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Embryology and Gross Anatomy of the Renal System

Revision:
Formation of the trilaminar disc results in the: ectoderm, mesoderm and endoderm.
Mesoderm arises from epiblast cells invaginating through the primitive streak, in between the epiblast and
hypoblast to form a new middle layer of cells.
Embryology of the renal system:
Urogenital system = urinary system + genital system, formed from the intermediate mesoderm germ layer
3rd week primitive neural tube + notochord formed. Beside the neural tube is the paraxial mesoderm
forms somites eventually form muscle tissue
Lateral plate mesoderm (outer portion, has two leaflets) has visceral and parietal layer form the parietal
(external lining of trunk, body, external peritoneal surfaces of abdomen) and visceral linings (covers
developing gut tube) Inof the body and trunk.
Intermediate mesoderm forms kidneys and reproductive system
Intermediate mesoderm runs the length of the embryo and forms a tube, from neck lumbar region
(represented by red and blue)

Tube is split into 3 renal structures:

o Pronephros (red) starts to grow ~3rd/4th week, but by the end of that
week will atrophy
Rudimentary and non-functional, disintegrates before lower
structures formed
o Mesonephros (blue) starts to grow/lengthen ~4th week, little
capillaries form early glomeruli, but then signals are turned off, the
elongating tube disintegrates and the only parts that persist go on to
form the part of the gonads/ductal system in males
Functions for a short time during early fetal period
o Metanephros (black) ~5th week, forms permanent kidney, both the
excretory and collecting parts derived from this tissue.
Kidneys and gonads develop both derived from intermediate mesoderm and
develop similarly:
o Mesonephric duct forms epididymis and vas deferens
o Duct doesnt persist in females, but another duct pyromesonephric duct forms uterus and
paired uterine tubes
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Mesonephros
Early 4th week (while the pronephros degrades), the first excretory tubules of the metanephros appear,
lengthening rapidly and acquire a tuft of capillaries that form the glomerulus at their medial extremity.
Around the glomerulus (capillary network) the tubules form Bowmans capsule together these make up
the renal corpuscle
~2nd month the gonads form from the mesonephros. Most tubules will degenerate, but some persist to form
testes in male

Metanephros
Develops 5th week, is the definitive kidney
Ureteric bud = forms collecting system; metanephric mesoderm = excretory units (PCT, Loop of Henle, DCT)
Collecting system:
The uteric bud (an outgrowth of the mesonephric duct) invades the metanephric tissue to form the
collecting ducts
The uteric bud dilates forming primitive renal pelvis
Then bifurcates into cranial and caudal portions forming early major calyces
Each calyx forms two new buds for about 12 successive splitting events forming 1-3 million collecting
tubules by 5 months
Minor calyces form when tubules of the 2nd order enlarge and absorb those of the 3rd and 4th generation
Renal pyramid arises when the collective tubules of the 5th generation and onwards elongate and converge
on the minor calyx
The uretic bud gives rise to the ureter, renal pelvis, major and minor calyces and ~1-3 million collecting
tubules.
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Excretory system:
Each newly formed tubule (~2 million) is covered at its distal end by a metanephric tissue cap.
Under inductive influences (transcription factors etc.), the tissue cap forms small vesicles (renal vesicles),
which elongate to form S shaped tubules

Capillaries grow into the pocket at one end of the S, and differentiate into glomeruli the S shaped tubule
+ their glomeruli form nephrons (excretory units).
The proximal end of each nephron forms Bowmans capsule (which is deeply indented by a glomerulus)
The distal end of the S tube forms a connection with one of the collecting tubules (yellow)
Continued lengthening of the excretory tubule results in the formation of
o Proximal convoluted tubule
o Loop of Henle
o Distal convoluted tubule

