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URINARY SYSTEM The urinary system or renal system is the system that produces, stores, and eliminates urine , a sterile liquid which contains a concentrate of various waste products that are filtered out of the blood system. In humans it includes two kidneys, two ureters, the bladder and the urethra. Kidneys and ureters form the upper urinary tract, whereas the bladder and the urethra belong to the lower urinary tract. URINARY SYSTEM The female and male urinary system are very similar, differing only in the length of the urethra. URINARY SYSTEM: Clinical Anatomy UROGRAPHY (CT) UROGRAPHY (X-ray) The kidneys are a pair of reddish brown organs, situated on the posterior abdominal wall, one on each side of the vertebral column, behind the peritoneum (retroperitoneal). •Each kidney is bean-shaped. It has upper and lower poles, medial and lateral borders, and anterior and posterior surfaces. •The upper pole is thick and rounded and it is in close contact with the corresponding suprarenal gland. The lower pole is is smaller and thinner than the upper pole. •The anterior surface is irregular and flat.The posterior surface is flat. •The lateral border is convex and the medial border is concave. •The middle part of the medial border shows a depression called the hilus (hilum). In the hilus are seen: •the renal vein •the renal artery •the renal pelvis (upper expanded portion of the ureter) The hilum expands into a central cavity, the renal sinus, this contains the upper part of the renal pelvis and the calyces, surrounded by some fat in which are imbedded the branches of the renal vessels and nerves. The renal sinus is lined by a prolongation of the fibrous tunic, which is continued around the lips of the hilum. The renal calyces, from seven to thirteen in number, are cup-shaped tubes, each of which embraces one or more of the renal papillæ; they unite to form two or three short tubes, and these in turn join to form a funnel- shaped sac, the renal pelvis. The renal pelvis, wide above and narrow below where it joins the ureter, is partly outside the renal sinus. The renal calyces and pelvis form the upper expanded end of the excretory duct of the kidney. Each kidney is about 12 cm long, 6 cm broad and 3 cm thick, weighing 150 g males and 135 g in females. the kidneys from behind Vertically,the kidneys extend from the upper border of vertebra T12 to the centre of the body of vertebra L3. They are partially protected by the 11th and 12th pairs of ribs. The right kidney is slightly lower than the left kidney because of the large area occupied by the liver.The left kidney is a little longer and narrower than the right kidney. KIDNEY LOBULATIONS In the fetus the kidney is made up of 12 lobules. After birth the lobules gradually fuse. KIDNEY MALFORMATIONS KIDNEY MALFORMATIONS: Horseshoe kidney COVERINGS OF KIDNEY Innermost layer (fibrous membrane) - renal capsule. It is continuous with the outer coat of ureter at the hilus. Renal capsule serves as a barrier against trauma and the spread of infections to the kidney. COVERINGS OF KIDNEY Middle layer (fatty tissue) - adipose capsule. It protects from trauma and holds the kidney in place within the abdomen. COVERINGS OF KIDNEY Outermost layer (perirenal fascia) The renal fascia or Gerota's fascia is a layer of connective tissue encapsulating the kidneys and the suuprarenal glands. Anterior attachment (Toldt’s fascia): it passes anterior to the kidney, renal vessels, abdominal aorta and inferior vena cava and fuses with the anterior layer of the renal fascia of the opposite kidney. Posterior attachment (Zuckerkandl’s fascia): it fuses with the psoas fascia and side of the body of the vertebrae. The anterior fascia and posterior fascia fuse laterally to form the lateroconal fascia which fuses with the fascia transversalis. Superior attachment: The anterior and posterior layers fuse at the upper pole of the kidney and then split to enclose the suprarenal gland. At the upper part of the suprarenal gland they again fuse to form the suspensory ligament of the suprarenal gland and fuse with the diaphragmatic fascia. Inferior attachment: The layers don't fuse. The posterior layer descends downwards and fuses with the iliac fascia. The anterior layer blends with the connective tissue of the iliac fossa. Transverse section, showing the relations of the capsule of the kidney (after Gerota) Sagittal section through posterior abdominal wall, showing the relations of the capsule of the kidney (after Gerota) Floating kidney (nephroptosis)- it is a downward displacement/dropping of the kidney. Individuals - especially thin people - in whom either the adipose capsule or the renal fascia is deficient, may develop nephroptosis. KIDNEY: RELATIONS (anterior) The anterior surfaces of the kidneys, showing the areas of contact of neighboring viscera CT KIDNEY: RELATIONS (posterior) The posterior surfaces of the kidneys, showing areas of relation to the parietes KIDNEY: INTERNAL