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Renal System Renal System Anatomy & Anatomy & PHYSIOLOGYPHYSIOLOGY
DR. AMAR UL-ALA BUTTDR. AMAR UL-ALA BUTTCONSULTANT UROLOGISTCONSULTANT UROLOGIST06-R-M-12967 (MOH 88/458)06-R-M-12967 (MOH 88/458)BURAIDAH CENTRAL BURAIDAH CENTRAL HOSPITAL(7/1)HOSPITAL(7/1)
Renal system summaryRenal system summary
Functions:Functions:1. Remove wastes from the body (urine)1. Remove wastes from the body (urine)
2. Regulates fluid balance, maintains homeostasis2. Regulates fluid balance, maintains homeostasis
Structures:Structures: 2 kidneys2 kidneys - filter blood, produce urine- filter blood, produce urine 2 ureters2 ureters - transport urine (kidneys to bladder)- transport urine (kidneys to bladder) bladderbladder - reservoir for urine- reservoir for urine urethraurethra - transport of urine- transport of urine
Renal anatomyRenal anatomy
lies retroperitoneal, on lies retroperitoneal, on posterior abdominal wallposterior abdominal wall
lies from T12-L3 of lies from T12-L3 of vertebral column, next to vertebral column, next to m. psoas majorm. psoas major
superior parts are superior parts are protected by ribs 11, 12protected by ribs 11, 12
tilted: superior poles are tilted: superior poles are closer to midline than closer to midline than inferiorinferior
KIDNEY KIDNEY FEATURES FEATURES
2 Poles2 Poles– UpperUpper– LowerLower
2 Borders2 Borders– LateralLateral– MedialMedial – – has hilumhas hilum
2 Surfaces2 Surfaces– AnteriorAnterior– PosteriorPosterior
RIGHT KIDNEY RIGHT KIDNEY ANTERIOR RELATIONSANTERIOR RELATIONS
Right suprarenal glandRight suprarenal gland
LiverLiver
DuodenumDuodenum
ColonColon
Coils of small intestineCoils of small intestine
LEFT KIDNEYLEFT KIDNEY ANTERIOR RELATIONSANTERIOR RELATIONS
Left suprarenal glandLeft suprarenal gland
Stomach Stomach
Spleen Spleen
Pancreas Pancreas
ColonColon
Coils of small intestineCoils of small intestine
KIDNEYKIDNEY POSTERIOR RELATIONSPOSTERIOR RELATIONS
Diaphragm Psoas
major
Transversus abdominis
Quadratuslumborum
Last ribsIlioinguinal
NIliohypo-gastric N
Rt Lt
Renal anatomyRenal anatomy
R kidney R kidney lowerlower than L than L (due to R lobe of liver)(due to R lobe of liver)
~ 12cm long x 5cm ~ 12cm long x 5cm
wide x 2.5cm thickwide x 2.5cm thick
bean-shaped , bean-shaped , reddish- brown organsreddish- brown organs
renal hilumrenal hilum
kidney levels change kidney levels change during respiration and during respiration and postural changespostural changes
External surface – 3 layers of External surface – 3 layers of tissuetissue
1.1. renal fasciarenal fascia (outer) (outer)– CT attaches kidney to CT attaches kidney to
posterior abdominal wall posterior abdominal wall – flexible, allows kidney – flexible, allows kidney to move with respirationto move with respiration
– covered by layer of fatcovered by layer of fat
2. 2. perirenal fatperirenal fat (middle (middle layer)layer)– protective cushionprotective cushion
3. 3. renal capsulerenal capsule ( (innermost)innermost)– layer of collagen fibres - layer of collagen fibres -
barrier against trauma, barrier against trauma, infection etc.infection etc.
