DEVELOPMENT AL ANOMALIES OF RENAL SYSTEM AND COURSE OF URETER

SUDARSHAN PANDEYKATHMANDU UNIVERSITY SCHOOL OF MEDICAL SCIENCES, DHULIKHELMBBS

DEVELOPMENT OF URINARY SYSTEM

•POLYHYDRAMNIOS•OLIGOHYDRAMNIOS•WILMS TUMOR

MOLECULAR REGULATION•WT-1•Cell adhesion molecule- syndecan , E-cadherin

MEDIAL ROTATION AND ASCENT OF KIDNEY FROM PELVIS TO ABDOMEN

Congenital anomalies of kidney• RENAL AGENESIS1. Bilateral agenesis Incompatible with life- stillborn infants. Ultrasound – oligohydramnios Potter facies Talipes equinovarus Pulmonary hypoplasia

2. Unilateral agenesis Remaining kidney- compensatory hypertrophy Often adequate renal function May develop progressive glomerular sclerosis.

RENAL HYPOPLASIA Failure of kidney to develop to normal weight. Usually unilateral The hypoplastic kidney has decreased number of calyces and lobes(lobes<6).

Horseshoe kidney Kidney show fusion -lower pole(90%) -upper pole(10%) Horseshoe shaped structure – anterior to the great vessels. Affected individual have normal renal function Common -1 in 500-1000 autopsies. The central portion of a horseshoe kidney may

be found just inferior to the inferior mesenteric artery

Ectopic location Most common- pelvic kidney Usually has normal function Tortuosity of ureters may predispose to pyelonephritis.

OTHERSABBERENT RENAL ARTERIESCONGENITAL POLYCYSTIC KIDNEY DISEASES

Congenital ureter anomalies1. Double ureter Double ureters may persue separate courses to the bladder but are

commonly joined within the bladder wall and drain through single orifice

2.Congenital megaureter3.Utero pelvic junction (UPJ) Obstruction Most common cause of hydronephrosis in infants, children, male. In adults ,UPJ obstruction common in female, unilateral-common

4.Diverticula Saccular outpouchings of the ureteral wall Asymptomatic Secondary infection common

5.Hydroureter

Congenital anomalies of bladder1. Diverticula Pouch like evagination of bladder wall (1-10cm in diameter) Due to urinary tract obstruction during fetal development Urinary stasis and predispose to infection

2. Extrophy Developmental failure in anterior abdominal wall and bladder Very good surgical correction rate

3. Vesico-ureteral reflux Most common anomaly Can cause hydronephrosis and chronic pyelonephritis

4. Persistent urachus5. Fistula:vagina , rectum , uterus

COURSE OF URETER Fibromuscular tubes that connect kidneys to the urinary bladder in the pelvis. Begin as continuations of the renal pelves and run retroperitonially, anterior to psoas major,

crossing the external iliac arteries as they pass over the pelvic brims

• 3 constrictions 1. At ureteropelvic junction2. At pelvic brim, where the ureters cross the common iliac vessels.3. Where the ureters enter the wall of the

bladder. Clinical correlationThese constrictions are the common sites of ureteral obstructions by renal calculi

Course of ureter ureters pass under

uterine artery and under

ductus deferens (retroperitoneal).

WATER (URETERS) UNDER THE BRIDGE (ARTERY,DUCTUS DEFERENS).

Clinical correaltion•The ureter passes inferior to the uterine artery and must be avoided during surgical procedure• The ureter courses just medial to the suspensory ligament of the ovary and must be protected when ligating the ovarian vessels.

• IMAGES FROM INTRAVENOUS UROGRAPHY (IVU)

NORMAL

Right kidney duplex collecting system