The kidneys are two bean-shaped organs found in vertebrates.

They are located on the left and

right in the retroperitoneal space, and in adult humans are about 11 centimetres (4.3 in) in length.
They receive blood from the paired renal arteries; blood exits into the paired renal veins. Each
kidney is attached to a ureter, a tube that carries excreted urine to the bladder.

The nephron is the structural and functional unit of the kidney. Each human adult kidney
contains around 1 million nephrons, while a mouse kidney contains only about 12,500 nephrons.
The kidney participates in the control of the volume of various body fluid compartments, fluid
osmolality, acid-base balance, various electrolyte concentrations, and removal of toxins.
Filtration occurs in the glomerulus: one-fifth of the blood volume that enters the kidneys is
filtered. Examples of substances reabsorbed are solute-free water, sodium, bicarbonate, glucose,
and amino acids. Examples of substances secreted are hydrogen, ammonium, potassium and uric
acid. The kidneys also carry out functions independent of the nephron. For example, they convert
a precursor of vitamin D to its active form, calcitriol; and synthesize the hormones erythropoietin
and renin.

Renal physiology is the study of kidney function. Nephrology is the medical specialty which
addresses diseases of kidney function: these include chronic kidney disease, nephritic and
nephrotic syndromes, acute kidney injury, and pyelonephritis. Urology addresses diseases of
kidney (and urinary tract) anatomy: these include cancer, renal cysts, kidney stones and ureteral
stones, and urinary tract obstruction.[1]

Procedures used in the management of kidney disease include chemical and microscopic
examination of the urine (urinalysis), measurement of kidney function by calculating the
estimated glomerular filtration rate (eGFR) using the serum creatinine; and kidney biopsy and
CT scan to evaluate for abnormal anatomy. Dialysis and kidney transplantation are used to treat
kidney failure; one (or both sequentially) of these are almost always used when renal function
drops below 15%. Nephrectomy is frequently used to cure renal cell carcinoma.

Contents
 1Structure
o 1.1Gross anatomy

o 1.2Blood supply

o 1.3Nerve supply

o 1.4Microanatomy

o 1.5Gene and protein expression

o 1.6Development

 2Function
 o 2.1Mechanism

 2.1.1Filtration
o 2.2Reabsorption

 2.2.1Secretion
 2.2.2Excretion
o 2.3Homeostasis

 2.3.1Acid-base balance
 2.3.2Regulation of osmolality
 2.3.3Hormone secretion
 2.3.4Blood pressure regulation
o 2.4Calculations of function

 2.4.1Filtration fraction
 2.4.2Renal clearance
o 2.5Mathematical modelling of function

 3Clinical significance
o 3.1Acquired

o 3.2Kidney injury and failure

o 3.3Dialysis

o 3.4Congenital disease

o 3.5Diagnosis

 3.5.1Imaging
 3.5.2Biopsy
 4Other animals
o 4.1Evolutionary adaptation

 5Society and culture

o 5.1Significance

 5.1.1Egyptian
 o 5.2Hebrew

 5.2.1India: Ayurvedic system

 5.2.2Medieval Christianity
o 5.3As food

 6Additional images
 7See also
 8References
 9External links

Structure

Surface projections of the organs of the trunk, showing kidneys at the level of T12 to L3.
left and right kidney labelling

In humans, the kidneys are located high in the abdominal cavity, one on each side of the spine,
and lie in a retroperitoneal position at a slightly oblique angle.[2] The asymmetry within the
abdominal cavity, caused by the position of the liver, typically results in the right kidney being
slightly lower and smaller than the left, and being placed slightly more to the middle than the left
kidney.[3][4][5] The left kidney is approximately at the vertebral level T12 to L3,[6] and the right is
slightly lower. The right kidney sits just below the diaphragm and posterior to the liver. The left
sits below the diaphragm and posterior to the spleen. On top of each kidney is an adrenal gland.
The upper parts of the kidneys are partially protected by the 11th and 12th ribs. Each kidney,
with its adrenal gland is surrounded by two layers of fat: the perirenal fat present between renal
fascia and renal capsule and pararenal fat superior to the renal fascia.
 1. Renal pyramid • 2. Interlobular artery • 3. Renal artery • 4. Renal vein 5. Renal hilum •
6. Renal pelvis • 7. Ureter • 8. Minor calyx • 9. Renal capsule • 10. Inferior renal capsule •
11. Superior renal capsule • 12. Interlobular vein • 13. Nephron • 14. Renal sinus • 15. Major
calyx • 16. Renal papilla • 17. Renal column

CT scan of the kidneys. Left: cross section at upper abdomen level – the liver is seen on the left
side of scan (right side of body). Center: longitudinal section though the center of the kidneys –
the liver partially covers the right kidney. Right: transverse section through the left kidney.

