DEVELOPMENT OF THE URINARY SYSTEM

The urinary system begins to develop before

the genital system and consists of:
The kidneys, which excrete urine
The ureters, which convey urine from the
kidneys to the urinary bladder
The urinary bladder, which stores urine
temporarily
The urethra, which carries urine from the
bladder to the exterior of the body
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 Related with the genital system
developmentally
In adults these two systems are also related
In males the urethra conveys both urine and
semen
In females the urethra and vagina open into
a small common space-the vestibule of the
vagina.

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 The urogenital system develops from the
intermediate mesenchyme derived from
the dorsal body wall of the embryo
A longitudinal elevation of mesoderm-the
urogenital ridge-forms on each side of the
dorsal aorta.
The part of the urogenital ridge giving rise
to the urinary system is the nephrogenic
cord; the part giving rise to the genital
system is the gonadal ridge.

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 A, Dorsal view of an embryo during the third week
(approximately 18 days). B, Transverse section of the
embryo showing the position of the intermediate
mesenchyme before lateral folding of the embryo.

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 Transverse section of the embryo after the
commencement of folding, showing the
nephrogenic cords (nephrotome) at day 24.

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Development of the Kidneys and Ureters

Three sets of kidneys develop in human

embryos.
The first set-the pronephroi-is rudimentary,
and the structures are never functional.
The second set-the mesonephroi-is well
developed and functions briefly.
The third set-the metanephroi-becomes the
permanent kidneys.

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Illustrations of the three sets of excretory systems in an
embryo during the fifth week. A, Lateral view. B,
Ventral view. The mesonephric tubules have been
pulled laterally

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 Pronephroi
These bilateral transitory, nonfunctional
structures appear forming cell clusters and
tubular structures in the cervical region
early in fourth week (by day 21).
The pronephric ducts run caudally and open
into the cloaca.
Degenerates by day 24; however, most of the
length of the pronephric ducts persists and
is used by the next set of kidneys.

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 Mesonephroi

These large, elongated

excretory organs appear
late in the fourth week,
caudal to the rudimentary
pronephroi in thoracic
and lumbar segments of
intermediate mesoderm.

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 Mesonephroi cont.

Well developed and function as interim

kidneys for approximately 4 weeks, until the
permanent kidneys develop.

The mesonephric kidneys consist of

glomeruli and tubules.

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 The mesonephric tubules open into bilateral
mesonephric ducts, which were originally
the pronephric ducts.
The mesonephric ducts open into the cloaca.

The mesonephroi degenerate toward the

end of the first trimester; however, their
tubules become the efferent ductules of the
testes.

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 Metanephroi
The primordia of permanent kidneys-begin
to develop early in the fifth week and start
to function approximately 4 weeks later.
The metanephros begins when the
metanephric ducts (ureteric buds) sprout
from the distal end of mesonephric duct.
The ureteric buds induce intermediate
mesoderm in the sacral region to form a
metanephric blastema which forms the
glomeruli and tubules of the nephrons.

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 A, Lateral view of a 5-week embryo showing
the primordium of the metanephros.
Metanephric diverticulum is
an outgrowth of mesonephric
duct near its entrance into
the cloaca
Metanephrogenic blastema is
derived from the caudal part
of the nephrogenic cord.
As it elongates, the
metanephric diverticulum
penetrates the
metanephrogenic blastema.
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The metanephrogenic blastema form small metanephric
vesicles.
These vesicles elongate and become metanephric
tubules.
The proximal ends of these tubules are invaginated by
glomeruli.
The tubules differentiate into proximal and distal
convoluted tubules, and the nephron loop (Henle loop)

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 B to E, Successive stages in the development of the
metanephric diverticulum (fifth to eighth weeks).

The stalk of the metanephric

diverticulum becomes the
ureter, and the cranial
portion of the diverticulum
undergoes repetitive
branching events, forming
the branches which
differentiate into the
collecting tubules of the
metanephros.
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 Positional Changes of the Kidneys
Initially the metanephric kidneys (primordial
permanent kidneys) lie close to each other in
the pelvis, ventral to the sacrum.
In the 6th week the kidneys begin to ascend
from the sacral region to their position in the
upper abdomen and move farther apart.
This relative ascent results mainly from the
growth of the embryo's body caudal to the
kidneys.

