The Kidneys

• The kidneys regulate

blood pressure and the
ionic balance and water
content of the blood
• eliminate metabolic
waste and produce
urine
The paired kidneys are reddish, kidney
bean–shaped organs
located just above the waist between the
peritoneum and the
posterior wall of the abdomen. Because
their position is posterior
to the peritoneum of the abdominal
cavity, they are said to be
retroperitoneal organs.

The kidneys are located between the

levels of the last thoracic and third lumbar
vertebrae, a position where they are
partially protected by the eleventh and
twelfth pairs of ribs. The right kidney is
slightly lower than the left because the
liver occupies considerable space on the
right side superior to the kidney.
 Posterior relations

Right Kidney: T12-L4

Left Kidney: T11-L3
 Posterior abdominal wall
Psoas major

Psoas minor

Quadratus lumborum

Iliacus
 Anterior relations

Right Kidney - right suprarenal gland, liver, descending duodenum, right colic flexure,
small intestines
Left Kidney- left suprarenal gland, stomach, spleen, tail of the pancreas, and left colic
flexure, small intestines
The concave medial
border of each kidney faces the
vertebral column.
Near the center of the concave
border is an indentation called
the renal hilum or hilus, through
which the ureter emerges from the
kidney along with blood vessels,
lymphatic vessels, and nerves.
The hilum expands into a cavity within
the kidney called the
renal sinus, which contains part of the
renal pelvis, the calyces,
and branches of the renal blood vessels
and nerves.
A frontal section through the kidney
reveals two distinct regions:
a superficial, light red area called the
renal cortex and a deep, darker
reddish-brown inner region called the
renal medulla.

The renal medulla consists of several

cone-shaped renal pyramids. The
base of each pyramid faces the renal
cortex, and its apex, called a renal
papilla, points toward the renal hilum.

The renal cortex is the smooth-

textured area extending from the
renal capsule to the bases of the renal
pyramids and into the spaces
between them. Those portions of the
renal cortex that extend between
renal pyramids are called renal
columns.
 Internal Anatomy

Cortex
• extends into the medullary region
as renal columns

Medulla
• pyramids with the broad base
facing outward and the apex fitting
into a cup-shaped minor calyx

Minor calyces  major

calyces  renal pelvis
Three layers of tissue surround each
kidney.
The deep layer, the renal capsule, is a
smooth, transparent sheet of
dense irregular connective tissue that is
continuous with the outer
coat of the ureter. It serves as a barrier
against trauma and helps
maintain the shape of the kidney.
The middle layer, the adipose
capsule, is a mass of fatty tissue
surrounding the renal capsule. It
also protects the kidney from trauma and
holds it firmly in place
within the abdominal cavity.
The superficial layer, the renal
Fascia, is another thin layer of dense
irregular connective
tissue that anchors the kidney to the
surrounding structures
and to the abdominal wall.
On the anterior surface of the
kidneys, the renal fascia is deep to the
peritoneum.
 Nephron

Corpuscular component
• Bowman’s capsule
• Glomerulus

Tubular component
• Proximal convoluted
• Loop of Henle
• Distal Convoluted
• Collecting ducts
Nephrons are the functional units of the kidneys.
Each nephron consists of two parts: a renal corpuscle
where blood plasma is filtered, and a renal tubule into which the filtered fluid passes.

The two components of a renal corpuscle are the glomerulus (capillary network) and the
glomerular (Bowman’s) capsule, a double-walled epithelial cup that surrounds the glomerular
capillaries. Blood plasma is filtered in the glomerular capsule, and then the filtered fluid passes
into the renal tubule, which has three main sections.

In the order that fluid passes through them, the renal tubule consists of a proximal convoluted
tubule, loop of Henle, and distal convoluted tubule. The renal corpuscle and both convoluted
tubules lie within the renal cortex; the loop of Henle extends into the renal medulla, makes a
hairpin turn, and then returns to the renal cortex.

The distal convoluted tubules of several nephrons empty into a single collecting duct. Collecting
ducts then unite and converge into several hundred large papillary ducts, which drain into the
minor calyces. The collecting ducts and papillary ducts extend from the renal cortex through the
renal medulla to the renal pelvis. So one kidney has about 1 million nephrons, but a much
smaller number of collecting ducts and even fewer papillary ducts.
 Renal blood flow

Renal Artery  segmental arteriy interlobar artery arcuate artery interlobular

artery  afferent arteriole  glomerulus  efferent arteriole  peritubular capillaries
Renal Artery
• A single renal artery, a
direct branch of the
abdominal aorta at L2,
normally supplies
each kidney.
– The right renal artery is
longer than the left
artery and passes
posterior to the
inferior vena cava.
Each nephron receives one afferent arteriole, which divides into
a tangled, ball-shaped capillary network called the glomerulus.
The glomerular capillaries then reunite to form an efferent arteriole
that carries blood out of the glomerulus.
Glomerular capillaries are unique among capillaries in the body because
they are positioned between two arterioles, rather than between an
arteriole and a venule.