– kidney hangs suspended kidney hangs suspended by collagen fibres and by collagen fibres and packed in soft cushion of packed in soft cushion of adipose tissueadipose tissue
Internal anatomyInternal anatomy
outer outer cortexcortex, inner , inner medullamedulla
6-18 conical 6-18 conical renal renal pyramidspyramids
apex - apex - renal papillarenal papilla projects into the projects into the renal renal sinussinus
renal columnsrenal columns extend from cortex inward extend from cortex inward
to renal sinus between to renal sinus between adjacent renal pyramidsadjacent renal pyramids
granular texture similar to granular texture similar to that of the cortexthat of the cortex
Internal anatomyInternal anatomy
ureter enters renal sinus, it ureter enters renal sinus, it expands to form a chamber expands to form a chamber called - called - renal pelvisrenal pelvis
pelvis branches to form 2-3 pelvis branches to form 2-3 major calycesmajor calyces
branch further to form 6-8 branch further to form 6-8 minor calycesminor calyces
Each minor calyx surrounds Each minor calyx surrounds the papilla of a renal the papilla of a renal pyramidpyramid
ducts within papilla connect ducts within papilla connect to wall of the calyx and to wall of the calyx and discharge urine produced in discharge urine produced in the cortex and medullathe cortex and medulla
Urine passes through the Urine passes through the calyces into the uretercalyces into the ureter
Left kidney: coronal sectionLeft kidney: coronal section
KIDNEY KIDNEY BLOOD SUPPLYBLOOD SUPPLY
IVC
Abdominal aorta
Renal A Renal V
Blood supply to the kidney:Blood supply to the kidney:
Renal arteriesRenal arteries from abdominal aorta enter hilum and branch: from abdominal aorta enter hilum and branch:
1. 1. Interlobar arteriesInterlobar arteries - pass through renal columns and reach - pass through renal columns and reach junction between medulla and cortexjunction between medulla and cortex
2. 2. Arcuate arteriesArcuate arteries run parallel with the base of the pyramids run parallel with the base of the pyramids
3. 3. Interlobular arteriesInterlobular arteries move up into the cortex and branch to move up into the cortex and branch to form the afferent arteriole form the afferent arteriole
The The peritubular capillariesperitubular capillaries unite to form the interlobular unite to form the interlobular veins, arcuate vein, interlobar vein, renal veinveins, arcuate vein, interlobar vein, renal vein
The The renal veinrenal vein exits at hilus and joins the IVC exits at hilus and joins the IVC
Blood supply to kidneyBlood supply to kidney
NephronNephron
= Functional unit of the kidney, ~ 1.2 million nephrons per kidney!= Functional unit of the kidney, ~ 1.2 million nephrons per kidney!
Tubular components:Tubular components:1. 1. Glomerular (Bowman’s) capsuleGlomerular (Bowman’s) capsule – double-walled cup – double-walled cup
– simple squamous epitheliumsimple squamous epithelium
2. 2. Proximal convoluted tubuleProximal convoluted tubule - coiled 1- coiled 1stst section section– simple cuboidal epithelium with microvillisimple cuboidal epithelium with microvilli
3. 3. Loop of HenleLoop of Henle - hair-pin loop - hair-pin loop– thin descending limb, thick ascending limbthin descending limb, thick ascending limb
4. 4. Distal convoluted tubuleDistal convoluted tubule - last section - last section – simple cuboidal epitheliumsimple cuboidal epithelium– specialised region - Juxta glomerular apparatusspecialised region - Juxta glomerular apparatus
Distal convoluted tubule opens into the collecting system Distal convoluted tubule opens into the collecting system collecting ductscollecting ducts papillary ducts papillary ducts minor calyx… minor calyx…
Nephron Nephron
Vascular component of Vascular component of nephronnephron
Made up of blood vessels:Made up of blood vessels:
1. 1. GlomerulusGlomerulus - network of capillaries within Bowman’s - network of capillaries within Bowman’s capsulecapsule
2. 2. Afferent arterioleAfferent arteriole - leading into glomerulus - leading into glomerulus
3. 3. Efferent arterioleEfferent arteriole - leading out of glomerulus - leading out of glomerulus
4. 4. Peritubular capillariesPeritubular capillaries - surrounding tubules - surrounding tubules
5. 5. Vasa rectaVasa recta - specialised loops of blood vessels around - specialised loops of blood vessels around long long Loop of Henle (juxtamedullary Loop of Henle (juxtamedullary nephrons)nephrons)
Nephrons:Nephrons: 85% are cortical, 15% are juxtamedullary 85% are cortical, 15% are juxtamedullary
Renal corpuscleRenal corpuscle
Ureters Ureters Pyelogram (colour-enhanced)Pyelogram (colour-enhanced)
tubes that transport urine from tubes that transport urine from renal pelvis to bladderrenal pelvis to bladder
20-30 cm long20-30 cm long
muscular walls - peristaltic muscular walls - peristaltic waves force urine down to waves force urine down to bladderbladder
