Kidneys and Suprarenal Glands

Gross Anatomy


Kidneys, Ureters and Suprarenal Glands


Anatomy Tables for Today's Topic

Viscera
Arteries
Veins
Lymphatics
Nerves

Viscera

Organ/Part of Organ Location/Description Notes
kidney excretory organ of the urinary tract located on the posterior abdominal wall retroperitoneal; right kidney is lower than the left - its superior pole reaches the 12th rib; superior pole of the left kidney reaches as high as the 11th rib; kidneys develop from the intermediate mesoderm in the embryo
calyx, minor portion of the urinary collecting system within the kidney that drains one renal papilla one renal papilla projects into the lumen of one minor calyx; several minor calyces unite to form a major calyx
calyx, major portion of the urinary collecting system within the kidney that drains several minor calyces major calyx collects urine from several renal papillae; all major calyces unite to form the renal pelvis
renal columns columns of tissue that are histologically identical to tissue found in the renal cortex, but which are located in the medulla between the renal pyramids interlobar arteries pass from the renal sinus to the renal cortex within the renal columns
renal cortex outer layer of kidney renal cortex contains the majority of the glomeruli
renal fascia a fascial pouch derived from extraperitoneal connective tissue that contains the kidneys, the suprarenal glands, the renal vessels and perirenal fat renal fascia of the right and left sides is joined across the midline in close relationship to the renal aa. and vv.; renal fascia encapsulates the inferior vena cava and aorta at the level of origin of the renal vessels; do not confuse renal fascia with the renal capsule - the renal capsule is histologically part of the kidney and there is no fat between it and the kidney
renal hilum opening on medial margin of the kidney leading into the renal sinus the renal vessels enter/leave the kidney at the hilum; the renal pelvis leaves the kidney at the hilum
renal medulla inner layer of the kidney renal medulla contains most of the tubules of the kidney organized as renal pyramids; renal columns consist of cortex-like tissue arranged between the pyramids in the renal medulla
renal papilla tip of renal pyramid projecting into a minor calyx several minor calyces combine to form a major calyx; all of the major calyces in the kidney unite to form the renal pelvis
renal pelvis large collecting duct for urine that is formed by the union of the major calyces renal pelvis is the dilated origin of the ureter; it is located at the renal hilum and is surrounded by the renal sinus
renal pyramid cone-shaped arrangement of tubules in the renal medulla tip of the renal pyramid (papilla) projects into a minor calyx
renal sinus hollowed out area on the medial margin of the kidney renal sinus opens at the renal hilum; it contains the renal aa. and vv., major calyces and renal pelvis, perirenal fat
suprarenal gland endocrine gland located superomedial to the kidney; right suprarenal gland is somewhat triangular in shape, left suprarenal gland is semilunar in sha suprarenal cortex manufactures corticosteroids; suprarenal medulla manufactures epinephrine and norepinephrine; suprarenal medulla receives preganglionic sympathetic innervation from the greater thoracic splanchnic n.; also known as: adrenal gland
ureter muscular tube that serves as the duct of the kidney to carry urine to the bladder ureter is continuous proximally with the renal pelvis; it passes over the pelvic brim medial to the testicular/ovarian vessels; it passes obliquely through the posterior wall of the urinary bladder and drains at the posterolateral angle of the vesical trigone

Arteries

Artery Source Branches Supply to Notes
celiac trunk abdominal aorta at the level of the T12-L1 intervertebral disc left gastric a., splenic a., common hepatic a. stomach, lower esophagus, liver, upper duodenum, pancreas, spleen celiac trunk supplies the foregut derivatives
lumbar abdominal aorta anterior br., posterior br., spinal br. psoas major m., psoas minor m., quadratus lumborum m., spinal cord and vertebral column, deep back muscles the 4 lumbar arteries on each side arise from the posterior surface of the aorta at the level of vertebrae L1-L4; they course posterior to the psoas major m.
phrenic, inferior abdominal aorta superior suprarenal aa. diaphragm, suprarenal gland inferior phrenic a. is the first abdominal branch of the aorta; it may arise from the celiac trunk
renal abdominal aorta at the level of the upper border of the L2 vertebra inferior suprarenal a., apical segmental a., anterior br: superior anterior segmental a., middle anterior segmental a., inferior segmental a.; posterior br.: posterior segmental a. kidney, upper ureter, suprarenal gland the right renal a. is longer than the left renal artery; the right renal artery passes posterior to the inferior vena cava
splenic celiac trunk dorsal pancreatic a., pancreatic brs., pancreatica magna a., caudal pancreatic a., short gastric aa., left gastro-omental a., splenic brs. pancreas, spleen, greater curvature of the stomach splenic a. courses through the substance of the pancreas near its superior border; splenic artery is very tortuous
suprarenal, inferior renal a. numerous unnamed branches inferior aspect of the suprarenal gland inferior suprarenal a. may anastomose with the superior suprarenal a.
suprarenal, middle abdominal aorta numerous unnamed branches medial side of the suprarenal gland middle suprarenal a. anastomoses with the superior suprarenal a. and the inferior suprarenal a.
suprarenal, superior inferior phrenic a. multiple small aa. superior aspect of the suprarenal gland superior suprarenal aa. are numerous small vessels that enter the suprarenal gland independently