The kidney is a bean-shaped structure with a convex and a concave border. A recessed area on
the concave border is the renal hilum, where the renal artery enters the kidney and the renal vein
and ureter leave. The kidney is surrounded by tough fibrous tissue, the renal capsule, which is
itself surrounded by perirenal fat, renal fascia, and pararenal fat. The anterior (front) surface of
these tissues is the peritoneum, while the posterior (rear) surface is the transversalis fascia.

The superior pole of the right kidney is adjacent to the liver. For the left kidney, it is next to the
spleen. Both, therefore, move down upon inhalation.

In adult males, the kidney weighs between 125 and 170 grams. In females the weight of the
kidney is between 115 and 155 grams.[7] A Danish study measured the median renal length to be
11.2 cm (4.4 in) on the left side and 10.9 cm (4.3 in) on the right side in adults. Median renal
volumes were 146 cm3 on the left and 134 cm3 on the right.[8]
Gross anatomy

The substance, or parenchyma, of the kidney is divided into two major structures: the outer renal
cortex and the inner renal medulla. Grossly, these structures take the shape of eight to 18 cone-
shaped renal lobes, each containing renal cortex surrounding a portion of medulla called a renal
pyramid.[7] Between the renal pyramids are projections of cortex called renal columns. Nephrons,
the urine-producing functional structures of the kidney, span the cortex and medulla. The initial
filtering portion of a nephron is the renal corpuscle, which is located in the cortex. This is
followed by a renal tubule that passes from the cortex deep into the medullary pyramids. Part of
the renal cortex, a medullary ray is a collection of renal tubules that drain into a single collecting
duct.

The tip, or papilla, of each pyramid empties urine into a minor calyx; minor calyces empty into
major calyces, and major calyces empty into the renal pelvis. This becomes the ureter. At the
hilum, the ureter and renal vein exit the kidney and the renal artery enters. Hilar fat and
lymphatic tissue with lymph nodes surrounds these structures. The hilar fat is contiguous with a
fat-filled cavity called the renal sinus. The renal sinus collectively contains the renal pelvis and
calyces and separates these structures from the renal medullary tissue.[9]

The kidneys possess no overtly moving structures.

Blood supply

3D-rendered computed tomography, showing renal arteries and veins

The renal circulation supplies the blood to the kidneys via the renal arteries, left and right,
which branch directly from the abdominal aorta. Despite their relatively small size, the kidneys
receive approximately 20% of the cardiac output.[7]

Each renal artery branches into segmental arteries, dividing further into interlobar arteries, which
penetrate the renal capsule and extend through the renal columns between the renal pyramids.
The interlobar arteries then supply blood to the arcuate arteries that run through the boundary of
the cortex and the medulla. Each arcuate artery supplies several interlobular arteries that feed
into the afferent arterioles that supply the glomeruli.

After filtration occurs, the blood moves through a small network of venules that converge into
interlobular veins. As with the arteriole distribution, the veins follow the same pattern: the
interlobular provide blood to the arcuate veins then back to the interlobar veins, which come to
form the renal vein exiting the kidney for transfusion for blood.

The table below shows the path that blood takes when it travels through the glomerulus, traveling
"down" the arteries and "up" the veins. However, this model is greatly simplified for clarity and
symmetry. Some of the other paths and complications are described at the bottom of the table.
The interlobar artery and vein (not to be confused with interlobular) are between two renal lobes,
also known as the renal column (cortex region between two pyramids).

Arteries (down) Veins (up)

Abdominal aorta Vena cava
Renal artery (Note 1) Renal vein
Segmental arteries (Note 2) –
Lobar arteries –
Interlobar artery Interlobar vein
Afferent arterioles Efferent arterioles (Note 4)
Glomerulus Glomerulus
 Note 1: The renal artery also provides a branch to the inferior suprarenal artery to supply
the adrenal gland.
 Note 2: Each renal artery partitions into an anterior and posterior branch. The anterior
branch further divides into the superior (apical), anterosuperior, anteroinferior and
inferior segmental arteries. The posterior branch continues as the posterior segmental
artery.
 Note 3: Also called the cortical radiate arteries. The interlobular artery also supplies to the
stellate veins.
 Note 4: The efferent arterioles do not directly drain into the interlobular vein, but rather
they go to the peritubular capillaries first. The efferent arterioles of the juxtamedullary
nephron drain into the vasa recta.

