hi let's talk about the renal fascial spaces and their contents in this video we'll discuss
the relative locations and surroundings of the kidneys in the retroperitoneal space
the kidneys sit in the retroperitoneal space that is the space behind
the peritoneum approximately between the t11 and l3 vertebral levels although
not shown very well in this photograph the left kidney typically sits higher than the right kidney
generally the the left kidney is at about the t11 down to about the l2 vertebral level whereas the
right kidney is sitting at approximately the the t12 down to about the l3 vertebral level
but this is a rough estimation and the exact positions of the kidneys
are a little more dynamic than we give them credit for now if we look um the hilah of the kidneys
are best described at the l1 level we often times refer to that l1 level as the transpyloric plane
so if one were to look at the the superficial structures being the jugular notch which isn't
shown here but is palpable on on yourself at home and then the pubic symphysis which we can't quite
see here because the anterior abdominal wall is reflected anteriorly but again imminently
palpable at home the midpoint of that would be this transpyloric plane and it's going to coincide
with the plane at which the pyloric part of the stomach is going to empty into the
proximal part of the duodenum so if we were to kind of imagine the digestive system in here
here's our stomach and then that stomach is going to feed into the
duodenum there at the at the l1 level that transpyloric plane now even though the kidneys
are within the retroperitoneum they can move around their their position is um is
mobilizable through either the process of respiration so as the the diaphragm depresses or
by the action of gravity upon the kidneys as we'll discuss so here we have a um an inferior view of a
cross section or a transverse section of the body this would be approximately at the the l1 level
here is the right side and then this is the the midline there and we can see the kidney
here
and the kidney here is located within the retroperitoneal space so that
retroperitoneal space is everything that is posterior to the peritoneum
the peritoneum is a serous membrane lining the abdominal pelvic cavity there's a parietal
layer on the walls and a visceral layer on the organs and it is behind that posterior parietal
layer that we have this retroperitoneal space now the retroperitoneal space can
be further subdivided especially with respect to the kidney so there is
perirenal fascia sometimes just called renal fascia that is going to separate what are known as
perirenal spaces and the perirenal space would be the space within this fascia
from the pararenal spaces and the pararenal spaces are the spaces outside of that perirenal or just
renal fascia those pararenal spaces can be divided into anterior perirenal spaces and
posterior perirenal spaces that sometimes aren't even in contact with one another um one way that
that i remember perirenal from pereira renal is perirenal has an i for inside
the renal fascia now if we look here i really like this view because we can see
you know there's the parenchyma of the kidney but we can also see how the perirenal space
and its contents namely the perirenal fat can come within the renal sinus so here is
the hilum of the kidney and as we move beyond that plane we enter into a space that's surrounded by
kidney parenchyma which is the renal sinus now because these peri-renal and para-renal spaces
are imbued with a significant amount of adipose connective tissue sometimes with the rapid loss of
fat tissue um kidneys can become more mobile and so that puts a person at a greater risk of a
condition known as nephroptosis with nephroptosis so nephro meaning kidney and ptosis meaning
a sagging the the kidneys become displaced inferiorly and what happens there is gravity
can pull the kidneys down and this can emblematic because when the kidneys displace inferiorly that
conductive system for urine like the renal pelvis and proximal ureter can kink and cause
a blockage for urine to to pass smoothly along the ureter sometimes nephroptosis can
cannot resolve itself but it can acutely resolve itself when a person uh takes on a more recumbent
position so when they lie down the effect of gravity upon the kidney in that inferior
direction is lessened and they uh they can ascend back into their their more typical locations
so that peri-renal fascia that's the the fascia that is separating the peri-renal space from
the inside from the para-renal spaces on the outside of that fascia is oftentimes referred to
clinically as garota's fascia it's probably best conceptualized as an inverted cone it's
quite variable in its full extent but it tends to taper down towards the down towards the transition
of the abdominal cavity into the pelvis and so that's approximately in in the area where the
the common iliac vessels are but they can go down to where those common iliac vessels uh bifurcate
into external and internal iliac arteries um contained within this cone are the suprarenal
glands the kidney
and the ureters at least the the first and in
part of the ureter um referred to as the abdominal part of the ureter um sometimes
the proximal part of the the pelvic ureter can be within this fascia oftentimes however it is not
so when we look inside that fascia we can see all of the contents here so we can see that
suprarenal gland we can see the kidney we can see the ureter we can see a healthy amount
of perirenal fat within and so this this space sets up the the ability to remove
all of the contents within without disrupting contents outside of this space so um a nephrectomy
is the surgical removal of a kidney and a simple nephrectomy would be just the removal of the
kidney and the ligation of the renal vessels but a radical nephrectomy which may be called for
for a significant malignant disease would remove everything within that perirenal space
so suprarenal glands the kidney the the ureter the adipose connective tissue
any lymph nodes within there everything
and that leads us to the assessment question of the video which is which vertebral level
is best associated with the hila of the kidneys t11 t12 nope those are usually associated with the
superior poles l2 l3 nope those are usually associated with the inferior poles
l1 is best typically associated with the hyla of the kidneys thank you very much for your time