Editing Kidneys (section)

== Surface anatomy and relationships ==

* Appearance
**Kidneys in children have more prominent fetal lobulations, which generally disappear by the first year of life. 
**The adult kidney’s lateral contour might have a focal renal parenchymal bulge (dromedary hump), which is more common on the left side and of no pathological significance
*Dimensions
**Each kidney measures 10-12cm in length, 5.5-7.5cm in width, and 2.5-3cm in thickness
* Weight
**Each adult male kidney weighs ≈125-170g; the kidney is 10-15g smaller in females
* '''Position'''
** Varies based on (3):
**# Phase of respiration (inspiration vs. expiration)
**# Body position
**# Presence of anatomic anomalies
** '''Supine end-expiration position:'''
*** '''Right kidney'''
**** '''Between the top of L1 to bottom of L3 vertebra'''
**** '''1-2cm lower than the left kidney''' (liver causes inferior displacement)
**** '''Upper pole at level of the 12th rib'''
**** Lower pole between the L3-L4 vertebrae
*** '''Left kidney'''
**** '''Between T12 and L3 vertebrae'''
**** '''Related to the 11th and 12th ribs'''
**** '''Upper pole at level of the 11th rib'''
**** '''The tail of the pancreas lies in close proximity to the upper pole of the left kidney and left adrenal gland'''
*** '''Both renal hila ≈at the level of L1'''
** '''Pleural cavity'''
*** '''The inferior limit of the pleural cavity may lie anywhere between the 10th and 12th ribs.'''
**** '''Access through the 10th or 11th intercostal space (above the 11th or 12th rib) requires careful mobilization of the lower edge of the pleura to avoid entering it'''
**** '''Access through the 9th intercostal space (above the 10th rib) inevitably requires entry into the pleural cavity'''
**** '''<span style="color:#ff0000">Clinical implication: Percutaneous access above the 11th rib (10th intercostal space) is associated with increased risk for injuring pleura and even lungs. Therefore, when possible, subcostal (below the 12th rib) or the 11th intercostal (between the 11th and 12th ribs) access should be achieved</span>'''
** The posterior surface is adjacent to the quadratus lumborum muscle and the diaphragm.
** The anteromedial surface is adjacent to the psoas major.
** '''Longitudinal axes are oblique'''
*** '''The upper poles more medial and posterior than the lower poles = Lower poles Lateral Anterior = Lower LANTern'''
*** '''The medial aspect is rotated anteriorly at ≈30°'''
** '''The parietal peritoneum bridging the upper pole of the right kidney to the liver forms the hepatorenal ligament'''; excessive downward traction of the right kidney may cause capsular tear of the liver and may lead to hemorrhage.
** '''The parietal peritoneum bridging the upper pole of the left kidney to the spleen forms the splenorenal ligament'''; excessive downward traction of the spleen may cause capsular tear of the spleen and may lead to hemorrhage.