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30 Cards in this Set
- Front
- Back
What are the precursor structures to the kidney?
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- Pronephros (until week 4)
- Mesonephros (1st trimester) - Metanephros (permanent) |
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When is the fate of the Pronephros?
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Renal precursor structure that is present until week 4 when it degenerates
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When is the fate of the Mesonephros?
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- Functions as interim kidney for 1st trimester
- Later contributes to male genital system |
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When is the fate of the Metanephros?
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- Permanent renal structures, first appears at 5th week of gestation
- Nephrogenesis continues through 32-36 weeks of gestation |
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What structure is derived from the caudal end of the mesonephric duct? What does it become?
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Ureteric Bud
- Gives rise to ureter, pelvises, calyces, and collecting ducts - Fully canalized by 10th week |
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What structure interacts with the ureteric bud to induce differentiation and formation of the glomerulus through to the distal convoluted tubule?
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Metanephric Mesenchyme
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What structures form the permanent tubular system of the kidney? How?
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- Metanephric Mesenchyme: forms glomerulus through distal convoluted tubule
- Ureteric Bud: forms collecting ducts, calyces, pelvises, and ureter - These form through interaction of the two structures |
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What happens if there is aberrant interaction between the ureteric bud and metanephric mesenchyme?
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May result in several congenital malformations of the kidney
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What is the last part of the renal structures to canalize? Implications?
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Ureteropelvic Junction - most common site of obstruction (hydronephrosis) in fetus
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What is the most common site of obstruction, leading to hydronephrosis, in the fetus?
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Ureteropelvic Junction
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What syndrome occurs in babies who can't pee in utero?
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Develop Potter Syndrome
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What syndrome is associated with Pulmonary hypoplasia, Oligohydramnios, Twisted face, Twisted skin, Extremity defects, and Renal failure (in utero)? Cause?
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Potter Syndrome
- Causes: ARPKD, posterior urethral valves, bilateral renal agenesis - Leads to oligohydramnios → compression of developing fetus → limb deformities, facial anomalies (low set ears and retrognathia), and compression of chest → pulmonary hypoplasia (cause of death) |
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What can cause Potter Syndrome?
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Causes:
- ARPKD - Posterior Urethral Valves - Bilateral Renal Agenesis Leads to: - Oligohydramnios → compression of developing fetus → limb deformities, facial anomalies (low set ears and retrognathia), and compression of chest → pulmonary hypoplasia (cause of death) |
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What are the consequences of ARPKD, posterior urethral valves, or bilateral renal agenesis?
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Potter Syndrome:
- Pulmonary hypoplasia - Oligohydramnios - Twisted face - Twisted skin - Extremity defects - Renal failure (in utero) |
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What facial abnormalities are associated with Potter Sequence?
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- Low-set ears
- Retrognathia (posterior positioning of mandible) |
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What happens in horseshoe kidney? Consequences?
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Inferior poles of both kidneys fuse
- As the kidneys ascend from the pelvis during fetal development, horseshoe kidneys get trapped under the inferior mesenteric artery - Remain low in abdomen |
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How do kidneys that are fused at the inferior poles function?
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Horseshoe kidneys function normally, but there is an increased risk of ureteropelvic junction obstruction, hydronephrosis, renal stones, and rarely renal cancer (Wilms tumor)
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What is horseshoe kidney associated with?
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Turner Syndrome
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What kidney problem are patients with Turner Syndrome associated with having? Risk of?
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Horseshoe kidney, increased risk of:
- Ureteropelvic junction obstruction - Hydronephrosis - Renal stones - Rarely renal cancer (Wilms tumor) |
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What does this axial CT of abdomen with contrast show?
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Enhancing midline fused kidney (horseshoe kidney)
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What kidney problem is often diagnosed prenatally via ultrasound with a unilateral cystic kidney and a contralateral hypertrophic kidney? Cause?
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Multicystic Dysplastic Kidney - abnormal interaction between ureteric bud and metanephric mesenchyme → non-functional kidney
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What is wrong if a patient has a Multicystic Dysplastic Kidney?
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- Abnormal interaction between ureteric bud and metanephric mesenchyme
- Leads to a non-functional kidney consisting of cysts and connective tissue - If unilateral (most common), generally asymptomatic with compensatory hypertrophy of the contralateral kidney |
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When is Multicystic Dysplastic Kidney typically diagnosed?
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Prenatally with ultrasound
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Which kidney is usually taken during living donor transplantation? Why?
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Left kidney - longer renal vein
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What is the branching pattern of the arteries in the kidney?
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Renal artery → Segmental artery → Interlobar Artery → Interlobular Artery → Arcuate Artery
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What does blood need to flow through to enter the kidney tubules?
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Glomerulus:
- Endothelial cells of blood vessel - Basement membrane - Podocytes (visceral layer) |
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What are the labeled components of this glomerulus?
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- A: Macula Densa
- B: Afferent arteriole - C: Efferent arteriole - D: Bowman Capsule |
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Where is the Macula Densa?
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Distal Renal Tubule - adjacent to glomerulus and juxtaglomerular cells
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What is the course of the ureters?
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- Ureters pass UNDER uterine artery and UNDER ductus deferens (retroperitoneal)
- Water (ureters) are under the bridge (uterine artery and vas deferens) (But pass over the iliac arteries |
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What can happen in gynecologic procedures involving ligation of the uterine vessels?
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May damage the ureter → ureteral obstruction or ureteral leak
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