Updated: 3/13/2018

Kidney Embryology

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Illustration of renal development. A. Transverse view of early embryo, illustrating the formation of the urogenital ridge and nephrogenic cord from  the intermediate mesoderm. B. Lateral view of early embryo summarizng relative cranial to caudal progression of renal development;  not specific for any particular period during embryonic development.  
 
Overview
  • Kidney development
    • progresses in a cranial to caudal direction
    • intermediate mesoderm → urogenital ridge → nephrogenic cord → urinary system
  • Pronephros
    • non-functional
    • appears by week 4
    • degenerates by week 5
  • Mesonephros
    • development induced by pronephric duct
    • forms mesonephric duct (Wolffian duct)
    • interim kidney for 1st trimester
    • opens into urogenital system and gives rise to male genital system
  • Metanephros
    • develops from mesonephric outgrowth called ureteric bud during week 5
    • fully canalized and functioning at week 10
    • nephrogenesis continues through 32 - 36 weeks of gestation
    • derivatives include
      • ureteric bud develops into
        • ureter
        • pelvises
        • calyces and collecting ducts 
        • aberrant development may result in congenital malformations of the lower urinary tract
      • metanephric mesenchyme
        • interaction with ureteric bud causes metranephric mesenchyme to differentiate the renal structures from collecting tubules to glomerulus
        • abnormal interaction with ureteric bud may cause malformations
  • Ureteropelvic junction with kidney
    • canalizes last
    • most common site of obstruction in fetus which results in hydronephrosis 
  • Adult kidney
    • embryo grows faster caudally causing a change in location of the kidney from S1 - S2 to a final position of T12 - L3
Developmental Abnormalities
  • Renal agenesis
    • failure of ureteric buds to form → no kidney formation
  • Potter's Syndrome 
    • bilateral renal agensis oligohydramnios → fetal compression resulting in
      • limb deformities
        • clubbed feet 
      • facial deformities
      • pulmonary hypoplasia  
  • Horseshoe kidney
    • fusion of inferior poles of kidneys 
      • ascension of kidney is prevented by the inferior mesenteric artery 
      • fused kidneys remain low in abdomen and may cause other renal vascular anomalies.
      • normal kidney function
This is an illustration comparing normal kidney ascent with a horseshoe kidney, where the ascent gets arrested by the IMA. 
 

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Questions (8)
Lab Values
Blood, Plasma, Serum Reference Range
ALT 8-20 U/L
Amylase, serum 25-125 U/L
AST 8-20 U/L
Bilirubin, serum (adult) Total // Direct 0.1-1.0 mg/dL // 0.0-0.3 mg/dL
Calcium, serum (Ca2+) 8.4-10.2 mg/dL
Cholesterol, serum Rec: < 200 mg/dL
Cortisol, serum 0800 h: 5-23 μg/dL //1600 h:
3-15 μg/dL
2000 h: ≤ 50% of 0800 h
Creatine kinase, serum Male: 25-90 U/L
Female: 10-70 U/L
Creatinine, serum 0.6-1.2 mg/dL
Electrolytes, serum  
Sodium (Na+) 136-145 mEq/L
Chloride (Cl-) 95-105 mEq/L
Potassium (K+) 3.5-5.0 mEq/L
Bicarbonate (HCO3-) 22-28 mEq/L
Magnesium (Mg2+) 1.5-2.0 mEq/L
Estriol, total, serum (in pregnancy)  
24-28 wks // 32-36 wks 30-170 ng/mL // 60-280 ng/mL
28-32 wk // 36-40 wks 40-220 ng/mL // 80-350 ng/mL
Ferritin, serum Male: 15-200 ng/mL
Female: 12-150 ng/mL
Follicle-stimulating hormone, serum/plasma Male: 4-25 mIU/mL
Female: premenopause: 4-30 mIU/mL
midcycle peak: 10-90 mIU/mL
postmenopause: 40-250
pH 7.35-7.45
PCO2 33-45 mmHg
PO2 75-105 mmHg
Glucose, serum Fasting: 70-110 mg/dL
2-h postprandial:<120 mg/dL
Growth hormone - arginine stimulation Fasting: <5 ng/mL
Provocative stimuli: > 7ng/mL
Immunoglobulins, serum  
IgA 76-390 mg/dL
IgE 0-380 IU/mL
IgG 650-1500 mg/dL
IgM 40-345 mg/dL
Iron 50-170 μg/dL
Lactate dehydrogenase, serum 45-90 U/L
Luteinizing hormone, serum/plasma Male: 6-23 mIU/mL
Female: follicular phase: 5-30 mIU/mL
midcycle: 75-150 mIU/mL
postmenopause 30-200 mIU/mL
Osmolality, serum 275-295 mOsmol/kd H2O
Parathyroid hormone, serume, N-terminal 230-630 pg/mL
Phosphatase (alkaline), serum (p-NPP at 30° C) 20-70 U/L
Phosphorus (inorganic), serum 3.0-4.5 mg/dL
Prolactin, serum (hPRL) < 20 ng/mL
Proteins, serum  
Total (recumbent) 6.0-7.8 g/dL
Albumin 3.5-5.5 g/dL
Globulin 2.3-3.5 g/dL
Thyroid-stimulating hormone, serum or plasma .5-5.0 μU/mL
Thyroidal iodine (123I) uptake 8%-30% of administered dose/24h
Thyroxine (T4), serum 5-12 μg/dL
Triglycerides, serum 35-160 mg/dL
Triiodothyronine (T3), serum (RIA) 115-190 ng/dL
Triiodothyronine (T3) resin uptake 25%-35%
Urea nitrogen, serum 7-18 mg/dL
Uric acid, serum 3.0-8.2 mg/dL
Hematologic Reference Range
Bleeding time 2-7 minutes
Erythrocyte count Male: 4.3-5.9 million/mm3
Female: 3.5-5.5 million mm3
Erythrocyte sedimentation rate (Westergren) Male: 0-15 mm/h
Female: 0-20 mm/h
Hematocrit Male: 41%-53%
Female: 36%-46%
Hemoglobin A1c ≤ 6 %
Hemoglobin, blood Male: 13.5-17.5 g/dL
Female: 12.0-16.0 g/dL
Hemoglobin, plasma 1-4 mg/dL
Leukocyte count and differential  
Leukocyte count 4,500-11,000/mm3
Segmented neutrophils 54%-62%
Bands 3%-5%
Eosinophils 1%-3%
Basophils 0%-0.75%
Lymphocytes 25%-33%
Monocytes 3%-7%
Mean corpuscular hemoglobin 25.4-34.6 pg/cell
Mean corpuscular hemoglobin concentration 31%-36% Hb/cell
Mean corpuscular volume 80-100 μm3
Partial thromboplastin time (activated) 25-40 seconds
Platelet count 150,000-400,000/mm3
Prothrombin time 11-15 seconds
Reticulocyte count 0.5%-1.5% of red cells
Thrombin time < 2 seconds deviation from control
Volume  
Plasma Male: 25-43 mL/kg
Female: 28-45 mL/kg
Red cell Male: 20-36 mL/kg
Female: 19-31 mL/kg
Cerebrospinal Fluid Reference Range
Cell count 0-5/mm3
Chloride 118-132 mEq/L
Gamma globulin 3%-12% total proteins
Glucose 40-70 mg/dL
Pressure 70-180 mm H2O
Proteins, total < 40 mg/dL
Sweat Reference Range
Chloride 0-35 mmol/L
Urine  
Calcium 100-300 mg/24 h
Chloride Varies with intake
Creatinine clearance Male: 97-137 mL/min
Female: 88-128 mL/min
Estriol, total (in pregnancy)  
30 wks 6-18 mg/24 h
35 wks 9-28 mg/24 h
40 wks 13-42 mg/24 h
17-Hydroxycorticosteroids Male: 3.0-10.0 mg/24 h
Female: 2.0-8.0 mg/24 h
17-Ketosteroids, total Male: 8-20 mg/24 h
Female: 6-15 mg/24 h
Osmolality 50-1400 mOsmol/kg H2O
Oxalate 8-40 μg/mL
Potassium Varies with diet
Proteins, total < 150 mg/24 h
Sodium Varies with diet
Uric acid Varies with diet
Body Mass Index (BMI) Adult: 19-25 kg/m2
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(M1.EB.70) A child is born by routine delivery and quickly develops respiratory distress. He is noted to have epicanthal folds, low-set ears that are pressed against his head, widely set eyes, a broad, flat nose, clubbed fleet, and a receding chin. The mother had one prenatal visit, at which time the routine ultrasound revealed an amniotic fluid index of 3 cm. What is the most likely underlying cause of this patient's condition? Review Topic

