How is the renal pelvis formed?
The renal pelvis is formed sequentially within the system of urine-collecting cavities:
- Renal papillae (papillae renales) are the apices of the renal pyramids of the medulla. 1–3 renal papillae open into a single minor calyx.
- Minor calyces (calices renales minores), numbering 8–9, receive the renal papillae.
- Major calyces (calices renales majores) are formed by the fusion of minor calyces. There are usually 2–3 of them in a kidney.
- Renal pelvis (pelvis renalis) is formed by the fusion of the major calyces.
Where is the renal pelvis located?
The renal pelvis is located in the region of the internal, concave border of the kidney, where the renal hilum (hilum renale) is situated. The hilum faces anteriorly and medially, toward the aorta and inferior vena cava, and leads into the renal sinus (sinus renalis).
The kidneys lie retroperitoneally (retroperitonealiter) on either side of the vertebral column at the level of Th12–L3. The renal hilum projects at the level of the body of the first lumbar vertebra (LI) or the intervertebral disc between LI and LII. The right kidney is typically situated slightly lower than the left.
Topography within the renal pedicle
The renal pelvis is a component of the renal pedicle. In addition to the pelvis continuing as the ureter, the pedicle includes the renal artery (a. renalis), renal vein (v. renalis), branches of the nerve plexus, lymphatic vessels, and lymph nodes. All these structures are surrounded by adipose tissue.
Syntopy of the elements of the renal pedicle from posterior to anterior:
- Renal pelvis with the origin of the ureter — the posteriormost element.
- Renal artery — located superior and anterior to the pelvis.
- Renal vein — the anteriormost and superior element of the complex.
Clinical significance
In clinical practice and oncology, upper tract urothelial carcinoma is of major significance:
- Primary tumor location within the upper urinary tract — in the renal pelvis or ureter — is no longer considered a prognostic factor.
- Tumor localization within the pelvicalyceal system or the ureter does not affect the staging of the neoplastic process.
Terminology and grammar
- In Latin anatomical nomenclature, the term pelvis renalis is used. The word pelvis is a third-declension feminine noun: (pelvis, is f).
- The Greek combining form pyelo- is used to denote the renal pelvis. The kidney is denoted by the root nephro-.
Class and exam questions
What structures fuse to form the renal pelvis?
The renal pelvis is formed by the fusion of 2–3 major renal calyces (calices renales majores).
What structure does the renal pelvis continue into?
At the renal hilum, the renal pelvis continues as the ureter.
What position does the renal pelvis occupy within the renal pedicle?
When viewed from posterior to anterior, the pelvis along with the origin of the ureter is the posteriormost element of the renal pedicle. Anterior to it lie the renal artery and renal vein.
Does the location of urothelial carcinoma in the renal pelvis affect disease staging?
No, according to recent data, tumor location in the renal pelvis compared to the ureter does not affect staging and is no longer considered a prognostic factor.
What else to study on this topic
- Kidney (Ren) and its internal structure
- Renal pedicle and its structures
- Ureter
- Pelvicalyceal system
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