S.

Thiyagarajan

3 overlapping renal systems are formed in a cranial to caudal sequence during intra uterine life in humans: 1. Pronephros 2. Mesonephros 3. Metanephros

PRONEPHROS
7- 10 solid cell groups in the cervical region at the beginning of the 4th week These forms vestigeal excretory units, nephrotomes, that regress as caudal ones form Completely disappears by end of week 4

MESONEPHROS
Derived from intermediate mesoderm from upper thoracic to upper lumbar segments, during regression of pronephric nephrotomes Excretory tubules develop in the mesonephros which open laterally into a duct called Mesonephric or Wolffian duct

METANEPHROS

Appear in the 5th week Forms the permanent kidneys

The metanephros develops in the lower lumbar and sacral regions

Excretory units appear in the metanephros

The ureteric bud (mesonephric diverticulum) is an outgrowth from the mesonephric duct close to its entrance to the cloacae

 It grows into the metanephros, dilating to form the pelvis of the ureter

 Further divisions of the ureteric bud

give rise to the major and minor calyces and collecting tubules (1 to 3 million)

Parts of the Kidney

Cortex

KIDNEY
Medulla

Renal sinus

Space within the kidney that is occupied by renal pelvis, calices, vessels, nerves and fat.

Cortex

outer zone of the kidney (approximately one third of its depth) Consist of Glomerulous, Proximal Convoluted Tubule, Distal Convoluted Tubule.

Medulla

Inner zone of the kidney (approximately two third of its depth) consist of
o Pyramids, which consist

descending loop, ascending loop, & collecting tubule.

o Renal columns

Papillae and calices

The anatomy of the collecting system is variable. The normal papilla is usually seen as a conical convexity indenting the calyx with sharply defined fornices on either side.

The superior end of the ureter expands to form the renal pelvis which divides in 2-4 major calyces, each of which divide into 2-4 minor calyces.

The minor calyces drain into a major calyx via a neck, called infundibulum. The infundibula may be long or short. Occasionally calices arise directly from the pelvis.

Normal interpapillary line

Drawing illustrates how the renal outline should be closely paralleled by a line connecting the papillary tips (dotted line). Deviations from this pattern require explanation

The shape of the papillae varies widely from patient to patient. the variations tend to be symmetrical and associated with other natural variation in the kidney.

Fetal lobulations

Kidneys are scalloped appearance. The number of lobe depends on the overall calyceal number.

Lobes represents a vestige of lobar development of kidney, which is visible at birth. With cellular multiplication, lobar anatomy is usually obscured by the age of 2 years.

Fetal lobulation of kidney can mimic, Tumor, Pyelonephritic scar,( reflux nephropathy) Multiple renal infarcts. (when interlobar vessels are involved)

But these conditions can be easily ruled out.

In fetal lobulation ,
parenchymal thickness should be normal (approx 1 cm). calyces are centered between indentation.

Normal increased parenchymal thickness

Nephrotomogram shows prominent cortical tissue (arrowheads), a finding that can also reflect normal fetal renal anatomy.

Typical areas of prominence include the hilar lips, cortical columns (usually seen at the junction of the upper and middle thirds of the kidney), and other humps that should be reflected in the interpapillary line

Suprahilar bump

Compound calices

Two or more papillae may enter in one major calyx.

Circumcaval ureter

Urographic image shows the proximal right ureter with a reversed J appearance, a finding that is characteristic of circumcaval ureter

Flat or small papillae

confused with other causes of blunt calices such as post-obstructive atrophy. The symmetry observed in normal patients.

Megacalices

developmental abnormality. calices appear uniformly dilated. Due to underdevelopment of the papillae.

Large papillae
much larger than usual. symmetry is observed.

Simple papillae

Mega papillae

Papillary blush
papillae show a homogeneous blush due to well concentrated contrast medium in the collecting tubules. particularly prominent when lowosmolality contrast media are used. no clinical significance.

Papillary blush...
Early Urographic image shows prominent papillary opacity but no resolvable tubular structures in the region of the papillae. Ten-minute image obtained with compression shows a decrease in the prominence of the papillary opacity, a finding that is typical of papillary blush.

Disappearing calyces
The number of calyces demonstrated on EU may change from study to study in the same patient. Different calyces may be visualized on sequential studies. This is duo to contraction of smooth muscle around the calyces may keep contrast from entering and opacifying them.

Duplex kidney

Minor degrees of duplication are extremely common.

Bifid renal pelvis

seen in about 10% of the population.

Column of Bertin

Partial duplication may be associated with hypertrophy of the septal cortex (hypertrophied column of Bertin). Typically in upper or mid polar region.

Diagnosis is made by identify the anomalous calyx on EU, normal renal cortex on nuclear scintigraphy or normally echogenic renal cortex extending in renal sinus in the USG.

Vascular impressions

The renal vessels run close to the pelvis and major calices in the renal sinus and may cause indentations which can be mistaken for intraluminal filling defects.

Such filling defects are most obvious when the collecting system is relatively empty and usually become less obvious or even vanish during effective ureteric compression.

Box shaped pelvis

Normal one is delicate funnel shaped pelvis. Box shaped extrarenal pelvis is normal variation.

Bilobed calyx

Bilobed or cleft lower pole calyx.

Cut-off calyx