QID: 106475
1

An extra 18th chromosome

26%

(50/195)

2

Bilateral renal agenesis

55%

(108/195)

3

Autosomal recessive polycystic kidney disease (ARPKD)

10%

(19/195)

4

Unilateral renal agenesis

5%

(10/195)

5

A microdeletion in chromosome 22

3%

(6/195)

M1

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PREFERRED RESPONSE 2

(M1.EB.40) A 27-year-old female in her 20th week of pregnancy presents for a routine fetal ultrasound screening. An abnormality of the right fetal kidney is detected. It is determined that the right ureteropelvic junction has failed to recanalize. Which of the following findings is most likely to be seen on fetal ultrasound: Review Topic

QID: 101934
1

Bilateral renal agenesis

2%

(1/50)

2

Unilateral hydronephrosis

66%

(33/50)

3

Renal cysts

8%

(4/50)

4

Pelvic kidney

2%

(1/50)

5

Duplicated ureter

12%

(6/50)

M1

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PREFERRED RESPONSE 2

(M1.EB.26) At a 20-week screening ultrasound of a 31-year-old G1P0 woman, the technician finds bilateral renal aplasia (Figure A). While discussing the findings with the expectant parents, the physician notes that this condition leads to which of the following? Review Topic

QID: 101920
FIGURES:
1

Polyhydramnios

20%

(3/15)

2

Intraventricular hemorrhage

0%

(0/15)

3

Pulmonary hypoplasia

60%

(9/15)

4

Ventricular septal defect

13%

(2/15)

5

Malrotation of the midgut

0%

(0/15)

M1

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PREFERRED RESPONSE 3
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(M1.EB.9) A 28-year-old pregnant female presents for a prenatal check-up at 20 weeks gestation, which includes routine screening ultrasound. Fetal ultrasound demonstrates bilateral multicystic dysplastic kidneys. Her pregnancy has been complicated by persistent oligohydramnios. The child requires significant pulmonary support upon delivery. Which of the following clinical findings is most likely present in this child as a result of these abnormalities? Review Topic

QID: 101903
1

Urachal fistula

13%

(33/256)

2

Esophageal atresia

17%

(44/256)

3

Spina bifida occulta

3%

(7/256)

4

Clubbed feet

61%

(156/256)

5

Macrosomia

5%

(13/256)

M1

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PREFERRED RESPONSE 4
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