Download Renal05-KidneysUretersSuprarenalGlands

Renal #5
Mon, 03/17/03, 2pm
Dr. Rosales
Jennifer Uxer for Prateek Chadhaury
Page 1 of 6
I.
II.
Kidneys, Ureters, and Suprarenal Glands
Components of the urinary tract
 Kidneys—a pair of organs, make urine
 Ureters—transport urine from the kidneys to the urinary bladder
 Urinary bladder—temporary urine storage
 Urethra—expels urine from the bladder. In males, it is part of the urinary and
reproductive systems.
Kidneys
A. Functions
1. Maintenance of homeostasis
2. Regulation of fluid and electrolyte balance
3. Production of erythropoietin (hemopoietin, hematopoietin)—stimulates
production of RBCs
-Enhances erythropoiesis by stimulating formation of proerythroblasts and
release of reticulocytes from bone marrow
4. Production of renin (angiotensinogenase)
-Renin used to be called a hormone, but it’s actually an enzyme.
-Secreted under conditions of hypovolemia by the juxtaglomerular (JG) cells
as part of the renin-angiotensin system to elevate blood pressure and elevate
blood volume. Angiotensin I is a potent vasoconstrictor.
B. Surface Anatomy
 In the posterior abdominal wall
 They are primarily retroperitoneal and have no relation to peritoneum.
(Secondary retroperitoneal structures were identified in GI, and only their
anterior surfaces were covered by peritoneum.)
 Bean shaped
 Lateral convex border, and concave medial border.
 Right kidney is lower than the left due to the liver.
C. Development
 They develop low and ascend to their final position in the posterior
abdominal wall.
 What anatomical structure will arrest the ascent of a “horseshoe kidney” into
the retroperitoneal region?—3 Blood Vessels on the abdominal aorta. The
1st is the inferior mesenteric artery.
 The ascent of normal kidneys is stopped by the suprarenal glands.
D. Posterior Relations—listed in the on-line notes
 12th rib. Forms the costovertebral angle with the vertebral column. To test
for kidney disease, put your palm over the angle and hit the back of your
hand with your other fist. Pain is a positive for CVA (costovertebral angle)
tenderness—something is wrong with the kidneys.
 Psoas muscle. When the kidneys are inflamed, this muscle is irritated. To
test, have the patient lie on the unaffected side. The affected thigh is
extended against resistance. It’s a positive psoas sign if pain is felt. This is
also used to test for appendicitis.
Renal #5
Mon, 03/17/03, 2pm
Dr. Rosales
Jennifer Uxer for Prateek Chadhaury
Page 2 of 6

Right kidney: diaphragm, costodiaphragmatic recess of the pleura, 12th rib,
psoas m., quadratus lumborum m., transversus abdominis m., subcostal n.,
iliohypogastric n. ilioinguinal n. [N312, N320—3rd ed.]
 Left kidney: diaphragm, costodiaphragmatic recess of pleura, 11th (left
kidney is higher) and 12th ribs, psoas m., quadratus lumborum m.,
transversus abdominis m., subcostal n., iliohypogastric n., ilioinguinal n.
[N312]
E. Anterior Relations
 Right kidney: suprarenal gland, bare area of the liver, 2nd part of the
duodenum, right colic (hepatic) flexure [N311, N319—3rd ed.]
 Left kidney: suprarenal gland, spleen, stomach, pancreas, left colic (splenic)
flexure, coils of jejunum
F. Coverings (N324, N332—3rd ed)
 Transverse Section at Level of Body of L.V. 1
1. Fibrous capsule of the kidney—thin, innermost covering; is easily stripped
off. It does not divide the kidney into lobes
2. Perirenal fat—thin layer of fat that covers the capsule
3. Renal fascia of Gerota—derived from the transversalis fascia. Encloses the
kidney and suprarenal glands. It’s tight at the top and loose inferiorly so
that the kidneys descend during deep inspiration. If it were tight inferiorly,
it would be painful to breathe deeply.
4. Pararenal fat—part of the fat in the posterior abdominal wall.
G. Gross Structure
 The hilus—found in the medial, concave border. It’s the area where
structures enter and exit the organ. The relationship is VAU(A). Renal
vein is most anterior. Behind it is the renal artery. The ureter is most
posterior. Occasionally, there’s another artery behind the ureter.
 Look for the direction of the concavity and the way the ureter points. Both
ureters point down.
 Sectioning kidney shows 2 areas:
1. Renal Cortex—outer area, striated, dark brown.
 Medullary rays, extensions of the medulla into the cortex, located
in the cortex and give its striated appearance.
2. Renal Medulla—inner area. Made of the renal pyramids whose bases
are directed to the cortex and apices are directed medially toward the
hilum.
 The apex is the renal papilla, where the 1st drops of urine come out.
 Renal columns, extensions of the cortex into the medulla, are
between the renal pyramids.
 Minor Calyx—start of the excretory duct. Catch the 1st drops of urine and
is related to the renal papilla. (Calyx means cup.)
 Major Calyx—formed by 2 or 3 minor calyces.
 Renal Pelvis—formed by the merger of the major calyces. It’s the most
proximal, dilated portion of the ureter.
Renal #5
Mon, 03/17/03, 2pm
Dr. Rosales
Jennifer Uxer for Prateek Chadhaury
Page 3 of 6


