Updated: 5/17/2020

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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(M1.EB.14.70) 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? Tested Concept

QID: 106475
1

An extra 18th chromosome

24%

(53/221)

2

Bilateral renal agenesis

55%

(122/221)

3

Autosomal recessive polycystic kidney disease (ARPKD)

10%

(22/221)

4

Unilateral renal agenesis

5%

(11/221)

5

A microdeletion in chromosome 22

5%

(10/221)

M 1 E

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(M1.EB.14.26) 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? Tested Concept

QID: 101920
FIGURES:
1

Polyhydramnios

22%

(4/18)

2

Intraventricular hemorrhage

0%

(0/18)

3

Pulmonary hypoplasia

61%

(11/18)

4

Ventricular septal defect

11%

(2/18)

5

Malrotation of the midgut

0%

(0/18)

M 1 E

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(M1.EB.12.40) 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: Tested Concept

QID: 101934
1

Bilateral renal agenesis

2%

(1/65)

2

Unilateral hydronephrosis

74%

(48/65)

3

Renal cysts

6%

(4/65)

4

Pelvic kidney

2%

(1/65)

5

Duplicated ureter

9%

(6/65)

M 2 D

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(M1.EB.12.9) 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? Tested Concept

QID: 101903
1

Urachal fistula

12%

(36/290)

2

Esophageal atresia

18%

(52/290)

3

Spina bifida occulta

3%

(10/290)

4

Clubbed feet

60%

(174/290)

5

Macrosomia

5%

(15/290)

M 2 E

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