Size: 12cm long, 7cm wide, and 3cm thick.

Posterior

Left kidney:

Upper pole: T11

Renal pelvis: L1

Lower pole: L3

The right kidney is located approximately 1–1.5cm lower than the left kidney.

Fig. 14.1 Location of the kidneys.

Anterior

Left kidney:

Upper pole: rib 9

Lower pole: 1–2cm above the navel

Right kidney:

Upper pole: rib 9

Lower pole: level of the navel

The axis of the kidney runs slightly diagonally from cranial–medial to caudal–lateral.

This consists of an anterior leaf and a posterior leaf. Both leaves merge superior and lateral to the kidneys. This “fascial sac” is open on the bottom.

The fascias of both kidneys merge at the level T12–L1 in front of the spinal column.

Retrorenal lamina:

This covers quadratus lumborum and psoas major and is fixed anteriorly and laterally to the spinal column (medial to the psoas and diaphragm).

Prerenal lamina:

This lies next to the peritoneum and Toldt fascia. On the left side, it is associated with this fascia in a larger area. It covers the kidney, hilum, and the large prevertebral vessels.

Both laminae surround the adrenal glands, merge superiorly, and are attached to the diaphragm.

Inside the fascial layers and surrounding the kidney, we find fat (fat capsule). This exists from about age 10 on.

Fig. 14.2 Connections of the right kidney.

Posterior

diaphragm and psoas arcade

pleura (indirectly in the area of the costodiaphragmatic recess up to the level of L1)

rib 12, on the left also rib 11

psoas major and its fascia

quadratus lumborum and transversus abdominis

subcostal, iliohypogastric, ilioinguinal nerves

Anterior

Right kidney:

liver

hepatoduodenal ligament

right colic flexure

transverse mesocolon

duodenum, descending part

Left kidney:

spleen

stomach

pancreas

duodenojejunal flexure

jejunum

left colic flexure (stronger fixation than on the right)

The adrenal glands lie superior to both kidneys.

turgor

pressure of other organs and tonicity of the abdominal muscles

fat capsule

hilar vessels and ureter (braking function)

thoracic suction effect and tonicity of the abdominal muscles during respiration

Fig. 14.3 Connections of the left kidney.

Renal artery (originates in the aorta, roughly 1 cm below the superior mesenteric artery; the left one is shorter than the right one).

Renal vein (left vein is longer than the right one, ends in the inferior vena cava).

lumbar nodes

lumbar trunk

thoracic duct

sympathetic nervous system from T10 to L1 via the lesser and lowest splanchnic nerves and the lumbar splanchnic nerves 1 and 2 to the celiac plexus, aorticorenal ganglion, renal plexus, and posterior renal ganglion

vagus nerves (via the celiac plexus)

sacral parasympathetic part (S2–S4) via the superior hypogastric plexus to the renal plexus

Maximal time: 5–7p.m.

Minimal time: 5–7a.m.

Three factors determine the movement of the kidneys:

1. The renal fascia is open toward the bottom and medially.
   
2. The hilum vessels pull on the kidney.
   
3. The psoas is a slide rail.

The engine of this movement is the diaphragm. During inhalation (20000/day, 600m/day), the kidney moves 3–4cm caudally.

The upper pole is pressed forward during inhalation (psoas slide rail). In addition, the kidney moves in a caudal–lateral direction and rotates outward.

During inhalation, we feel a movement from medial–cranial to lateral–caudal in connection with an outward rotation (“windshield wiper”). During exhalation, the kidney completes the opposite movement.

regulation of the fluids and electrolytes

regulation of the acid–base balance

excretion of substances through the urine (urea, creatinine, uric acid, etc.)

excretion of foreign substances (medications)

regulation of blood pressure (renin–angiotensin– aldosterone system)

hormone production (erythropoietin, renin, calcitriol, prostaglandins)

degradation of peptide hormones

Definition. Urinary stones in the kidney and excretory urinary tracts.

Causes. Excessive amounts of stone-forming substances in the urine.

Risk factors include:

lack of physical movement

insufficient fluid supply

familial predisposition

medications (calcium, vitamin C and D therapy)

gout

diabetes mellitus

kidney disorders

hyperparathyroidism

Clinical. Asymptomatic if the calculi do not constrict the urinary tracts.

Obstructing stone causes:

colic with hematuria

nausea

vomiting

abdominal pain

flank pain

pain radiating into the genitals and inside of the thighs

Definition. Infection of the upper urinary tract caused by pathogenic organisms.

Causes. Highly virulent organisms coinciding with a weakened state of defense.

Precipitating factors include:

stricture of the urinary tract

vesicoureteral reflux

neurogenic disturbance of bladder voiding

calculi

diabetes mellitus

immunosuppressive therapy

Clinical

pain elicited by percussion in the kidney area

flank pain

headache

sweating

nausea

vomiting

fever >38.5°C

Definition. Complex of symptoms, consisting of:

proteinuria

hypoproteinemia

dysproteinemia

hyperlipoproteinemia

edemas

poststreptococcal glomerulonephritis

rapidly progressive glomerulonephritis

systemic disorders, e.g., lupus erythematosus

Clinical

microhematuria

edemas

hypertonicity

Definition. Most common form of malignant tumor in the kidney, in most cases originating in the tubular cells.

Causes. Degeneration of proximal tubular cells.

hematuria

elevated ESR

palpable abdominal mass

hypertonicity

weight loss

anemia

intermittent fever

asymptomatic in the early stages