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 During the changes in kidney position, they
receive their blood supply from vessels that are
close to them.
Initially from branches of the common iliac
arteries
Later, from the distal end of the aorta.
The position of the kidneys becomes fixed once
they come into contact with the suprarenal glands
in the ninth week.
The kidneys receive their most cranial arterial
branches from the abdominal aorta; these
branches become the permanent renal arteries.
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A D shows blood supply to the kidneys
during its ascent

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 Ectopic kidneys
Results from failure of the kidneys to alter
position during embryo growth
Most ectopic kidneys are located in the
pelvis, but some lie in the inferior part of the
abdomen

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 Horseshoe Kidney

In 0.2% of the population,

the poles of the kidneys are
fused; usually the inferior
poles.
The large U-shaped kidney
usually lies in the
hypogastrium, anterior to
the inferior lumbar
vertebrae
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 A horseshoe kidney usually produces no
symptoms because its collecting system
develops normally and the ureters enter the
bladder.
Normal ascent of these fused kidneys is
prevented because they are caught by the root
of the inferior mesenteric artery.

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 Accessory Renal Arteries
Approximately 25% of adult kidneys have
two to four renal arteries.
They usually enter to the hilum but may also
enter the kidneys directly, usually into the
superior or inferior poles.
An accessory artery to the inferior pole
(polar renal artery) may cross anterior to the
ureter and obstruct it, causing
hydronephrosis-distention of the renal
pelvis and calices with urine.
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 If an accessory artery is damaged or ligated,
the part of the kidney supplied by it will
become ischemic b/c they are end arteries.

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 Unilateral Renal Agenesis
occurs approximately once in every 1000
newborn infants.
Males are affected more often than females,
and the left kidney is usually the one that is
absent.
Often causes no symptoms and is usually
not discovered during infancy because the
other kidney performs the function of the
missing kidney.

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 Bilateral renal agenesis
Is associated with oligohydramnios. why?
Most infants with bilateral renal agenesis die
shortly after birth or during the first months of life.
Renal agenesis results when the metanephric
diverticula fail to develop or the primordia of the
ureters degenerate.
Failure of the metanephric diverticula to penetrate
the metanephrogenic blastema results in failure of
kidney development
Renal agenesis has a multifactorial etiology.

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If a kidney fails to rotate, the hilum faces anteriorly, that
is, the fetal kidney retains its embryonic position.
If the hilum faces posteriorly, rotation of the kidney
proceeded too far; if it faces laterally, lateral instead of
medial rotation occurred.

C, Right side, malrotation of the kidney; left side,

bifid ureter and supernumerary kidney.
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Duplication of ureter result from division of the
metanephric diverticulum.
Incomplete division of the metanephric diverticulum
results in a divided kidney with a bifid ureter.
Complete division results in a double kidney with a bifid
ureter or separate ureters

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Autosomal recessive polycystic kidney disease
Both kidneys contain many hundreds of small cysts,
which result in renal insufficiency.
Death of the infant usually occurs shortly after birth.
But now?
Multicystic dysplastic kidney disease
Good outcome b/c it is unilateral in 75% of the
cases.
Fewer cysts are seen than in autosomal recessive
polycystic kidney disease
It is believed that cystic structures are wide
dilations of parts of nephrons, particularly the
nephron loops
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 Development of the Urinary Bladder
Develops mainly from the vesical part of
the urogenital sinus, but its trigone region
is derived from the caudal ends of the
mesonephric ducts.

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 The epithelium is endodermal in origin.
Other layers from adjacent splanchnic
mesenchyme.
The allantois is at first continues with the
bladder , then it becomes a thick fibrous
cord urachus which extends from apex of
the bladder to the umbilicus, in adult it is
represented by the median umblical
ligament.

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 As the bladder enlarges, distal parts of the
mesonephric ducts are incorporated into
its dorsal wall.
These ducts contribute to the formation of
the connective tissue in the trigone of the
bladder.
As the mesonephric ducts are absorbed, the
ureters come to open separately into the
urinary bladder.

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 Dorsal views of the bladder showing the relations of
the ureter and the mesonephric duct during
development (A-D)
Initially the ureters are formed by an outgrowth of the
mesonephric duct (A)
But with time, they assume a separate entrance into the
urinary bladder (B-D)

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 Orifices of the ureters move superolaterally
and the ureters enter obliquely through the
base of the bladder. Why?
In infants and children, the urinary bladder,
even when empty, is in the abdomen.
It begins to enter the greater pelvis at
approximately 6 years of age, but it does not
enter the lesser pelvis and become a pelvic
organ until after puberty.

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Bladder anomalies
Urachal fistula- when the lumen of intraembryonic
portion of allantois persists
Urachal cyst-if only a local area of the allantois
persists
Urachal sinus- when the lumen in the upper part
persists-usually continuous with bladder

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 The epithelium of most of the male urethra and the
entire female urethra is derived from endoderm of
the urogenital sinus (pelvic part).
In males, the epithelium of the terminal part of
penile urethra in glans is derived from the surface
ectoderm.

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 Genital
tubercle

The connective tissue

and smooth muscle of
the urethra in both
sexes are derived
from splanchnic
mesenchyme.
Phallus