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Renal > Renal Embryology > Flashcards

Renal Embryology Flashcards

1
Q

What are posterior urethral valves?

A

Membrane remnants in the posterior urethra (prostatic) in males that may lead to urethral obstruction

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2
Q

What are the 6 findings associated with Potter sequence?

A

Pulmonary hypoplasia, Oligohydramnios, Twisted face, Twisted skin, Extremity deformities, Renal failure in utero (POTTER)

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3
Q

When are the fetal kidneys fully developed?

A

At 36 weeks’ gestation

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4
Q

How does a duplex collecting system often present?

A

Hydronephrosis

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5
Q

What is the typical presentation for a patient with a congenital solitary functioning kidney?

A

The functioning kidney will be hypertrophied, but the patient typically has no symptoms

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6
Q

An embryo’s ureteric bud fails to induce differentiation of the metanephric mesenchyme in utero. Is the kidney functional?

A

No; this results in a multicystic dysplastic kidney, a nonfunctional kidney

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7
Q

What is a congenital solitary functioning kidney?

A

The presence of only 1 functioning kidney at birth

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8
Q

What is the most common cause of bladder outlet obstruction in male infants?

A

Posterior urethral valves

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9
Q

How are posterior urethral valves diagnosed?

A

By detection of bilateral hydronephrosis or thick/dilated bladder walls on prenatal ultrasonography

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10
Q

What adult structures in the urinary tract are derived from the ureteric bud?

A

Collecting ducts, calyces, pelvises, and ureters

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11
Q

What is the ureteric bud (metanephric diverticulum) derived from?

A

The caudal end of the mesonephric duct

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12
Q

How is congenital solitary functioning kidney diagnosed?

A

Often prenatally by means of ultrasonography

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13
Q

Is multicystic dysplastic kidney usually unilateral or bilateral?

A

Unilateral

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14
Q

Why is the ureteropelvic junction the most common site of obstruction in the kidneys?

A

The ureteropelvic junction is the last structure to canalize (congenital obstruction)

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15
Q

What is a patient with vesicoureteral reflux at increased risk for?

A

Recurrent urinary tract infections

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16
Q

What are the 2 mechanisms by which a duplex collecting system may develop?

A

1) Bifurcation of the uteric bud before it enters the metanephric blastema results in a bifid ureter in the shape of a Y; 2) 2 ureteric buds interact with metanephric blastema

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17
Q

A patient with bilateral multicystic dysplastic kidney has what condition?

A

Potter sequence

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18
Q

What are 2 common causes of vesicoureteral reflux?

A

Insufficient/abnormal insertion of the ureter within the vesicular wall or ↑↑ pressure in the bladder leading to retrograde flow via the ureterovesical junction

19
Q

When does the pronephros degenerate during embryonic development?

A

Week 3

20
Q

What complications may arise in a patient born with a horseshoe kidney?

A

Infection, renal stones, hydronephrosis (eg, ureteropelvic junction obstruction), and rarely increased risk of renal cancer

21
Q

What 3 complications are associated with a duplex collecting system?

A

Urinary tract infections, ureteral obstruction, vesicoureteral reflux

22
Q

Posterior urethral valves are associated with what condition in the fetus?

A

Oligohydramnios in severe cases of obstruction

23
Q

Are multicystic dysplastic kidneys hereditary?

A

No; this is generally not a hereditary disorder

24
Q

Horseshoe kidney is associated with what genetic abnormalities?

A

Chromosomal aneuploidies, such as Turner syndrome and trisomies 13, 18, and 21

25
Q

What structure contributes to the development of male genitalia?

A

The mesonephros

26
Q

How is a prenatal hydronephrosis diagnosed?

A

It can be detected by prenatal ultrasonography; it may be unilateral or bilateral

27
Q

During which week of development is mesonephros present?

A

Week 4

28
Q

What permanent structure of the kidneys develops in the 5th week of gestation?

A

Metanephros

29
Q

What is the pathophysiology behind the horseshoe kidney?

A

Inferior poles of both kidneys fuse, which leads them to be trapped under the inferior mesenteric artery during ascension in fetal development

30
Q

The interaction of which 2 structures in the developing kidney induces differentiation and formation of the renal tubules?

A

The ureteric bud and the metanephric mesenchyme (metanephric blastema)

31
Q

What is the most common pathologic cause of prenatal hydronephrosis?

A

Congenital ureteropelvic junction obstruction (the obstruction leads to hydronephrosis)

32
Q

What is the definition of vesicoureteral reflux?

A

Retrograde flow of urine from the bladder to the upper urinary tract

33
Q

What fetal structure functions as the interim kidney for the 1st trimester?

A

The mesonephros

34
Q

What are 4 causes of Potter sequence?

A

Reduced renal output (eg, ARPKD), bilateral renal agenesis, chronic placental insufficiency, and obstructive uropathy (including posterior urethral valves)

35
Q

An abnormal interaction between an embryo’s ureteric bud and the metanephric mesenchyme occurs in utero. What is the kidney made of?

A

Connective tissue and cysts; this is a multicystic dysplastic kidney, which is nonfunctional

36
Q

What may occur if there is an abnormal interaction between the ureteric bud and metanephric mesenchyme?

A

Severe congenital malformation of the kidneys, such as renal agenesis or multicystic dysplastic kidneys

37
Q

What would most likely lead to death in a newborn with Potter sequence?

A

Oligohydramnios → compression of chest → lack of amniotic fluid aspiration into fetal lungs → pulmonary hypoplasia (cause of death)

38
Q

What adult structures in the urinary tract are derived from the metanephric mesenchyme?

A

Structures in the kidney, from the glomerulus to the distal convoluted tubule

39
Q

What is the mechanism through which unilateral renal agenesis occurs?

A

Failure of development of the ureteric bud induces differentiation of the metanephric mesenchyme, resulting in a complete lack of kidney and ureter.

40
Q

In kidney development, at what week in embryonic development is full canalization of the metanephros complete?

A

Week 10

41
Q

A horseshoe kidney gets trapped beneath which artery?

A

Inferior mesenteric artery (and it remains low in the abdomen)

42
Q

In which trimester of pregnancy does the fetal mesonephros develop?

A

First trimester

43
Q

A newborn has a flattened nose, low-set ears, and retrognathia (see image). Diagnosis?

A

Potter sequence (syndrome)

44
Q

A newborn is diagnosed with Potter sequence. By what mechanism did this condition occur?

A

Oligohydramnios→ fetal compression → limb deformities and facial anomalies (babies who can’t “Pee” in utero develop Potter sequence)

Renal (4 decks)

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