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KIDNEY
Development
The third urinary organ, the metanephros, appears in the 5th week
and it is the permanent kidney. It comprises of two systems: collecting
system and the excretory system.
Collecting System
The collecting duct system develops from the ureteric bud which is
an outgrowth of the mesonephric duct close to its entrance to the cloaca.
The bud penetrates the metanephric tissue and is moulded at its distal
end which dilates and thus forming the primitive renal pelvis. Each calyx
as it penetrates the metanephric tissue form new buds and continues to
subdivide up to 12 times or more. This process continues till the end of
the 5th month. Minor calyces are formed from the 2nd generation by
absorbing the 3rd and the 4th generation. The ureteric bud gives rise to
ureter, renal pelvis, major and minor calyces and about 1-3 millions
collecting tubules.
ANATOMY 5
The cells of the metanephric tissue cap form small vesicles the
renal vesicles, which in turn form small tubules. These tubules together
with tufts of capillaries form the excretory unit known as the nephrons.
The proximal end of the nephrons which is indented by the glomerulus
forms the Bowman’s capsule. The distal end opens in to one of the
collecting ducts.
The kidney first develops in the pelvic region but ascends and lies
more cranially in the abdomen. This ascend is thought to be due to
diminution of body curvature and also due to the growth of the body in the
lumbar and sacral region.
Gross Anatomy
The renal hilum opens into the renal sinus, a space that forms the
central portion of the kidney and is surrounded by the renal parenchyma.
The urinary collecting structures and renal vessels occupy the renal sinus
and exit the kidney via the hilum medially.
The long axis of the kidney is parallel to the long axis of the 12 th rib.
The right kidney reaches the upper border of the 12th rib and the left
kidney reaches the lower border of the 11th rib. The outer border of the
organ lies about 1.25 cm lateral to the sacrospinalis muscle. The pelvis of
the kidney lies opposite the 1st & 2nd lumber transverse process. The
kidneys are remarkably mobile organs, and moves freely with respiration.
ANATOMY 6
Anatomic Relations
Upper pole of the right kidney is related with the right adrenal gland
and liver, the hepatic flexure below, 2nd part of duodenum medially and in
the lower pole is related to posterior peritoneum and right colic vessels lie
above it. The left kidney is related with to the left adrenal gland above, the
pancreas and the splenic vessels in the middle, the stomach and the
spleen lie above the pancreas and the jejunum below. Medially the right
kidney is related to inferior vena cava and the ureter. The left kidney is
related medially to dudenojejunal flexure, inferior mesenteric vein and the
ureter. The lateral aspect of the right kidney is related to the ascending
colon and the liver. The left kidney is related to the descending colon and
spleen laterally.
Coverings of kidney
Microscopic Anatomy
roughly parallels the external contour of the kidney. The renal cortex
covers the pyramids, not only peripherally but also extending between the
pyramids to the renal sinus. Microscopically, the renal parenchyma
consists of multiple tubular structures, in part the kidneys abundant
vascular and capillary networks, in part the various tubules that carry the
urinary filtrate, with scant intervening interstitial connective tissue in the
normal state.
Blood Supply
They are highly vascular organs, receiving one fifth of the total
cardiac output under normal conditions. Usually there is one renal artery,
a branch of the aorta that enters the hilum of the kidney between the
pelvis and the renal vein. It may branch before it reaches the kidney, and
2 or more separate arteries may be noted. In duplication of the pelvis and
ureter, it is usual for each renal segment to have its own arterial supply.
The renal artery divides into anterior and posterior branches. The
posterior branch supplies the mid segment of the posterior surface. The
anterior branch supplies both upper and lower poles as well as the entire
anterior surface. The renal arteries are all end arteries.
Nerve Supply
The renal nerves derived from the renal plexus accompany the
renal vessels throughout the renal parenchyma.
Lymphatics
The lymphatics of the kidney drain into the para aortic lymph nodes
at the level of the origin of the renal arteries. The lymphatics from the
upper pole may drain into the Posterior mediastinum.
ANATOMY 8
Relations
The calices are intrarenal and are intimately related to the renal
parenchyma. If the Renal pelvis is partly extrarenal, it lies along the
lateral border of the psoas muscle and on the quadratus lumborum
muscle; the renal vascular pedicle is placed just anterior to it. The left
renal pelvis lies at the level of the first or second lumbar vertebra; the
right pelvis is a little lower. As followed from above downward, the ureters
lie on the psoas muscles, pass medially to the sacroiliac joints, and then
swing laterally near the ischial spines before passing medially to
penetrate the base of the bladder. In females, the uterine arteries are
closely related to the juxtavesical portion of the ureters. The ureters are
covered by the posterior peritoneum; their lowermost portions are closely
attached to it, while the juxtavesical portions are embedded in vascular
retroperitoneal fat.
Histology
Blood Supply
The renal calices, pelvis, and upper ureters derive their blood
supply from the renal arteries; the mid ureter is fed by the internal
spermatic (or ovarian) arteries. The lowermost portion of the ureter is
served by branches from the common iliac, internal iliac (hypogastric),
and vesical arteries. The veins of the renal calices, pelvis, and ureters are
paired with the arteries.
Lymphatics
Development:
The rest of the Prostatic urethra and the Membranous urethra are
derived from the Pelvic part of the Definitive urogenital sinus. Penile part
of urethra (except terminal part) is derived from the epithelium of the
phallic part of the Definitive urogenital sinus. The terminal part of the
penile urethra, lying in the glans penis is derived from the Ectoderm.
ANATOMY 10
The female urethra is derived from the caudal part of the Vesico
urethral canal (endoderm). The posterior part is again of mesodermal
origin as it is formed by the absorbed mesonephric ducts. It has a slight
contribution from the pelvic part of the urogenital sinus.
Gross structure:
The male urethra is 18-20 cm long. In flaccid state, the long axis
shows 2 curvatures and therefore ‘S’ shaped. In erect state, the distal
curve is obliterated and it becomes ‘J’ shaped.
True ligaments
4. Posterior ligaments.
False ligaments are the peritoneal folds and don’t give true
supports to the urinary bladder. They include the median umbilical folds,
lateral false ligaments and posterior false ligaments.
Blood supply:
The main supply is from the superior vesicle artery and inferior
vesicle artery, branches from the anterior trunk of the internal iliac
arteries. Additional supply may be derived from the Obturator, Inferior
gluteal artery and in females from the Uterine and Vaginal arteries.
Lymphatic drainage:
Nerve supply:
PROSTATE
portion of the urogenital sinus. Its homologous counter part in the females
is Skene’s tubules.