Renal & Genitourinary Anatomy

^[1]

Meet the patient

It is 0300. A 68-year-old diabetic is on your ICU in septic shock from pyelonephritis, anuric, with an acute kidney injury from a stone lodged at the left vesicoureteric junction. An obstructed, infected kidney is the dangerous combination - ureterolithiasis complicated by obstructive pyelonephritis and urosepsis, a situation that requires urgent drainage of the renal pelvis rather than definitive stone surgery. He needs continuous renal replacement therapy within the hour and he has no dialysis access.^[6]

Two anatomy questions will decide his next hour, and they are the two every CICM viva turns on: where has the stone stopped? (the three ureteric constrictions) and which vein do I cannulate? (the straight, valveless path to the cavoatrial junction). Hold those two questions and the rest of this page slots into place.^[1]

References11ShowHide

1. [1]Maschio G, Alberti D, Janin G, et al Effect of the angiotensin-converting-enzyme inhibitor benazepril on the progression of chronic renal insufficiency. The Angiotensin-Converting-Enzyme Inhibition in Progressive Renal Insufficiency Study Group N Engl J Med, 1996.PMID 8596594
2. [2]Ruggenenti P, Perna A, Gherardi G, et al Renoprotective properties of ACE-inhibition in non-diabetic nephropathies with non-nephrotic proteinuria Lancet, 1999.PMID 10437863
3. [3]Dember LM, Beck GJ, Allon M, et al Effect of clopidogrel on early failure of arteriovenous fistulas for hemodialysis: a randomized controlled trial JAMA, 2008.PMID 18477783
4. [4]Parienti JJ, Mongardon N, Mégarbane B, et al. Intravascular Complications of Central Venous Catheterization by Insertion Site N Engl J Med, 2015.PMID 26398070
5. [5]Lescay HA, Jiang J, Leslie SW, Tuma F Anatomy, Abdomen and Pelvis Ureter StatPearls, 2026.PMID 30422575
6. [6]Glazer K, Brea IJ, Leslie SW, Vaitla P Ureterolithiasis StatPearls, 2026.PMID 32809509
7. [7]Shermadou ES, Rahman S, Leslie SW Anatomy, Abdomen and Pelvis: Bladder StatPearls, 2026.PMID 30285360
8. [8]Garza FA, Leslie SW Anatomy, Abdomen and Pelvis: Kidneys StatPearls, 2026.PMID 29494007
9. [9]Kordzadeh A, Chung J, Panayiotopoulos YP Cephalic vein and radial artery diameter in formation of radiocephalic arteriovenous fistula: a systematic review J Vasc Access, 2015.PMID 26109534
10. [10]Lok CE, Huber TS, Lee T, et al KDOQI Clinical Practice Guideline for Vascular Access: 2019 Update Am J Kidney Dis, 2020.PMID 32778223
11. [11]Wu EH, De Cicco FL Anatomy, Abdomen and Pelvis, Male Genitourinary Tract StatPearls, 2026.PMID 32965962