
digestive portal systems?
3. Name the structures found in the renal hilum.

Glossary
Bowman’s capsule
cup-shaped sack lined by a simple squamous epithelium (parietal surface) and specialized
cells called podocytes (visceral surface) that participate in the filtration process; receives
the filtrate which then passes on to the PCTs
calyces
cup-like structures receiving urine from the collecting ducts where it passes on to the
renal pelvis and ureter
cortical nephrons
nephrons with loops of Henle that do not extend into the renal medulla
distal convoluted tubules
portions of the nephron distal to the loop of Henle that receive hyposmotic filtrate from
the loop of Henle and empty into collecting ducts
efferent arteriole
arteriole carrying blood from the glomerulus to the capillary beds around the convoluted
tubules and loop of Henle; portion of the portal system
glomerulus
tuft of capillaries surrounded by Bowman’s capsule; filters the blood based on size
juxtamedullary nephrons
nephrons adjacent to the border of the cortex and medulla with loops of Henle that extend
into the renal medulla
loop of Henle
descending and ascending portions between the proximal and distal convoluted tubules;
those of cortical nephrons do not extend into the medulla, whereas those of
juxtamedullary nephrons do extend into the medulla
 nephrons
functional units of the kidney that carry out all filtration and modification to produce
urine; consist of renal corpuscles, proximal and distal convoluted tubules, and descending
and ascending loops of Henle; drain into collecting ducts
medulla
inner region of kidney containing the renal pyramids
peritubular capillaries
second capillary bed of the renal portal system; surround the proximal and distal
convoluted tubules; associated with the vasa recta
proximal convoluted tubules (PCTs)
tortuous tubules receiving filtrate from Bowman’s capsule; most active part of the
nephron in reabsorption and secretion
renal columns
extensions of the renal cortex into the renal medulla; separates the renal pyramids;
contains blood vessels and connective tissues
renal corpuscle
consists of the glomerulus and Bowman’s capsule
renal cortex
outer part of kidney containing all of the nephrons; some nephrons have loops of Henle
extending into the medulla
renal fat pad
adipose tissue between the renal fascia and the renal capsule that provides protective
cushioning to the kidney
renal hilum
recessed medial area of the kidney through which the renal artery, renal vein, ureters,
lymphatics, and nerves pass
renal papillae
medullary area of the renal pyramids where collecting ducts empty urine into the minor
calyces
renal pyramids
six to eight cone-shaped tissues in the medulla of the kidney containing collecting ducts
and the loops of Henle of juxtamedullary nephrons
vasa recta
branches of the efferent arterioles that parallel the course of the loops of Henle and are
continuous with the peritubular capillaries; with the glomerulus, form a portal system
Solutions
Answers for Review Questions

1. D
2. A
3. A

Answers for Critical Thinking Questions

1. Retroperitoneal anchoring, renal fat pads, and ribs provide protection to the kidney.
2. The renal portal system has an artery between the first and second capillary bed. The
others have a vein.
3. The structures found in the renal hilum are arteries, veins, ureters, lymphatics, and
nerves.