1. Gross anatomy of the kidney and the ureter
Ákos Lukást MD., Ph.D

2. Parts of the urinary system
Two kidneys (production of urine)
Two ureters (transport of urine)
Urinary bladder (storage, urination)
Urethra

3. Main functions of the kidneys
Filtration of the blood and excretion of waste metabolic products, toxic materials, drugs etc.
Regulation of water-, electrolyte- and acid-base balance
Regulation of blood pressure (volume / electrolyte control and renin production)
Endocrine functions: erythropoietin, renin production

4. Positioning Beam shaped Size cca. 11 cm x 6 cm x 3 cm (thickness)
Retroperitoneal
Hilus points medially and slightly anteriorly
Th11 L3

5. Projection of kidney

6. „VAU”!!
Right
Left

7. Hilus of kidney: VAU glandula suprarenalis a. renalis pelvis renalis
v. renalis
glandula suprarenalis
a. renalis
pelvis renalis
ureter
papilla

8. Crossing of arteries and veins near the kidney
Left renal vein anterior to aorta
Rigth renal artery behind IVC

9. Longitudinal section Renal hilum – renal sinus:
- v. renalis – anterior
- a. renalis – intermed.
- pelvis renalis – posterior
adipose tissue, lymph vessels, nerves

10. Longitudinal section
Lobes, with cortex and medulla (pyramid, tip: papilla, medullary rays in cortex)
Cortex of adjacent lobes – renal columns (Bertini)

11. Calyces, renal pelvis
infundibula
Collecting ducts open to minor calyces at the papilla (cribriform plate)
Adjacent minor calyces conflue to major calyces
Upper and lower infundibulum
pelvis renalis
ureter

12. Renal artery and branches

13. Capsules of the kidney
Fibrous capsule (dense irregular CT on the surface of the kidneys)
Adipose capsule – perirenal fat, containing ureter, vessels, suprarenal (adrenal) gland, extends into renal sinus
Renal fascia (open inferiorly!!!)

14. Renal fascia
- anterior and posterior lamina
- continuous with each other posteriorly, anteriorly and superiorly
- open inferiorly (ureter)
Descend of the kidney is only prevented by the perirenal fat (anorexia nervosa!, cahexia!)
Descend of the kidneys may obstruct ureter or renal vessels

15. Kidneys, suprarenal glands, ureter in situ
3 arteries of adrenal gland:
A. suprarenalis sup. (a. phrenica inf.)
A. suprarenalis media (aorta)
A. suprarenalis inf. (a. renalis)

16. Contacts of the anterior surface of kidney

18. Contacts of the posterior surface of kidney
DIAPHRAGMA
M. transv. abd.
tendon

19. Ureter Location: posterior body wall Retroperitoneal
Hilus to urinary bladder
~25 cm long
3 crossings
-behind gonadal arteries
-anterior to iliac arteries (near bifurcation)
- behind/under uterine artery, above vaginal a.
- behind deferent ducts in males

20. Ureter Three constrictions : - exit from renal pelvis
- crossing with iliac vessels
- entery to bladder
Predilection sites for ureter stones to obstruct

24. Variations of blood supply
Renal vein encircling aorta
Accessory renal a.

26. Ureter stone

27. Irodalom
Szentagothai J, Réthelyi M: Funkcionális anatómia, Medicina, 1989
Sobota - Atlas of Human Anatomy, 20th edition, Urban and Schwarzenberger, 1993
Netter - Atlas of Human Anatomy, Medi Media INC, New York, 1989