Glomerular capillary blood pressure is high. Because the efferent

arteriole is smaller in diameter than the afferent arteriole,
resistance to the outflow of blood from the glomerulus is high.
As a result, blood pressure in glomerular capillaries is considerably
higher than in capillaries elsewhere in the body
• To produce urine, nephrons and collecting ducts perform three basic processes—
glomerular filtration, tubular reabsorption, and tubular secretion.
• Glomerular filtration. In the first step of urine production, water and most solutes in
blood plasma move across the wall of glomerular capillaries, where they are filtered and
move into the glomerular capsule and then into the renal tubule.
• Tubular reabsorption. As filtered fluid flows through the renal tubules and through the
collecting ducts, tubule cells reabsorb about 99% of the filtered water and many useful
solutes. The water and solutes return to the blood as it flows through the peritubular
capillaries and vasa recta.
• Tubular secretion. As filtered fluid flows through the renal tubules and collecting ducts,
the renal tubule and duct cells secrete other materials, such as wastes, drugs, and excess
ions, into the fluid. Solutes and the fluid that drain into the minor and major calyces and
renal pelvis constitute urine and are excreted.
About 80–85% of the nephrons are
cortical nephrons Their renal
corpuscles lie in the outer portion of
the renal cortex, and they have
short loops of Henle that lie mainly
in the cortex and penetrate only into
the outer region of the renal
medulla. The short loops of Henle
receive their blood supply from
peritubular capillaries that arise
from efferent arterioles.
The other 15–20% of the nephrons
are juxtamedullary nephrons. Their
renal corpuscles lie deep in the
cortex, close to the medulla, and
they have a long loop of Henle that
extends into the deepest region of
the medulla. Nephrons with long
loops of Henle enable the kidneys to
excrete very dilute or very
concentrated urine
In each nephron, the final part of the ascending limb of the loop of
Henle makes contact with the afferent arteriole serving
that renal corpuscle. Because the columnar tubule cells in this region
are crowded together, they are known as the macula densa. Alongside
the macula densa, the wall of the afferent arteriole
(and sometimes the efferent arteriole) contains modified
smooth muscle fibers called juxtaglomerular (JG) cells. Together with
the macula densa, they constitute the juxtaglomerular apparatus
(JGA). the JGA helps regulate blood pressure within the kidneys.
 Ureters

Abdominal Part
•Above the terminal line
•Anterior to the psoas major

Pelic part
• Below the terminal line
• Each of the two ureters transports urine from the renal pelvis of one
kidney to the urinary bladder. Peristaltic contractions of the muscular
walls of the ureters push urine toward the urinary bladder, but
hydrostatic pressure and gravity also contribute.
• The ureters are 25–30 cm (10–12 in.) long and are thickwalled, narrow
tubes that vary in diameter from 1 mm to 10 mm along their course
between the renal pelvis and the urinary bladder.
• Like the kidneys, the ureters are retroperitoneal. At the base of the
urinary bladder, the ureters curve medially and pass obliquely through
the wall of the posterior aspect of the urinary bladder.
• Three layers of tissue form the wall of the ureters.
• The deepest coat, the mucosa, is a mucous membrane
with transitional epithelium and an underlying lamina
propria of areolar connective tissue with considerable
collagen, elastic fibers, and lymphatic tissue.
• Throughout most of the length of the ureters, the
intermediate coat, the muscularis, is composed of inner
longitudinal and outer circular layers of smooth muscle
fibers. This arrangement is opposite to that of the
gastrointestinal tract, which contains inner circular and
outer longitudinal layers. The muscularis of the distal third
of the ureters also contains an outer layer of longitudinal
muscle fibers. Thus, the muscularis in the distal third of
the ureter is inner longitudinal, middle circular, and outer
longitudinal. Peristalsis is the major function of the
muscularis.
• The superficial coat of the ureters is the adventitia, a layer
of areolar connective tissue containing blood vessels,
lymphatic vessels, and nerves that serve the muscularis
and mucosa.
 Ureteric constrictions

Ureteropelvic junction

Pelvic brim

Vesicoureteral junction
 Urinary Bladder

Apex

Fundus

Body

Neck
• The urinary bladder is a hollow, distensible muscular
organ situated in the pelvic cavity posterior to the pubic
symphysis.
• In males, it is directly anterior to the rectum; in
females, it is anterior to the vagina and inferior to the
uterus .
• Folds of the peritoneum hold the urinary bladder in
position.
• As urine volume increases, it becomes pear-shaped and
rises into the abdominal cavity.
• Urinary bladder capacity averages 700–800 mL. It is
smaller in females because the uterus occupies the
space just superior to the urinary bladder.
• In the floor of the urinary bladder is a small triangular area called the
trigone .The two posterior corners of the trigone contain the two ureteral
openings; the opening into the urethra, the internal urethral orifice , lies in the
anterior corner.
• Three coats make up the wall of the urinary bladder. The deepest is the mucosa,
a mucous membrane composed of transitional epithelium and an underlying
lamina propria similar to that of the ureters. Rugae (the folds in the mucosa) are
also present to permit expansion of the urinary bladder. Surrounding the mucosa
is the intermediate muscularis, also called the detrusor muscle, which consists of
three layers of smooth muscle fibers: the inner longitudinal, middle circular, and
outer longitudinal layers.
• Around the opening to the urethra the circular fibers form an internal urethral
sphincter; inferior to it is the external urethral sphincter, which is composed of
skeletal muscle and is a modification of the deep muscles of the perineum.
• The most superficial coat of the urinary bladder on the posterior and inferior
surfaces is the adventitia, a layer of areolar connective tissue that is continuous
with that of the ureters. Over the superior surface of the urinary bladder is the
serosa, a layer of visceral peritoneum.
Female pelvic spaces
Male pelvic spaces