Nerve supply

The kidney and nervous system communicate via the renal plexus, whose fibers course along the
renal arteries to reach each kidney.[10] Input from the sympathetic nervous system triggers
vasoconstriction in the kidney, thereby reducing renal blood flow.[10] The kidney also receives
input from the parasympathetic nervous system, by way of the renal branches of the vagus nerve;
the function of this is yet unclear.[10][11] Sensory input from the kidney travels to the T10-11 levels
of the spinal cord and is sensed in the corresponding dermatome.[10] Thus, pain in the flank region
may be referred from corresponding kidney.[10]

Microanatomy
Diagram of a long juxtamedullary nephron (left) and a short cortical nephron (right). All parts of
the nephron are labelled except the (gray) connecting tubule located after the (dark red) distal
convoluted tubule and before the large (gray) collecting duct (mislabeled collection duct).

Renal histology is the study of the microscopic structure of the kidney. Distinct cell types
include:

 Kidney glomerulus parietal cell

 Kidney glomerulus podocyte
 Kidney proximal tubule brush border cell
 Loop of Henle thin segment cell
 Thick ascending limb cell
 Kidney distal tubule cell
 Collecting duct principal cell
 Collecting duct intercalated cell
 Interstitial kidney cells

Gene and protein expression

Further information: Bioinformatics § Gene and protein expression

About 20,000 protein coding genes are expressed in human cells and almost 70% of these genes
are expressed in normal, adult kidneys.[12][13] Just over 300 genes are more specifically expressed
in the kidney, with only some 50 genes being highly specific for the kidney. Many of the
corresponding kidney specific proteins are expressed in the cell membrane and function as
transporter proteins. The highest expressed kidney specific protein is uromodulin, the most
abundant protein in urine with functions that prevent calcification and growth of bacteria.
Specific proteins are expressed in the different compartments of the kidney with podocin and
nephrin expressed in glomeruli, Solute carrier family protein SLC22A8 expressed in proximal
tubules, calbindin expressed in distal tubules and aquaporin 2 expressed in the collecting duct
cells.[14]

Development

Main article: Kidney development

The mammalian kidney develops from intermediate mesoderm. Kidney development, also called
nephrogenesis, proceeds through a series of three successive developmental phases: the
pronephros, mesonephros, and metanephros. The metanephros are primordia of the permanent
kidney.[15]

Function
Main article: Renal physiology

Schematic diagram of the nephron (yellow), relevant circulation (red/blue), and the four methods
of altering the filtrate.

The microscopic structural and functional unit of the kidney is the nephron. It processes the
blood supplied to it via filtration, reabsorption, secretion and excretion; the consequence of those
processes is the production of urine.
Mechanism

Filtration

Filtration, which takes place at the renal corpuscle, is the process by which cells and large
proteins are retained while materials of smaller molecular weights are[16] filtered from the blood
to make an ultrafiltrate that eventually becomes urine. The kidney generates 180 liters of filtrate
a day. The process is also known as hydrostatic filtration due to the hydrostatic pressure exerted
on the capillary walls.

Reabsorption

Secretion and reabsorption of various substances throughout the nephron

See also: Clearance (medicine)

Reabsorption is the transport of molecules from this ultrafiltrate and into the peritubular
capillary. It is accomplished via selective receptors on the luminal cell membrane. Water is 55%
reabsorbed in the proximal tubule. Glucose at normal plasma levels is completely reabsorbed in
the proximal tubule. The mechanism for this is the Na+/glucose cotransporter. A plasma level of
350 mg/dL will fully saturate the transporters and glucose will be lost in the urine. A plasma
glucose level of approximately 160 is sufficient to allow glucosuria, which is an important
clinical clue to diabetes mellitus. Amino acids are reabsorbed by sodium dependent transporters
in the proximal tubule. Hartnup disease is a deficiency of the tryptophan amino acid transporter,
which results in pellagra.[17]