Veins

Vein Tributaries Drains Into Regions Drained Notes
inferior vena cava formed by the union of the paired common iliac vv; tributaries: lumbar vv. 1-4, right ovarian/testicular v., renal vv., right suprarenal v., right inferior phrenic v., hepatic vv. right atrium all of the body below the level of the respiratory diaphragm the inferior vena cava is longer than the abdominal aorta
lumbar, ascending lumbar vv. 1-4 right: azygos v.; left: hemiazygos v. posterior abdominal wall ascending lumbar v. connects adjacent lumbar vv.
phrenic, inferior unnamed tributaries from the respiratory diaphragm right: inferior vena cava; left: left suprarenal v. or inferior vena cava diaphragm left inferior phrenic v. may be paired
renal, left left ovarian/testicular v., left suprarenal v., sometime the left inferior phrenic v. inferior vena cava left ovary/testis; left ureter; left kidney; left suprarenal gland; left part of the respiratory diaphragm left renal v. crosses the abdominal aorta under the origin of the superior mesenteric a., creating a site of potential compression of the left renal vein
renal, right multiple tributaries exit the kidney inferior vena cava right kidney right renal v. is shorter than the left renal v.
suprarenal v. no named tributaries left: left renal v.; right: inferior vena cava suprarenal gland left suprarenal v. is usually joined by the left inferior phrenic v.; also known as: central v. of the suprarenal

Lymphatics

Structure Location Afferents from Efferents to Regions drained Notes
cisterna chyli between the abdominal aorta and the inferior vena cava anterior to the body of the L1 or L2 vertebra right and & left lumbar trunks; possibly the intestinal trunk thoracic duct all of the body below the respiratory diaphragm; all of the abdominal and pelvic viscera cisterna chyli is an enlargement of the lower end of the thoracic duct; it occurs in about 25% of individuals
intestinal lymphatic trunk left side of the abdominal aorta or between the abdominal aorta and the inferior vena cava near the level of the superior mesenteric artery union of efferent lymphatic vessels from the celiac nodes and superior mesenteric nodes left lumbar trunk or the cisterna chyli/thoracic duct large and small intestines intestinal lymph trunk carries lymph that is rich in fat; drains into the left lumbar trunk (70%), cisterna chyli (25%) or right lumbar trunk (5%)
lateral aortic nodes along the inferior vena cava and abdominal aorta from the aortic bifurcation to the aortic hiatus of the diaphragm common iliac nodes; lymphatic vessels from the posterior abdominal wall and viscera efferents form one lumbar trunk on each side lower limb; pelvic organs; perineum; anterior and posterior abdominal wall; kidney; suprarenal gland; respiratory diaphragm also known as: lumbar nodes; the intestinal trunk drains into to the left lumbar trunk; the lumbar trunks unite to form the thoracic duct/cisterna chyli
lumbar nodes along the inferior vena cava and abdominal aorta from the aortic bifurcation to the aortic hiatus of the diaphragm common iliac nodes; lymphatic vessels from the posterior abdominal wall and viscera efferents form one lumbar trunk on each side lower limb; pelvic organs; perineum; anterior and posterior abdominal wall; kidney; suprarenal gland; respiratory diaphragm also known as: lateral aortic nodes; the intestinal trunk drains into to the left lumbar trunk; the lumbar trunks unite to form the thoracic duct/cisterna chyli
lumbar trunk between the lumbar vertebral bodies and inferior vena cava (right) or aorta (left) at the upper end of the lumbar chain of nodes lumbar (lateral aortic) nodes; the intestinal trunk joins the left lumbar trunk thoracic duct/cisterna chyli left lumbar trunk - left side of the body below the respiratory diaphragm, gut; right lumbar trunk - right side of body below the diaphragm lumbar trunks unite to form the lower end of the thoracic duct; an enlargement of the lower end of the thoracic duct (called the cisterna chyli) occurs in about 25% of individuals, and when it is present, the lumbar trunks drain into it
thoracic duct between the esophagus anteriorly and the thoracic vertebral bodies posteriorly formed by the union of the lumbar lymph trunks, sometimes dilated to form a cisterna chyli junction of the left subclavian v. and the left internal jugular v. all of the body and limbs below the respiratory diaphragm; the left side of the chest, left upper limb and the left side of the head and neck above the diaphragm thoracic duct is the largest lymphatic vessel; it passes through the aortic hiatus on the right side of aorta; it swings to the left side of the esophagus at the T4-T5 intervertebral disc (at the level of the sternal angle)