MACROSTRUCTURE The kidney is divided into two main areas, an external area (cortex) and an internal area (medulla), and contains a space, the renal sinus, in which the upper part of the renal pelvis is located. Renal pelvis divides into 2-3 major calyces. These in turn divide into 7-13 minor calyces. The cortex is dark and convoluted, the medulla is pale and striated. Within the medulla there are 8 or more cone- shaped sections known as renal pyramids. Narrow masses of cortical tissue extending between pyramids towards the renal sinus are called renal columns. Radial, lighter-colored medullary rays project from the bases of the pyramids into the cortex. Each pyramid along with the overlying cortical arch forms a lobe of kidney. KIDNEY: INTERNAL The apices of the pyramids (renal papillae) converge to the renal sinus where project into MACROSTRUCTURE calices. KIDNEY: INTERNAL MACROSTRUCTURE KIDNEY: INTERNAL MACROSTRUCTURE ULTRASOUND KIDNEY: INTERNAL MICROSTRUCTURE KIDNEY: VASCULAR SUPPLY Because the major function of the kidneys is to filter the blood, a rich blood supply is delivered by the large renal arteries. Renal artery arising from the abdominal aorta. Accessory renal arteries are present in 30% of individuals. The renal artery for each kidney enters the renal hilus and successively branches into segmental arteries (5 segments: apical, upper, middle, lower, posterior) and then into interlobar arteries, which pass between the renal pyramids toward the renal cortex. The interlobar arteries then branch into the arcuate arteries, which curve as they pass along the junction of the renal medulla and cortex. Branches of the arcuate arteries, called interlobular arteries, penetrate the renal cortex. KIDNEY SEGMENTS Interlobular arteries Afferent arterioles Glomerular capillaries Efferent arterioles Peritubular Vasa rectae capillaries spuria (cortical (juxtamedullary nephrons) nephrons) Interlobular veins Arcuate veins Interlobar veins Segmental veins Renal vein The Lymphatic Vessels of the Kidney form three plexuses: one in the substance of the kidney, a second beneath its fibrous capsule, and a third in the perinephric fat; the second and third communicate freely with each other. The vessels from the plexus in the kidney substance converge to form four or five trunks which issue at the hilum. Here they are joined by vessels from the plexus under the capsule, and, following the course of the renal vein, end in the lateral aortic nodes. The perinephric plexus is drained directly into the upper lateral aortic nodes. The renal plexus is a dense nervous plexus of autonomic nerves around the renal artery. It is supplied by rami from: celiac ganglion and plexus, aorticorenal ganglion, lowest thoracic splanchnic nerve, first lumbar splanchnic nerve, aortic plexus. Autonomic nerves from the renal plexus follow the renal artery into the kidney through the renal hilus. The nerve fibers follow the branching pattern of the renal artery and serve as vasomotor fibers that regulate blood volume. Sympathetic fibers constrict arterioles (decreasing urine output), while less numerous parasympathetic fibers dilate arterioles (increasing urine output). The parasympathetic supply from vagus nerve explains the nausea and vomiting that may accompany renal pain. RENAL PELVIS AND CALYCES Urography - CT Urography – X-ray RENAL PELVIS AND CALYCES Within the sinus of each kidney there are short cup-shaped tubes, termed minor calyces, which encircle the renal papillæ. Since a single calyx may enclose more than one papilla the calyces are generally fewer in number than the pyramids — the former varying from seven to thirteen, the latter from eight to eighteen. The minor calyces join to form two or three short tubes, the major calyces, and these unite to form a funnel-shaped dilatation, wide above and narrow below, named the renal pelvis, which is situated partly inside and partly outside the renal sinus. It is usually placed on a level with the spinous process of the first lumbar vertebra. RENAL PELVIS AND CALYCES URETER The ureters convey the urine from the kidneys to the urinary bladder. Each ureter measures from 25 to 30 cm. in length, and is a thick- walled narrow cylindrical tube which is directly continuous near the lower end of the kidney with the tapering extremity of the renal pelvis. It runs downward and medialward in front of the Psoas major and, entering the pelvic cavity, finally opens into the fundus of the bladder. 1 The ureter has 3 constrictions (like the oesophagus): (1) at the pelvi-ureteric junction (2) at the rim of the lesser pelvis 2 (3) at the passage through the bladder wall 3 URETER The abdominal part (pars abdominalis) lies behind the peritoneum on the medial part of the Psoas major, and is crossed obliquely by the internal spermatic vessels. It enters the pelvic cavity by crossing either the termination of the common, or the commencement of the external, iliac vessels (iliac part).
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