Nephrons are formed until birth, at which point there are ~1 million in each kidney.
Urine production begins early in gestation, soon after the differentiation of the glomerular capillaries which
start to form by the 10th week
At birth, the kidneys have a lobulated appearance, but the lobulation disappears during infancy as a result of
further growth of the nephrons, although there is no increase in their number,
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Ascent of the kidneys
Initially lies in a pelvic position
Ascent is caused by growth of fetus in lumbar and
sacral regions and loss of curvature
Initially arterial supply is from the pelvic aorta, however
this changes to progressively higher vessels as the
kidney ascends
Pathology: Fusion of the lower poles during this ascent
results in horseshoe kidneys when this tries to rise
up, it meets the arterial fork and cannot ascend any
further so remains in pelvic position
Retroperitoneal organ = behind the perineum of the
abdominal cavity, posterior abdomen
Kidneys develop in pelvis ascend
Gonads develop higher up descend
Anatomically the kidneys are related to the adrenal
glands, but functionally completely different septal
plane between them

Function of fetal kidney

The definitive kidney formed from the metanephros becomes functional near the 12th week
Urine is passed into the amniotic cavity and mixes with the amniotic fluid
The fluid is swallowed by the the fetus and recycles through the kidneys
During fetal life, the kidneys are not responsible for excreting waste products as the placenta serves this
function

Bladder and Urethra

Occurs after kidneys have formed and are ascending. Ureter also derived from uteric bud.
Cloaca early primitive bladder
During 4th-7th weeks the cloaca divides into:
o Anterior urogenital sinus
o Posterior anal canal
As the ureter starts to develop, it gets pulled upwards and we end up with 3 parts to the urinary system
The urogenital sinus consists of:
o Upper part connects with allantois/yolk sac atrophies and becomes cord in adults (urachus,
connects apex of bladder with umbilicus)
o Pelvic part enlarges in males forms prostatic and membranous part of urethra
o Phallic part forms external genitalia, development varies markedly whether male or female
At 10/12wk mark looks similar in males in females, sonographers cant tell sex of baby in this
period
In males, lengthens and becomes penis
In females becomes clitoris
Urorectal septum invading tissue that divides urogenital and GI parts, by splitting the urethra and rectum
(2 distinct tubes/exit points)
Part of urethra and bladder is endoderm derived
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Portions of the mesonephric duct are absorbed into the wall of the urinary bladder. As a result, the ureters
(from uteric bud) enter the bladder separate to duct
As the kidneys ascend, the gonad and mesonephric duct descends forms the ductus deferens in males

Urethra
Final exit tube for urine
Epithelium of the bladder and urethra is derived from endoderm
In the male, the prostatic urethra proliferates to form buds prostate
The phallic part of the urethra in the male is pulled ventrally as a genital tubercle and scrotal swellings
increase in size
Indifferent stage:

o Urethra hasnt formed yet

o Genital tubercle = little bump that in males penis; females clitoris
o Urethral folds = like upside down horseshoe
In males fuses and forms penis with a lumen
In females labia minora (opening for urine in females is between labia minora)
o Genital swelling (yellow) = males scrotum; females labia majora
Development of penis
o Phallus enlarges and elongates
o Urethral fold fuses to form penis with lumen (penile urethra)
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o Genital swellings lengthen and from scrotum midline fusion point down scrotum and penis is
penile and scrotal raphe Pathology: congenital deformities where raphe doesnt close and you get
opening of urethra: Hypospadias

Gross anatomy
Kidneys
Highly vascular as receives ~25% of cardiac output
o Large blood vessels that supply kidneys segmental arteries
o These each supply a wedge of the kidney, rather than having an anastomosing network
o Makes surgery easy, as surgeons can isolate a wedge
Essential tissue composition is that of a gland with highly modified secretory units and highly specialised
ducts
Fnc: Kidneys excrete urine, produced by modifying a filtrate of blood plasma
o Apart from excreting waste, kidneys have endocrine functions:
Secretion of erythropoietin
Synthesis and secretion of renin
Hydroxylation of 25-OH vitamin D3
o Gluconeogenesis
o Nephrons in the cortex good for excreting drugs, nephrons deeper in medulla concentrating
urine
Urinary system
Development:
o Functional organ is the kidney
o Develops from intermediate mesoderm
o Initially lies in pelvis where it is formed, and ascends during its development
Gross anatomy:
o Retroperitoneal lies behind peritoneal cavity, behind true abdominal cavity
o Position T12 L3 (right kidney slightly lower, due to liver)
o Surrounded by renal capsule
o Covered by a perineal fat capsule
o Separated from adrenal glands by fascial septum
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o Superiorly associated with diaphragm