retroperitonealretroperitoneal
pressure in the bladder pressure in the bladder compresses ureter, helps compresses ureter, helps prevent backflow of urineprevent backflow of urine
(physiological valve) - still allows (physiological valve) - still allows urine to flow into the bladderurine to flow into the bladder
RIGHT URETER, RIGHT URETER, RELATIONSRELATIONS
– AnteriorlyAnteriorly DuodenumDuodenum Terminal part of ileumTerminal part of ileum Right colic & iliocolic vesselsRight colic & iliocolic vessels Right gonadal vesselsRight gonadal vessels Root of mesentryRoot of mesentry
– PosteriorlyPosteriorly Right psoas major muscleRight psoas major muscle Bifurcation of right common iliac ABifurcation of right common iliac A
LEFT URETER, LEFT URETER, RELATIONSRELATIONS
– AnteriorlyAnteriorly Sigmoid colonSigmoid colon Sigmoid mesocolonSigmoid mesocolon Left colic vesselsLeft colic vessels Left gonadal vesselsLeft gonadal vessels
– PosteriorlyPosteriorly Left psoas major muscleLeft psoas major muscle Bifurcation of left common iliac ABifurcation of left common iliac A
URETER URETER CONSTRICTIONSCONSTRICTIONS
1.1. Where it joins Where it joins
the the renal pelvisrenal pelvis
2.2. Where it crosses Where it crosses
the the pelvic brimpelvic brim
3.3. Where it piercesWhere it pierces
the the bladder wallbladder wall
BladderBladder
hollow muscular organhollow muscular organ retroperitoneal, posterior retroperitoneal, posterior
to pubic symphysisto pubic symphysis
Capacity ~ 300-400 ml Capacity ~ 300-400 ml (max = 1000 ml)(max = 1000 ml)
empty: looks like a empty: looks like a deflated balloon, deflated balloon, rugaerugae
full spherical rises above full spherical rises above abdominal cavityabdominal cavity
Males: anterior to rectum, Males: anterior to rectum, above prostateabove prostate
Females: inferior to Females: inferior to uterus, anterior to vaginauterus, anterior to vagina
URINARY BLADDER URINARY BLADDER FEATURESFEATURES
Apex:Apex: points anteriorly---points anteriorly---median median umbilical lig.umbilical lig.
Base:Base: (posterior surface) (posterior surface)
Superior surfaceSuperior surface
2 Inferiolateral surfaces2 Inferiolateral surfaces
Neck:Neck: rests on rests on prostateprostate
Support of bladderSupport of bladder
superior surfaces - superior surfaces - peritoneumperitoneum
middle umbilical ligamentmiddle umbilical ligament - - superior border to umbilicussuperior border to umbilicus
lateral umbilical ligamentslateral umbilical ligaments - - sides of bladder to umbilicussides of bladder to umbilicus
At base, tough ligamentous At base, tough ligamentous bands anchor bladder to bands anchor bladder to pelvic and pubic bonespelvic and pubic bones
TrigoneTrigone : triangular area : triangular area bounded by openings of bounded by openings of ureters and exit to urethraureters and exit to urethra
cystitis - inflammation of the cystitis - inflammation of the bladder wallbladder wall
Cross section of ureter & Cross section of ureter & bladderbladder
lined by transitional epithelium lined by transitional epithelium to allow for stretch of wallto allow for stretch of wall
lamina proprialamina propria - - mucous membranemucous membrane– elastin fibreselastin fibres
smooth muscle (smooth muscle (m. m. detrusor)detrusor)– inner and outer longitudinalinner and outer longitudinal– middle circularmiddle circular
contraction compresses contraction compresses bladder and expels contents bladder and expels contents into urethrainto urethra
internal sphincter - internal sphincter - involuntary controlinvoluntary control
Urethra Urethra
FemaleFemale ~ 4cm long ~ 4cm long– opens to exterior opens to exterior
between clitoris and between clitoris and vaginal openingvaginal opening
MaleMale ~ 20 cm long~ 20 cm long– passes through prostate passes through prostate
glandgland
– pierces urogenital pierces urogenital diaphragmdiaphragm
– enters penis and enters penis and extends throughout extends throughout lengthlength
– opens at urethral orificeopens at urethral orifice
MALE URETHRA MALE URETHRA PARTSPARTSProstatic part:Prostatic part:
– The widest partThe widest part– About 3 cmAbout 3 cm
Membranous part:Membranous part:– In the urogenital diaphragmIn the urogenital diaphragm– About 1.25 cmAbout 1.25 cm
Penile part:Penile part:– In the penisIn the penis– About 15 – 16 cm longAbout 15 – 16 cm long
FUNCTIONS OF THE FUNCTIONS OF THE KIDNEYKIDNEY
1) Regulate the osmotic pressure (osmolality) 1) Regulate the osmotic pressure (osmolality) of the body fluids by excreting osmotically of the body fluids by excreting osmotically dilute or concentrated urine.dilute or concentrated urine.
2) Regulate the concentrations of numerous 2) Regulate the concentrations of numerous ions in blood plasma, including Na, K, Ca, ions in blood plasma, including Na, K, Ca, Mg, Cl, bicarbonate (HCO3), phosphate, and Mg, Cl, bicarbonate (HCO3), phosphate, and sulfate.sulfate.
