14 The Kidneys


14 The Kidneys


General Facts

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



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.


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.

Renal Fascia

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.

Topographic Relationships

Fig. 14.2 Connections of the right kidney.


  • 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

  • Grynfeltt triangle


Right kidney:

  • liver

  • hepatoduodenal ligament

  • right colic flexure

  • transverse mesocolon

  • duodenum, descending part

  • ascending colon

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).

Lymph Drainage

  • 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

Organ Clock

Maximal time: 5-7p.m.

Minimal time: 5-7a.m.

Organ-Tooth Interrelationship

For basic information, see page 34.

  • Second incisor in the lower jaw on both sides

  • First incisor in the upper jaw on both sides

Movement Physiology according to Barral

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 3-4cmcaudally.

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.


Functions of the Kidney

  • 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


Symptoms that Require Medical Clarification

  • Pain elicited by percussion in the kidney area

  • Hematuria


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

Acute Pyelonephritis

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


  • pain elicited by percussion in the kidney area

  • flank pain

  • headache

  • sweating

  • nausea

  • vomiting

  • fever >38.5°C

Nephrotic Syndrome

Definition. Complex of symptoms, consisting of:

  • proteinuria

  • hypoproteinemia

  • dysproteinemia

  • hyperlipoproteinemia

  • edemas

Causes. We find primary or secondary preexisting glomerular disorders, e.g.:

  • poststreptococcal glomerulonephritis

  • rapidly progressive glomerulonephritis

  • systemic disorders, e.g., lupus erythematosus


  • microhematuria

  • edemas

  • hypertonicity

Renal Cell Carcinoma

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

Osteopathic Practice

Cardinal Symptoms

  • Pain elicited by percussion in the kidney area

  • Hematuria

Typical Dysfunctions

  • ptosis

  • adhesions/fixations

Theory of Kidney Ptosis according to Barral


  • ptosis up to the lesser pelvis is congenital

  • asthenic body

  • trauma (fall on the coccyx, vibrations)

  • rapid and extensive weight loss

  • depression

  • turgor effect decreases with increasing age

  • ptosis after childbirth

  • suction from below and pressure from above during delivery

  • loose ligaments

Ptosis of the Right Kidney

“Digestive kidney.” This name stems from the fact that the digestive tract has such a strong influence on the right kidney. See also “Notes for Clinical Application,” page 143.

The liver and ascending colon are the main factors affecting the kidney.

Ptosis of the right kidney is more common than ptosis of the left kidney because:

  • the large liver presses down more strongly

  • the Toldt fascia is weaker on the right side

  • the left colic flexure fixates more strongly

  • the scoliosis in the lumbar spinal column (LSC) brings the right kidney to anterior, which increases the pressure from the liver

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Jul 12, 2020 | Posted by in GASTROENTEROLOGY | Comments Off on 14 The Kidneys

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