Posterior relations
Surrounded by perineal fascia
Sit against the posterior abdominal wall overlying the quadratus lumborum, psoas major and transversus
abdominis

Movement of kidneys
On inspiration, descend 2-3cm
Superior poles of kidney bisected by transpyloric
plane from pylorus of stomach (L1)
Palpating kidneys: blotting technique
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Vascular supply

Arcuate artery

Interlobar artery

Segment artery

Renal artery

Anteriorly renal vein drain into IVC left renal vein is longer

Adrenal gland vasculature

Very vascular involved in endocrine function, most endocrine organs have extensive blood supply to get hormones
into blood for quick effect
Supplied by 1) vessels from diaphragm (inferior phrenic arteries), 2) blood vessels from the aorta and 3) blood vessels
from the renal arteries

Macroscopic kidney anatomy

Concave renal hilum where all blood vessels, nerves and ureter that is continuous with renal pelvis enter
o Renal arteries
o Renal veins
Renal sinus: at hilum, surface of kidney is rolled inwards creating a deep oval pocket/hole/cavity
Renal pelvis: formed by convergence of number of broad drainage channels, each called a calyx:
o Each major calyx branches into 3-4 minor calices, which end at a trumpet like opening
Outer cortex
o Contains renal corpuscles, convoluted & straight tubules, collecting ducts and vascular supply
Inner medulla
o Renal columns regarded as part of cortex. Inward extension of cortex, separates pyramids
o Renal/medullary pyramids
o Renal papillae at apex of pyramid, acts like a sieve where urine drips into minor calyx
o Major and minor calyces 3-4 minor calyces form a major calyx

Renal columns
The caps of cortical tissue spilling over the pyramids form renal columns
These are regarded as part of the cortex

Cortex and medulla

Histologically cortex has very haphazard appearance, while the medulla is very organised (straight tubules)
distinct different coloured tissue
The cortex and medulla together comprise millions of individual nephrons, all packed together
Each nephron consists of one renal corpuscle and its associated tubule
The cortex consists of convoluted tubules + renal corpuscles
The medulla consists of loops of Henle and collecting ducts
The cortex and medulla surround and drain into the hollow pelvis, the funnel shaped beginning of the ureter

Filtration
The proximal tubule, in the cortex, reabsorbs most minerals and other nutrients from the tubular fluid and passes
them to blood in the pertitubular capillaries
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The loop of Henle dips into the medulla where it helps establish the hypertonic environment of the medullar
interstitial fluid
The DCT returns to the juxtaglomerular apparatus of the corpuscle, from which the tubule arose
Finally, the collecting duct leads back through the medulla to drain into the pelvis

Blood supply/drainage
Paired renal arteries arise between L1 and L2
Right renal artery passes posterior to IVC
Divide into 5 segemental arteries
Renal veins lies anterior to arteries
Left vein is longer and receives gonadal vein drain
into IVC

Ureters
Paired retroperitoneal structures that carry urine to the bladder, by
passing through detrusor muscle
Ureters enter through left and right uteric orifices trigone exit
points start of urethra
Get blood supply from aorta
Pass into pelvis at bifurcation of common iliac artery landmark
Approx. 25-35cm long and lined by transitional epithelium

Cystoscopy
Telescope into bladder to see if ureters damaged during surgery

Bladder
Urinary bladder serves as storage reservoir for urine
Sub-peritoneal in position
Muscular walls that allow for distention
Varies in size and shape in relation to fullness
Bladder lies in same place, but is surrounded by different organs in males and females
In males:
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o Retrovesical pouch
o Gap between bladder and rectum
In females:
o Rectouterine pouch (eponymous name Pouch of Douglas)
Lowest dependant part of female abdomen if burst stomach ulcer or pussy appendix, will
gather here under gravity ultrasonagraphers comment on fluid in Pouch of Douglas
o Vesicouterine pouch
o Space between bladder and uterus AND space between bladder and rectum

