perirenal fascia

The
anatomical compartments and their connections as demonstrated by ectopic air. Duodenal perforation complicating ERCP in a 60-year-old man. Contrast-enhanced CT scan at the level of right renal hilum (a, b) and iliac crest (c) shows the retroperitoneal and interfascial planes. a Anterior pararenal space (APS) is limited by posterior parietal peritoneum and anterior renal fascia, with midline continuity; posterior pararenal space (PPS) between posterior renal fascia and transversalis layer of endoabdominal fascia; perirenal space (PS) between anterior and posterior renal fascias. Renal and lateroconal fasciae are laminated, defining potential spaces: the retromesenteric (RMP), the retrorenal (RRP) and lateroconal planes (LP) that all communicate at fascial trifurcation. b Axial image focused on fascial trifurcation. Ectopic gas is seen extending through the retromesenteric plane (RMP), retrorenal plane (RRP) and lateroconal plane (LP), and meeting at the fascial trifurcation (red star). Posterior pararenal space (PPS) anteriorly continues as a fat stripe in the properitoneal space (PP). c Inferior extension of the interfascial plane, delineated by ectopic gas/air. The retromesenteric and the retrorenal planes approximate one another as the fat cone of perirenal fat diminishes inferiorly, resulting in the combined interfascial plane (CIP); it continues in the pelvis along the anterolateral margins of the psoas muscle contiguous with the pelvic retroperitoneal perivesical and presacral spaces
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The perirenal fascia is a dense, elastic connective tissue sheath that envelops each kidney and adrenal gland together with a layer of surrounding perirenal fat forming the perirenal space.

It is a multi-laminated structure which is fused posteromedially with the muscular fasciae of the psoas and quadratus lumborum muscles. It extends anterolaterally behind the kidney as a bileaved layer, which then divides into two perirenal fasciae that pass in front of and behind the kidney:

  • Gerota fascia (anterior perirenal fascia): a thin lamina that passes around the front of the kidney and variably interleaves with the opposite anterior fascia
  • Zuckerkandl fascia (posterior perirenal fascia): a thicker posterior fascia which continues anterolaterally as the lateroconal fascia and fuses with the parietal peritoneum

Generally the anterior and posterior fascial leaflets fuse inferiorly closing off the perirenal space from the rest of the retroperitoneum.

History and etymology

Emil Zuckerkandl (1849-1910) , was a Professor of Anatomy at the University of Vienna who described his eponymous fascia in 1883 . However Zuckerkandl did not recognize the separate anterior perirenal fascia.

Dimitrie D Gerota (1867-1939) , a Romanian Professor of Anatomy and Surgery described his fascia in 1885 and at the same time named the posterior fascial layer after Zuckerkandl.

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