Renal Anatomy

General Overview

The kidneys are bean-shaped organs located retroperitoneally (behind the

peritoneum) on either side of the vertebral column.

Renal Functional Anatomy

1. Nephron: The basic functional unit of the kidney. Each kidney contains
approximately 1 to 1.5 million nephrons. Each nephron consists of:

• Glomerulus: A tuft of small blood vessels where blood filtration begins.

• Bowman's Capsule: Surrounds the glomerulus and captures the filtrate.

• Renal Tubule: Divided into the proximal convoluted tubule, loop of Henle,
distal convoluted tubule.

2. Collecting Ducts: Receive urine from nephrons and pass it into the renal
calyces.

3. Excretory Pathway (Renal Calyces and Pelvis):

• Minor Calyces: These funnel-

shaped structures collect urine
from the collecting ducts at the
tip of each renal pyramid.

• Major Calyces: They receive

urine from several minor calyces.

• Renal Pelvis: This is the central

collecting chamber within the
kidney, which receives urine from
all the major calyces. The renal
pelvis then narrows to become
the ureter, which carries the urine to the bladder.

Thus, each kidney has one pelvis which then becomes the ureter.
Anatomy of the Glomerular Membrane

The glomerular membrane (or glomerular filtration barrier) is crucial for the kidney's ability to filter
blood and form urine. Here are the detailed components:

1. Capillary Endothelium:

• This is the innermost layer of the glomerular membrane. The endothelial cells are fenestrated,
meaning they have small pores. These pores allow for the free passage of blood plasma while
restricting the passage of > 100 nm molecules and blood cells.

2. Glomerular Basement Membrane (GBM):

• This is the central layer and is

composed of a dense matrix of
type IV collagen chains and
heparan sulfate, which provide
structural support. This layer is
negatively charged, which
helps to repel negatively charged
molecules such as plasma
proteins, thereby preventing
their filtration.

3. Podocytes:

• These are specialized epithelial

cells that cover the outer side of the glomerular capillaries. Podocytes have foot processes
(FPs; pedicels) that interdigitate with one another, leaving filtration slits between them. These
slits are covered by a thin diaphragm that further restricts the passage of molecules > 40–50
nm like albumin.

• The negative charge on the podocytes also contributes to the selective filtration barrier,
enhancing the repulsion of anions (-).
Renal Parenchyma

1- Cortex: The outer layer of the kidney where the majority of glomeruli are located. The renal cortex
also contains the proximal and distal convoluted tubules.

2- Medulla: The inner region of the kidney,

composed of the renal pyramids, which are
cone-shaped masses composed primarily of
the loops of Henle, vasa recta, and
collecting ducts. The apex (tip) of each
pyramid, known as the renal papilla, empties
urine into the minor calyces.

Blood Supply

• Renal Artery: Branches off from the

abdominal aorta and enters each kidney at
the hilum.

• The renal artery then branches into smaller and smaller arteries:

• Segmental arteries

• Interlobar arteries (between the renal pyramids)

• Arcuate arteries (curve around the base of the pyramids)

• Interlobular arteries (up into the cortex)

• Afferent Arterioles: Each feeds a single glomerulus where

filtration occurs.

• Efferent Arterioles: Each leaves the glomerulus and gives rise to

the peritubular capillaries and vasa recta.

• Renal medulla receives significantly less blood flow than the

renal cortex. This makes medulla very sensitive to hypoxia and
vulnerable to ischemic damage.
Venous Drainage

• Venules: Collect blood from the capillary networks of the

nephrons.

• Interlobular Veins: Collect from the venules

• Arcuate Veins: Follow the arcuate arteries (curve around

the base of the pyramids).

• Interlobar Veins: Drain the arcuate veins and then merge

into segmental vein which drain into the renal vein (between
the renal pyramids).

• Renal Veins: leave the kidneys at the hilum and empty into
the inferior vena cava.

• Left renal vein receives two additional veins: left

suprarenal and left gonadal veins.

Anatomy of the Ureter

1. Origin and Path:

• The ureter arises from the renal pelvis of

each kidney, and then travels downward,
retroperitoneally throughout its course.

2. Crossing Points:

• The ureters travel inferiorly, and in their course, they

pass under (posterior to) the gonadal arteries
(testicular or ovarian arteries).

• They then cross over (anterior to) the common iliac

arteries.

• As the ureters enter the pelvis (your pelvis not your kidney’s pelvis) they pass under
(posterior to) the uterine artery in females or the vas deferens in males. This anatomical
relationship is crucial because these structures are often manipulated during gynecologic
(e.g., hysterectomy) or some urologic surgeries, making the ureters vulnerable to damage.

• The portion of the ureter that traverses the bladder wall (intramural
ureter) is compressed during bladder contraction. This compression
helps prevent the backflow (reflux) of urine from the bladder back into
the ureters, which is a critical mechanism to prevent kidney damage.
Blood Supply to the Ureter

• Proximal Segment: Supplied by branches from the renal arteries.

• Middle Segment: Receives blood supply from the gonadal artery, aorta, and common and internal
iliac arteries (i.e., anastomosis).

• Distal Segment: Primarily supplied by the internal iliac and superior

vesical arteries.

Common Points of Ureteral Obstruction

1. Ureteropelvic Junction (UPJ): This is where the ureter leaves the renal
pelvis. Obstruction here can be due to congenital abnormalities (last to
canalize, wait for the embryology lecture), stones, or fibrosis.

2. Pelvic Inlet: As the ureter crosses the pelvic brim, it can be

compressed or obstructed by pelvic tumors, fibrosis, or during
pregnancy.

3. Ureterovesical Junction (UVJ): Where the ureter enters the

bladder. Obstructions at this point can be due to ureteral stones,
congenital anomalies (like vesicoureteral reflux – i.e., shortened
intravesical ureter), or iatrogenic injuries.

Where’s the obstruction?

Renal Transplantation

• During kidney transplantation, the donor's left kidney is preferred because it has a longer renal
vein. This extended length of the renal vein facilitates the process of vascular anastomosis—the
surgical connection of blood vessels—during transplantation. In addition to the kidney, the
transplantation also includes the proximal third of the ureter, as well as the renal vein and artery,
from the donor.

• The native (diseased) kidneys are typically left in place, and

the donor left kidney is placed retroperitoneally in the right
iliac fossa.

• Blood supply is established by anastomosing the donor

renal artery with the recipient's external iliac artery.

• Although the transplanted ureter will continue to receive

blood through the donor's renal artery, the most distal
portion may be susceptible to ischemia due to lack of
anastomotic connections. Distal ureteral ischemia is a
recognized complication of renal transplant and causes
leakage of urine 5-10 days following transplant.

Good Luck

- Hadeel