Rugae peaks and troughs of distensible endothelium

In males only outflow of bladder, because of prostate, has
autonomically controlled smooth muscle (internal urethral
sphincter) prevent retrograde ejaculation (semen and
sperm going back up bladder). Pathology: damage, e.g.
surgery results in infertility
Pre-prostatic urethra prostatic urethra membranous
urethra (passes through perineal pouch of male)

Urethra:
Male:
Conveys urine from the internal urethral orifice to the external
urethral orifice (at tip of penis)
Divided into 4 parts: distinct changes of angle, difficult catherisation
o Pre-prostatic urethra
o Prostatic urethra
o Membranous urethra
o Spongy (penile) urethra
Female:
Shorter than male equivalent (4-6cm) easier catheterisation but increased UTIs
No internal urethral sphincter present
External urethral orifice is located in the vaginal vestibule
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Nephron: corpuscle + tubule

o Nephron is the structural and functional unit of kidney over 1 million per kidney kidneys grow in size but never in
#nephrons
o Filters blood and alters composition to form urine
o Each renal corpuscle consists of an epithelial cup (Bowmans capsule), enclosing a knot of capillaries (glomerulus) and
other elements
Both cortical and juxtamedullary nephrons have the corpuscle in the cortex. Cortical corpuscles are higher up
in the cortex, and juxtamedullary corpuscles are closer to the medullary boundary
o Renal tubules run through cortex and medulla, and are differentiated into:
A proximal convoluted tubule (reabsorbs most substances and water)
A loop of Henle descends into the medulla, makes a hairpin turn and returns to the cortex (re-absorption of
water and salts)
Described in ascending and descending portions
The distal convoluted tubule passes near to the original corpuscle (at the macula densa: measures urinary
contents), then leads to a collecting duct
A collecting duct receives fluid from several nephrons, then drains into the nephric pelvis. The filtrate here is
not modified further, and is its final form and so can be called urine.

Nephrons: cortical and juxtamedullary

o Cortical nephrons:
85% of nephrons
Small portion of loop of Henle projects into the outer medulla
o Juxtamedullary nephrons:
15%, located in the cortex-medullary junction
Important in producing concentrated urine
Loops of Henle deeply invade medulla
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Surrounded by vasa recta
Nephrons: capillary beds
o Every nephron has two capillary beds:
o Glomerulus:
High pressure capillaries: specialised for its function in filtration, is distinct from all other capillaries as the
glomerulus is both fed and drained by arterioles. As opposed to the 15mmHg pressure drop in other body
capillary beds when blood travels from arterioles to weaker, thin walled veins; the glomerulus maintains
uniform high pressure for filtration.
Afferent and efferent arterioles: Efferent arterioles are smaller in diameter to combat any pressure drop
across capillaries
Site of filtration: fluids and solutes forced into glomerulus due to higher hydrostatic pressure than osmotic
o Peritubular capillaries:
Arise from efferent arterioles
Low pressure porous capillaries which readily reabsorb water and solutes from filtrate in tubule bac into
blood (since will flow from area of high pressure to low)
Vasa recta: long, straight vessels that serve juxtamedullary nephrons
Nephrons: Juxtaglomerular apparatus (JGC)

o Region where the distal portion of the ascending limb of the nephron loop lies against the afferent arteriole feeding
the glomerulus both the ascending limb and afferent arteriole are modified at this point of contact:
o JGC included 3 populations of cells that help regulate the rate of filtration and systematic blood pressure:
o Macular densa:
Closely packed cells of ascending limb
Chemoreceptor: monitor amount of NaCl present in DCT too much suggests filtrate moving through
nephron too quickly and not being reabsorbed
Response: vasoconstriction
o Juxtaglomerular/granular cells
Enlarged smooth muscle cells
Secretory granules containing enzyme renin
Mechanoreceptors: sense changes in BP in afferent arteriole
Response: renin is released in response to low BP, triggering a cascade of reactions to release hormones that
elevate BP
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