Transitional epithelium lines the excretory ducts of the kidneys.
Renal sinus—space that holds the vein, artery, and ureter. Filled with
perirenal fat to support the structures.
 Renal hilum—the depression/space. Leads to the renal sinus.
H. Blood Supply
 It’s from the right and left renal arteries.
 They divide before they enter the kidneys to form the segmental arteries,
which are found in the sinus. These supply specific segments of the
kidneys, so if a segment is diseased, you only remove that section. This
surgery is renal segmentectomy.
 They are known as lobar arteries as they approach the pyramids.
 These divide and ascend between the pyramids and are called interlobar
arteries.
 They run on the upper border of the pyramids and are the arcuate arteries.
 Vasa recta vera, the true straight arteries, come off of the arcuate arteries
and enter the pyramids.
 These give off branches into the medulla and are the interlobular arteries.
 These are the origin of the afferent arteriole which enters the glomerulus.
 The efferent arteriole leaves the glomerulus and starts the venous drainage.
 Vasa recta spurious, the false straight arteries, branch off the efferent
arterioles as it leaves the glomerulus. They extend into the medulla and
are related to the ascending and descending limbs of Henle and the
collecting duct. Their contents flwo in the opposite direction of the
contents in the Loop of Henle. This countercurrent causes the
concentration of urine.
 Interlobular vein, arcuate vein, interlobar vein, lobar vein, segmental vein,
renal vein, inferior vena cava.
 NOTE how the efferent arteriole is interposed between the glomerulus (a
tuft of capillaries) and the cortical capillary network. Based on this
relationship, how would you classify the efferent arteriole as a vessel? As a
portal vessel because it can be an artery or vein. Other portal vessels are
found in the liver (portal vein) and hypothalamus.
 What are the arteries of the kidney: anatomical end arteries or functional
end arteries? Anatomical end arteries.
 Anatomical—two unconnected branches
 Functional—two branches with a small connection that will develop if
needed.
Renal #5
Mon, 03/17/03, 2pm
Dr. Rosales
Jennifer Uxer for Prateek Chadhaury
Page 4 of 6
abdominal aorta

renal a.

segmental aa.

lobar aa.

interlobar aa.

arcuate aa.

interlobular aa.

inferior vena cava

renal v.

segmental vv.

lobar vv.

interlobar vv.

arcuate vv.

interlobular vv.

