THE KIDNEY

Dr. Qaiser Inayat

Professor & Head
Department of Anatomy
Kabir Medical College
Peshawar
 Gross anatomy
 The urinary system of
the human body
consists of two kidneys,
two ureters, the bladder
and a single urethra.
 The kidneys are located
on the posterior wall of
the abdomen at waist
level. Each kidney is
roughly 10 cm long and
5 cm wide, and is
encased in a fibrous
outer capsule called the
renal capsule.
 The main functions of the kidneys are:
1. Control blood volume.
2. Acid base balance.
3. Electrolyte balance.
4. Removal of waste products.
5. Control of blood pressure.
6. Secretion of erythropoietin.
 Development of the urogenital
system
 In the third week a
trilaminar disc is
formed comprising of
the ectoderm,
mesoderm and the
endoderm.

 The mesoderm then

differentiates into
1. Paraxial: Somites
2. Intermediate:
Urogenital system
3. lateral mesoderm:
Body wall and wall of
the gut tube
 The intermediate
mesoderm will form
the urogenetal
system.
 In the fourth week
with the folding of the
embryo the
intermediate
mesoderm is carried
forwards and
separates from the
paraxial mesoderm.
 The intermediate
mesoderm forms a
longitudinal elevation
on each side of the
dorsal aorta, the
urogenital ridge.
 In the fifth week
urogenital ridge
differentiates into two
longitudinal ridges, a
lateral ridge the
nephrogenic ridge or
chord and a medial
ridge , the gonadal
ridge.
 The nephrogenic chord
will develop three sets of
excretory organs:
1. The pronephros.
2. The mesonephros.
3. The metanephros.
The primary excretory
duct:
a solid chord of cells
develops in the dorsal part of
the nephrogenic chord. It
begins to appear in the
cervical region and extends
caudally extending beyond
the intermidiate mesoderm
and communicating with the
cloaca. It cannalizes in a
cranial caudal direction as it
is being formed.
 PRONEPHOROS
 It develops in the fourth week.
 The pronephros consists of a few
primitive nephrons connected to
an unbranched nephric duct.
The pronephros forms a
functioning kidney in many
immature fish and the larvae of
amphibians. In the humans they
are vestigial organs and are
represented by a few cell
clusters and tortuous tubular
structures in the neck region. It
will soon degenerate. However
most of the pronephric duct
( cranial part of the primary
excretory duct) persists.
 MESONEPHROS
 In birds and amphibians it forms the
permanent kidney.
 In humans it is called the interim kidney. It
develops caudal to the pronephros at the
end of the fourth week. It extends from the
region of the septum transversum to the
level of the third lumbar vertebra.
 The Mesonephros projects from the
nephrogenic chord into the abdominal;
cavity as an elongated ridge.
 The primary excretory duct is now called
the mesonephric duct or the Wolffian duct.
 Mesonephros consists of glomeruli and
mesonephric tubules that open into the
mesonephric duct. A total of 70 to 80
tubules. Tubules are formed in a
craniocaudal direction. The cranial ones
degenerate as the caudal ones are being
formed. At any given time 30 to 40
tubules are present.
 All the tubules degenerate except for
the caudal 26 tubules. The cranial one to
two tubules form rostral aberrant
ductules of the testes, succeeding five or
six tubules develop into the efferent
ductules of the testes and the lobules of
the head of the epididymus in the male
and the tubules of the epoophoron in the
female. The caudal tubules form the
caudal aberrant ductules and the
paradidymus in the male and the
paraoophoron in the female.
 The tubules of the mesonephros are
functional and form urine. However they
lack the descending loop of Henle and
hence cannot concentrate urine.
 The mesonephric duct forms the canal of
the epididymus, the vas deferens and the
ejaculatory duct.
METANEPHRIC KIDNEY
 It is the permanent kidney. It begins to develop about
the fifth week and is fully functional by about the
ninth week of development.
 It develops from three sources:
1. The metanephric diverticulum or the ureteric bud: a
diverticulum of the mesonephric duct arising close to
its opening into the cloaca. It is the primordium of the
ureter, renal pelvis, calyces and collecting tubules.
2. The metanephric blastema: it is the undifferentiated
mesenchyme in the caudal part of the nephrogenic
chord. It will form the renal corpuscles, proximal and
distal tubules and the loop of Henley.
3. The angiogenic mesenchyme: it migrates into the
metanephric blastema from the surrounding
mesenchyme ot form the blood vessels.

The pronephros and the metanephros are linear

structures consisting of stacks of tubules arranged in a
cranio caudal direction. The metanephric kidney is
different. In it the tubules are concentrically arranged.
 The ureteric bud as it elongates it
penetrates the metanephric mass at the
caudal end of the nephrogenic chord.
There is epithelial mesenchymal
interaction between the two and they
induce the development of the
metanephric kidney.
 Under the inductive influence of the
metanephric mesenchyme the end of the
ureteric bud in contact with the
Mesonephros dilates and begins to divide
dichotomously forming several
generations of tubules.
 First 4 generations of tubules become
confluent to form the major calyces.
 The next four generations of tubules
coalesce to form the minor calyces
 The remaining generations of tubules
form the collecting tubules
 The mesenchyme of the caudal end of
the nephrogenic mesenchyme
condenses to form metanephric
blastema which forms a metanephric
cap over the dilated end of the ureteric
bud.
 The end of each arched tubule induces
the cells of the metanephric blastema
to form small cell clusters of about 20
cells. Each cluster of cells is then
transformed into a vesicle. Each
vesicle first elongates into a "comma"
shape and then forms a characteristic
S-shaped tube. As these tubules are
formed their proximal ends are
invaginated by glomeruli forming the
malpighian corpuscle. The rest of the
tube differentiates into the proximal
convoluted tubule, loop of Henle and
the distal convoluted tubule. While
this is happening, the distal end of the
epithelial tube break down the basal
lamina of the ureter bud ducts and
fuse with them. The number of
glomeruli increases upto the 32nd
week.
 Fetal kidneys are lobulated.
Lobulations diminish
towards the end of the fetal
period and disappear
altogether in infancy. Rarely
the lobulations may persist.
Lobulations presist in the
kidneys of some animals
such as cattle.
 At term each kidney
contains 800,000 to 100,000
nephrons. No new nephrons
are formed after birth.
Functional maturation of the
kidneys occurs after birth.
 Increase in size of kidneys
after birth is due to the
increase in length of the
proximal tubules and the
increase in the interstitial
tissue.
 Ascent of kidneys
 Initially the kidneys develop in
the pelvis ventral to the
sacrum. As the abdomen and
pelvis grow the kidneys move
apart and come to lie in the
abdomen. They reach their
final position by the ninth
week. This ascent of kidneys
results due to the growth of
the body caudal to the
kidneys.
 Initially the hilum of the
kidneys faces ventrally but
with the ascent the kidneys
rotate at an angle of 90
degrees and by the ninth
week the hilum is directed
anteromedially.
 CHANGES IN BLOOD SUPPLY
OF KIDNEYS
 As the kidneys develop in
the pelvis the renal
arteries are the branches
of the common iliac
arteries. Later they arise
from the caudal end of the
aorta. As they reach a
higher level they receive
new branches from the
aorta. Normally the caudal
branches involute. When
the ascent of kidneys stops
the most cranial branches
of aorta to the kidneys
become the renal arteries.
 ANOMALIES
 Accessory renal
arteries.
 Renal agenesis.
unitateral or
bilateral.
 Malrotation of
kidneys.
 Ectopic kidneys.
 Horshoe shaped
kidneys.