3) Play an essential role in acid-base balance 3) Play an essential role in acid-base balance by excreting H, when there is excess acid or by excreting H, when there is excess acid or HCO3, when there is excess base.HCO3, when there is excess base.
FUNCTIONS OF THE FUNCTIONS OF THE KIDNEY KIDNEY 4) Regulate the volume of the ECF by 4) Regulate the volume of the ECF by
controlling Na and water excretion.controlling Na and water excretion.
5) Help to regulate arterial blood pressure by 5) Help to regulate arterial blood pressure by adjusting Na excretion and producing various adjusting Na excretion and producing various substances (e.g.,renin) that can affect blood substances (e.g.,renin) that can affect blood pressure.pressure.
6) Eliminate the waste products of metabolism, 6) Eliminate the waste products of metabolism, including urea (the main nitrogen-containing including urea (the main nitrogen-containing end-product of protein metabolism in end-product of protein metabolism in humans), uric acid (an end-product of purine humans), uric acid (an end-product of purine metabolism), and creatinine (an end-product metabolism), and creatinine (an end-product of muscle metabolism).of muscle metabolism).
FUNCTIONS OF THE FUNCTIONS OF THE KIDNEY KIDNEY 7) Remove many drugs (e.g.penicillin) and 7) Remove many drugs (e.g.penicillin) and
foreign or toxic compounds.foreign or toxic compounds.
8) Are the major production sites of certain 8) Are the major production sites of certain hormones, including erythropoietin and hormones, including erythropoietin and 1,25-dihydroxy vitamin D3 1,25-dihydroxy vitamin D3
9) Degrade several polypeptide hormones, 9) Degrade several polypeptide hormones, including insulin, glucagon, and parathyroid including insulin, glucagon, and parathyroid hormonehormone
10) Synthesize ammonia, which plays a role in 10) Synthesize ammonia, which plays a role in acid-base balance acid-base balance
FUNCTIONS OF THE FUNCTIONS OF THE KIDNEY KIDNEY 11) Synthesize substances that affect renal 11) Synthesize substances that affect renal
blood flow and Na excretion, including blood flow and Na excretion, including arachidonic acid derivatives arachidonic acid derivatives (prostaglandins, thromboxane A2) and (prostaglandins, thromboxane A2) and kallikrein (a proteolytic enzyme that kallikrein (a proteolytic enzyme that results in the production of kinins).results in the production of kinins).
When the kidneys fail, a host of problems When the kidneys fail, a host of problems ensue. Dialysis and kidney transplantation ensue. Dialysis and kidney transplantation are commonly used treatments for are commonly used treatments for advanced (end-stage) renal failureadvanced (end-stage) renal failure
Bone StructureBone Structure
Vitamin DActivation
CalciumBalance
Blood FormationBlood Formation
ErythropoietinSynthesis
Cardiac ActivityCardiac Activity
PotassiumBalance
Regulation of Blood pHRegulation of Blood pH
Recovery ofBicarbonate
Blood PressureBlood Pressure
Water Balance
SodiumRemoval
MetabolicEnd Products
MetabolicEnd Products
Removal of Urea, Creatinine etc.
Functions of the Kidney Functions of the Kidney
Manifold Tasks of the Manifold Tasks of the KidneyKidney
Functions
Healthy Kidney
Functions of the Kidney Functions of the Kidney
Filtration and ReabsorptionFiltration and Reabsorption
1500 lblood per daythrough the renal arteries
180 l filtrate per dayin the glomeruli
60 l urine per dayat the end of the proximal tubules
20 l urine per dayat the beginning of the distal tubules
10 l urine per dayat the end of the distal tubules
1,5 l urine per dayat the end of the collecting ducts
real removal: 1,5 l urine
Healthy Kidney
Micturition reflex:Micturition reflex:
Stretch receptors stimulated when filled Stretch receptors stimulated when filled to ~ 220 mlto ~ 220 ml
afferent fibres to spinal cordafferent fibres to spinal cord motor neurons to sm in bladder wallmotor neurons to sm in bladder wall contracts m. detrusor and increases contracts m. detrusor and increases
pressurepressure
need to relax both internal and need to relax both internal and external sphincter - external under external sphincter - external under voluntary controlvoluntary control
if external sphincter does not relax, if external sphincter does not relax, internal sphincter remains closed & internal sphincter remains closed & sm in bladder wall relaxes againsm in bladder wall relaxes again
Once volume exceeds 500 ml, Once volume exceeds 500 ml, micturition reflex may generate micturition reflex may generate enough P to open internal sphincter enough P to open internal sphincter
leads to reflexive relaxation of leads to reflexive relaxation of external sphincterexternal sphincter
Thank youThank you
All the best with your studiesAll the best with your studies
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