Nerves

Nerve Source Branches Motor Sensory Notes
splanchnic, greater thoracic neurons in the intermediolateral cell column of spinal cord levels T5-T9; the greater thoracic splanchnic nerve arises by multiple contributions from the sympathetic trunk no named branches celiac ganglion; preganglionic fibers supply the adrenal medulla which releases epinephrine and norepinephrine into the blood pain from the abdominal viscera greater thoracic splanchnic n. passes through the crus of the respiratory diaphragm; postganglionic processes from the celiac ganglion spread down the aorta and distribute with its branches; they innervate the vascular smooth muscle of these vessels and the organs supplied
splanchnic, least thoracic neurons in the intermediolateral cell column of spinal cord level T12 no named branches renal plexus pain from the kidney and suprarenal gland least thoracic splanchnic n. passes through the crus of the diaphragm; it synapses in minute ganglia located in the renal plexus
splanchnic, lesser thoracic neurons in the intermediolateral cell column of spinal cord levels T10-T11; the lesser thoracic splanchnic nerve arises by multiple contributions from the sympathetic trunk no named branches aorticorenal ganglion pain from the kidney and suprarenal gland lesser thoracic splanchnic n. passes through the crus of the respiratory diaphragm; postganglionic processes from the ganglion supply vascular smooth muscle of branches of the renal a. and suprarenal aa.; kidney and suprarenal gland
vagus n. medulla: dorsal motor nucleus (GVE preganglionic parasympathetic); inferior ganglion (GVA); nucleus ambiguus (SVE); superior ganglion (GSA); inferior ganglion(SVA) auricular br., pharyngeal br., superior laryngeal, superior and inferior cervical cardiac brs., recurrent laryngeal n., thoracic cardiac brs., brs. to the pulmonary plexus, brs. to the esophageal plexus, anterior and posterior vagal trunks SVE: intrinsic muscles of the larynx, pharynx (except stylopharyngeus), and palate (except tensor veli palatini); GVE: smooth muscle of the respiratory tree & gut (proximal to the left colic flexure), heart; secretomotor: mucous glands of the larynx, respiratory tree, pharynx and gut; secretomotor to digestive glands GSA: skin of the external auditory meatus; GVA: viscera of head, neck, thorax & abdomen proximal to the left colic flexure; SVA: taste from the epiglottis also known as: CN X, 10th cranial nerve; the vagus n. passes through the jugular foramen to exit the posterior cranial fossa; vagus means "wanderer" in reference to its extensive distribution to the body cavities
celiac ganglion preganglionic sympathetic axons arrive via the greater thoracic splanchnic n. postganglionic sympathetic axons distribute via the celiac plexus along brs. of the celiac trunk vascular smooth muscle of the brs. of the celiac trunk pain from the stomach, liver & biliary system, spleen, upper half of the duodenum & pancreas a sympathetic ganglion; usually 2 celiac ganglia are located on the abdominal aorta at the origin of the celiac trunk; brs. of the vagal trunks pass through the celiac ganglion without synapsing
aorticorenal ganglion preganglionic sympathetic via the lesser thoracic splanchnic n. brs. to the renal plexus vascular smooth muscle of the brs. of the renal aa. pain from the kidney, suprarenal gland, upper ureter a sympathetic ganglion; located above or near the origin of the renal a. from the abdominal aorta
preaortic ganglia splanchnic nn. plexuses to abdominal and pelvic viscera vascular smooth muscle of vessels that supply abdominopelvic viscera pain from abdominopelvic viscera also known as: collateral ganglia which include the celiac ganglion, aorticorenal ganglion, superior mesenteric ganglion and inferior mesenteric ganglion; preganglionic parasympathetic axons of vagal trunk origin pass through the preaortic ganglia but do not synapse there
esophageal plexus right and left vagus (X) nn.; thoracic visceral brs. of the sympathetic trunk anterior and posterior vagal trunks preganglionic parasympathetic axons from the vagus n. supply smooth muscle and glands of the thoracic esophagus and abdominal gut and its derivatives proximal to the left colic flexure; postganglionic sympathetic axons from the thoracic visceral brs. supply vascular smooth muscle in the esophageal vessels vagus: GVA from the esophagus and abdominal gut proximal to the left colic flexure; thoracic visceral brs.carry pain from the esophagus during development of the gut, the stomach and esophagus rotate 90° to the right with the result that the left and right vagus nerves mix in the esophageal plexus and emerge as anterior and posterior vagal trunks


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Some of the material presented in these tables is contained in the book:
MedCharts Anatomy by Thomas R. Gest and Jaye Schlesinger
Published by ILOC, Inc., New York. Copyright 1995.

Content of these tables has been edited for use in this course by Patrick W. Tank, Ph.D.
Copyright 2005, Department of Neurobiology and Developmental Sciences, University of Arkansas for Medical Sciences.

Unauthorized use is prohibited.