1. Kidneys and Adrenal Glands
Department of Regional Anatomy and
Operative Surgery

2. Position, relation
Structure
Blood supply
Lymphatic drainage
Innervations

3. Position Retroperitoneal Upper poles T12 vertebra Lower poles
L3 vertebra
Right is lower than left

4. Cadaveric kidneys

5. Surface Projection of kidney

6. Renal Angle
Tenderness or percussing pain caused by kidney disease is localized here

7. Neighbor of Kidney

9. Anterior Surface of the kidney

11. Posterior Surface

12. Costodiaphragmatic recess of the pleural cavity

13. Renal hilum, Renal sinus and Renal pedicle
cortex
Renal pyramid
Renal column
Renal sinus
calyx
Renal hilum
papilla
Renal pedicle

16. From anterior to posterior
renal vein
renal artery
renal pelvis
From above downwards
the renal artery

17. Hydronephrosis

18. renal artery
T11

19. Renal
artery

20. Vascular renal segment
Superior (apical)
Anterior superior (upper)
posterior
Anterior inferior (middle)
Inferior (lower)

21. variation of renal artery!

22. Variation of Renal Artery

23. Renal veins

25. Aorta-renal artery-segmental artery-lobar artery-interlobar artery-arcuate artery-interlobulor artery-afferent arteriole-glomerulus (capillaries)-efferent arteriole-peritubular capillaries and vasa recta-interlobular vein-arcuate vein-interlobar vein-renal vein-interior vena cava

26. Renal Capsule
Renal fascia
Adipose capsule
Fibrous capsule

27. Renal fascia

29. Fibrous capsule
Adipose capsule
Perirenal fat
Pararenal fat

32. Fibrous Capsule

33. Ureter

34. Ureter is divided into 3 parts:
①abdominal part
②pelvis part
③intramural part

35. 28 to 34 cm
3 narrowing sites
the pelviureteric junction
crossing the pelvic brim
traversing the bladder wall

38. Horseshoe kidney

39. Suprarenal Gland

40. Endocrine gland
T11 level
Right is triangular
Left is semi-lunar

41. tail of pancreas & spleen vessel
Relation
Left
right
anterior
superior
stomach
liver
inferior
tail of pancreas & spleen vessel
posterior
diaphragm
medial
abdominal aorta
Inferior vena cava

43. Artery of Adrenal Gland

46. Veins of adrenal gland Left suprarenal vein, into the left renal vein
Right suprarenal vein, into the
inferior vena cava

49. Anterior transperitoneal approach
incision
Posterior retroperitoneal approach
Anterior transperitoneal approach

50. Case A
A 55-year-old woman was found rolling on her kitchen floor, crying out from agonizing pain in her abdomen. The pain came in waves and extended from the right loin to the groin and to the front of the right thigh. An anteroposterior radiograph of the abdomen revealed a calculus in the right ureter.

51. Question What causes the pain when a ureteral calculus is present?
Why is the pain felt in such an extensive area?
Where does one look for the course of the ureter in a radiograph?
Where along the ureter is a calculus likely to be held up?

52. Case B
An explorer in the Amazon jungle was found alive after having lost contact with the outside world for six months. On physical examination, he was found to be in an emaciated condition. On palpation of the abdomen, a rounded, smooth swelling appeared in the right loin at the end of inspiration. On expiration, the swelling moved upward and could no longer be felt. What anatomical structure could produce such a swelling?

53. Case C
An intravenous pyelogram revealed that a patient’s left kidney was in its normal position, but the right kidney was situated in front of the right sacroiliac joint. Can you explain this on embryological grounds?

54. Case D
An examination of a patient revealed that she had a horseshoe kidney. What anatomical structure prevents a horseshoe kidney from ascending to a level above the umbilicus?

55. Case E
An intravenous pyelogram revealed that the calyces and pelvis of a patient’s right kidney were grossly dilated (a condition known as hydronephrosis). What embryological anomaly may be responsible for this condition?

56. Case F
Which congenital anomaly of the ureter is likely to present as a case of urinary incontinence?

57. operation procedure
of kidney transplant

58. nephrectomy
For a nephrectomy, the kidney commonly is exposed in the loin. After an oblique incision midway between the twelfth rib and the iliac crest, the posterior free border of the external oblique is identified, and divided to reveal the peritoneum, which is pushed forward to reveal the renal fascia. The subcostal nerve and vessels are preserved; the renal fascia is opened; and the kidney exposed. Care must be taken not to damage the pleura, since it is separated from the upper pole of the kidney only by the diaphragm.
Posterior surgical approach
Since the kidneys lie in part above the twelfth rib, a direct posterior approach might pass first into the thorax, perforating the pleural cavity. A posterior approach to the kidney also puts at risk the subcostal and iliohypogastric nerves which pass laterally behind the kidney.