Anatomical Relations
The kidneys sit in close proximity to many other abdominal structures which are important to be aware of clinically:
Anterior
Posterior
Left
- Suprarenal gland
- Spleen
- Stomach
- Pancreas
- Left colic flexure
- Jejunum
- Diaphragm
- 11th and 12th ribs
- Psoas major, quadratus lumborum and transversus abdominis
- Subcostal, iliohypogastric and ilioinguinal nerves
Right
- Suprarenal gland
- Liver
- Duodenum
- Right colic flexure
- Diaphragm
- 12th rib
- Psoas major, quadratus lumborum and transversus abdominis
- Subcostal, iliohypogastric and ilioinguinal nerves
Arterial Supply
The kidneys are supplied with blood via the renal arteries, which arise directly from the abdominal aorta, immediately distal to the origin of the superior mesenteric artery. Due to the anatomical position of the abdominal aorta (slightly to the left of the midline), the right renal artery is longer, and crosses the vena cava posteriorly.
The renal artery enters the kidney via the renal hilum. At the hilum level, the renal artery forms an anterior and a posterior division, which carry 75% and 25% of the blood supply to the kidney, respectively. Five segmental arteries originate from these two divisions.
The avascular plane of the kidney (line of Brodel) is an imaginary line along the lateral and slightly posterior border of the kidney, which delineates the segments of the kidney supplied by the anterior and posterior divisions. It is an important access route for both open and endoscopic surgical access of the kidney, as it minimises the risk of damage to major arterial branches.