afferent arteriole  glomerulus  efferent arteriole  cortical capillary network
I. Lymphatic Drainage: to the nodes related to the renal arteries, the para-aortic
nodes. (pre-aortic is for the digestive system)
E. Nerve Supply—from the sympathetics and the vagus. They form a plexus of
nerves surrounding the renal arteries.
II.
Ureters
A. Function—convey urine from the kidneys to the urinary bladder
B. Anatomy
 Upper ½ is in the abdomen, and lower ½ is in the pelvic cavity.
 The division between the 2 halves occurs at the external iliac artery and its
point of bifurcation of the common iliac artery.
 The major component of urine is water.
 External iliac artery is the bridge between the common iliac artery and the
femoral artery. Here water passes over the bridge because the ureter passes
over here.
C. Anatomic Constrictions
1. Ureteropelvic junction (UPJ)—renal pelvis with the ureter
2. Pelvic brim (over external iliac a.)—ureter kinks as it passes over the
external iliac artery to enter the pelvic cavity.
3. Ureterovesical junction (UVJ)—enters the urinary bladder.
 What is the clinical significance of these constrictions? If you’re passing a
kidney stone, it can be stuck in 1 of these areas.
D. NOTE THE RELATIONSHIP OF THE URETER TO THE UTERINE
ARTERY. In females the ureterine artery (branch of the internal iliac
artery) passes OVER the ureter. This is important to note so that you don’t
transect a ureter. Another ureter injury can occur during catheterization and
may create a false passage (a hole)
Renal #5
Mon, 03/17/03, 2pm
Dr. Rosales
Jennifer Uxer for Prateek Chadhaury
Page 5 of 6
E. Blood Supply—no specific supply. It comes from branches of blood vessels in
the area—from the renal artery, the gonadal artery, the internal iliac artery.
F. Lymphatic Drainage—para aortic nodes/ lateral aortic nodes/ lumbar nodes
G. Nerve Supply—not specific; acquires innervation as the ureter descends.
 Upper part is from L1 (junction of the pelvis and the ureter). The branches
are the iliohypogastric and ilioinguinal nerves. Therefore the pain of a
kidney stone can be referred to the scrotum or the tip of the penis.
H. Intravenous Pyelogram (IVP)—inject a water soluble dye. After 15 minutes
you can see the excretory ducts of the kidneys. If you don’t see it being
excreted, there’s something wrong with the kidneys.
III.
Suprarenal Glands
 Have a right and left gland. Be able to identify them by shape. Right is a
pyramid/triangle shape. Left is a crescent/half moon shape that extends to
the hilum.
 Both rest on the superior pole of the kidney.
A. Blood Supply
 3 ARTERIES
1. Inferior phrenic artery  superior suprarenal artery
2. Abdominal aorta  middle suprarenal artery
3. Renal artery  inferior suprarenal artery
 1 VEIN
 Right suprarenal vein  inferior vena cava
 Left suprarenal vein  left renal vein
B. Nerve supply—celiac ganglia and plexus. It’s mainly sympathetic.
C. Suprarenal Cortex
 Yellowish
 Derived from mesoderm
 3 ZONES
1. Zona glomerulosa  mineralocorticoids (aldosterone)
-maintenance of fluid and electrolyte balance
2. Zona fasciculate  glucocorticoids (cortisol)
-control of metabolism of CHO, fats, proteins
3. Zona reticularis  sex hormones (androgens: androstenedione,
dehydroepiandrosterone)
-prepubertal development of sex organs
to remember—“the deeper you go the sweeter it gets.”
D. Suprarenal Medulla
 Redish
 derived from neural crest (neuroectoderm)  catecholamines (epinephrine,
norepinephrine)
 secretory cells called chromaffin cells
(stored hormones stain with chromium salts)
E. Increased Blood Pressure
Renal #5
Mon, 03/17/03, 2pm
Dr. Rosales
Jennifer Uxer for Prateek Chadhaury
Page 6 of 6
hypoglycemia, hypoxia, strenuous exercise, stressful emergency situations

increased secretory activity

greater strength of cardiac contraction
acceleration of heart rate
redirection of blood flow to muscles and liver
general increase in blood pressure
IV. Clinical Correlations of Suprarenal Glands
A. Cushing’s Syndrome
 Most common cause of hyperplasia of suprarenal cortex (benign or
malignant)
 Leads to hypersecretion of hormones
 This, in turn, results in a moon-shaped face, truncal obesity, hirsutism,
hypertension
B. Addison’s Disease
 Results from TB or atrophy of adrenal cortex
 Causes hyposecretion of hormones
 Results in increased skin pigmentation, muscular weakness, weight loss,
hypotension
 John F. Kennedy had this disease.
C. Pheochromocytoma
 Tumor of adrenal medulla (benign or malignant)
 Causes hypersecretion of catecholamines
 Normally, there is no epinephrine in the blood and it’s secreted only when
needed.
 Results in paroxysmal or sustained hypertension (260/160 and
asymptomatic)