S2) Development of Urinary System Flashcards

1
Q

What is the name of the first kidney system and where does it form?

A
  • Pronephros is the first kidney system
  • Forms in the cervical region
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2
Q

What is the purpose of the pronephros?

A
  • No function in adult humans
  • Pronephric duct drives the development of the next developmental stage
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3
Q

What is the urogenital ridge?

A

Urogenital ridge is a region of intermediate mesoderm giving rise to both the embryonic kidney and the gonad

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4
Q

Outline the development of the mesonephros

A

Mesonephric tubules develop caudally to the pronephric region and have no water conserving function

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5
Q

Identify the components of the embryonic kidney

A
  • Mesonephric tubules
  • Mesonephric duct
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6
Q

What are the 2 functions of the mesonephric duct?

A
  • Role in development of the male reproductive system
  • Sprouts the ureteric bud which induces development of the definitive kidney
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7
Q

Describe the structure and function of the ureteric bud

A
  • Structure: undifferentiated intermediate mesoderm, caudal to the mesonephros
  • Function: induces development of the true kidney, metanephros in this tissue
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8
Q

Explain how the ureteric bud drives the development of the definitive kidney

A
  • The collecting system is derived from the ureteric bud
  • The excretory component is derived from the intermediate mesoderm under the influence of the ureteric bud
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9
Q

Identify the steps involved in the ‘ascent’ of the kidney

A
  • The metanephric kidney first appears in the pelvic region
  • It undergoes a caudal to cranial shift
  • It crosses the arterial fork formed by vessels returning blood from the foetus to the placenta
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10
Q

What is different about the movement of the gonads and the kidneys during embryonic development?

A

Unlike the gonads which take their blood vessels with them, the kidney forms new branches as it ascends

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11
Q

Identify all the things that can go wrong during the development of the urinary system

A
  • Renal agenesis
  • Errors in migration
  • Ectopic ureter
  • Cystic disease
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12
Q

Identify two structural anomalies related to migration of the kidneys

A
  • Horseshoe kidney
  • Pelvic kidney
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13
Q

Renal agenesis is a congenital disorder of the urinary system.

What happens?

A

- Renal agenesis is when the ureteric bud fails to interact with intermediate mesoderm

  • Presentation:

I. Absence of one (unilateral) or both (bilateral) kidneys

II. Reduced amniotic fluid volume

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14
Q

Describe the structure and formation of the urogenital sinus

A
  • Structure: continuous with umbilicus (urachus)
  • Formation: created from the hindgut by the urorectal septum
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15
Q

Describe the differentiation of the urogenital sinus

A
  • Superior part connects to umbilicus
  • Majority differentiates into urinary bladder
  • Inferior part develops into the urethra
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16
Q

Outline the 4 steps involved in the development of the urinary system in females

A

Mesonephric duct reach urogenital sinus

Ureteric bud sprouts from urogenital sinus

⇒ Urogenital sinus expands and mesonephric duct regresses (lack of exogenous androgen)

⇒ Ureteric bud opens into urogenital sinus

17
Q

Outline the 5 steps involved in the development of the urinary system in males

A

Mesonephric duct reach urogenital sinus

Ureteric bud sprouts from urogenital sinus

Smooth musculature appears; urogenital sinus expands

⇒ Ureteric bud & mesonephric duct make independent openings in urogenital sinus

Prostate and prostatic urethra are formed

18
Q

Describe the formation of the female urethra

A

Female urethra is formed by the pelvic part of the urogenital sinus

19
Q

Describe the development of the male urethra

A
  • Genital tubercle elongates
  • Genital folds fuse to form the spongy urethra
20
Q

Describe the structure of the male urethra

A

Male urethra is divided into 4 parts:

  • Pre-prostatic
  • Prostatic
  • Membranous
  • Spongy
21
Q

What is hypospadias?

A
  • Hypospadias is a defect in fusion of urethral folds
  • Urethra opens onto the ventral surface rather than at the end of the glans
22
Q

Label the following structures on the diagram below:

  • Pronephros
  • Mesonephros
  • Mesonephric duct
  • Uteric bud
  • Metanephros
A
23
Q

What foetal abnormality would you suspect if you examined a pregnant patient with an abnormally low amniotic fluid volume?

A

Amniotic fluid is foetal urine, thus renal agenesis would cause low amniotic fluid volume

  • Partial decrease = unilateral renal agenesis
  • Abnormal decrease = bilateral renal agenesis
24
Q

On the diagram below, indicate the following:

  • Collecting system (and its origins)
  • Excretory system (and its origins)
A
25
Q

Based on your knowledge of the development of the kidney, provide a likely explanation of the anomalous anatomy below:

A

Pelvic kidney:

  • Kidneys develop in the pelvis then ascend to the abdomen
  • On occasion, one of the kidneys fail to ascend and remains at the pelvis at the level of the common iliac artery
26
Q

Based on your knowledge of the development of the kidney, provide a likely explanation of the anomalous anatomy below:

A

Horseshoe kidney:

  • Two developing kidneys come too close during ascent and fuse into a single horshoe-shaped structure
  • Consequently become stuck underneath the inferior mesenteric artery
27
Q

The presence of accessory/supernumerary renal arteries is relatively common.

Explain the embryological basis for this variation

A
  • Supernumerary renal arteries are blood vessels that aren’t required but fail to regress
  • As the kidney ascends, it forms new arteries
28
Q

Label the following structures on the diagram below:

A

A = Cloaca

B = Cloacal membrane

C = Hind gut

D = Urorectal septum

E = Urachus (/allantois)

29
Q

Label the following structures on the diagram below:

  • Urogenital sinus
  • Anorectal canal
  • Urorectal septum
A
30
Q

Identify the following sections of the urogenital sinus:

  • Pelvic part
  • Phallic part
A
31
Q

Identify the derivative of the phallic part of the urogenital sinus in the male

A

Spongy urethra

32
Q

Identify the derivative of the pelvic part of the urogenital sinus in the male

A
  • Pre-prostatic urethra
  • Prostatic urethra
  • Membranous urethra
33
Q

Suggest the likely embryological basis for the duplication of the ureter

A
  • Uteric bud splits and ureter is duplicated
  • Can lead to duplication of renal pelvis or complete renal duplication
34
Q

Why might a patient with a duplicated ureter complain of bladder incontinence?

A
  • The sphincter is at the level of the bladder
  • There is an ectopic ureteral opening inferior to the bladder
  • No sphincter control of urine
35
Q

What is the normal adult derivative of the urachus?

A

Median umbilicus ligament

36
Q

Label the following structures in the diagram:

  • Bladder
  • Anal canal
  • Urorectal fistula
A
37
Q

What is the embryological basis for a urorectal fistula?

A

The urorectal septum hasn’t pushed all the way through the hindgut