1. Anomalies of the
Upper Urinary Tract
By
Hassaan Ali Gad
Assistant lecturer of urology and Andrology
Aswan University
Dr.Hassaan Ali 2014
2. Embryology of kidney.
Normal Anatomy of kidney.
Congenital abnormalities of the kidney.
Complication.
Dr.Hassaan Ali 2014
3. kidneys develop from the intermediate
mesoderm(Kidneys, Adrenals and Gonads)
3 embryonic kidneys, in order of appearance
pronephros .
mesonephros
metanephros
first two regress in utero,
and the third becomes the permanent kidney
Kidney Development
Dr.Hassaan Ali 2014
8. The nephron (glomerulus, proximal tubule, loop of Henle, and
distal tubule) is thought to derive from the metanephric
mesenchyme
The collecting system (collecting ducts, calyces, pelvis, and
ureter) formed from the ureteric bud
Development of Nephrons/Collecting
System
Dr.Hassaan Ali 2014
10. - From 6th to 9th weeks: kidneys ascend to a lumbar site just
below adrenals
- the differential growth of the lumbar and sacral regions of the
embryo plays a role renal ascent.
as the kidneys migrate, they are vascularized by a succession of
transient aortic sprouts that arise at progressively higher levels
final pair forms in the upper lumbar region and becomes the
definitive renal arteries
Renal Ascent
Dr.Hassaan Ali 2014
13. Developmental anomalies of the
kidney
Abnormalities of the kidney number
Abnormalities of the kidney position
Abnormalities of the kidney rotation
Collecting system abnormalities
Cystic abnormalities of the kidney
Anomalies of renal vasculature
Dr.Hassaan Ali 2014
24. < 5% of ectopic kidney
Origin is delayed closure of diaphragmatic
Adrenal may or may not be thoracic
THORACIC ECTOPIA
Dr.Hassaan Ali 2014
25. 1 : 1000 to 1 : 2000, 90% crossed with fusion
2 : 1 male, 3 : 1 left crossed
Origin abnormal migration of ureteral bud
or rotation of caudal end
CROSSED ECTOPIA & FUSION
Dr.Hassaan Ali 2014
33. Rotation of the kidney during its ascent from the
pelvis
rotation during its ascent to the adult site.
A, Primitive embryonic
position; hilus faces ventrad (anterior)
B, Normal adult
position;
hilus faces mediad
C, Incomplete rotation.
D, Hyper-rotation;
hilus faces dorsad (posterior).
E, Hyper-rotation; hilus faces
laterad.
F, Reverse rotation; hilus faces laterad.
Dr.Hassaan Ali 2014
34. Rotation of the kidney during its ascent from the pelvis.
Dr.Hassaan Ali 2014
38. Adult type is the most common cystic disease in
humans
1 : 1250, 10 % of all ESRD
Present at age 30 – 50 yrs, can occur in children
Pain, hematuria, progressive renal impairment
IVU irregular renal enlargement + calyceal
distortion
Assoc. findings : liver cysts, berry aneurism
Autosomal dominant polycystic
kidney disease
Dr.Hassaan Ali 2014
39. Infantile type, rare (1 : 10.000)
IVU streaked appearance (sunburst
pattern)
Usually die within the first 2 mo of life
Autosomal recessive polycystic
kidney disease
Dr.Hassaan Ali 2014
40. Adult disease
Enlarged tortuous collecting ducts
1 : 20.000
IVU bristles on a brush
Complication : infection, stones, distal renal
tubular acidosis, hematuria
1/3 pat with hypercalcemia
Medullary sponge kidney (tubular
ectasia)
Dr.Hassaan Ali 2014
42. Bilateral small kidney, amedullary cysts
Progress to ESRD by age 20
Juvenile type 20% of childhood renal failure
deaths
Polydipsia & polyuria in 80%
Retinitis pigmentosa in 16%
Medullary cystic disease
Dr.Hassaan Ali 2014
43. Most common cystic disease of the newborn
Second most common abdominal mass in
infant after hydronephrosis
Left kidney is more common, =
Unilateral multicyctic dysplastic
kidney
Dr.Hassaan Ali 2014
44. Ureteropelvic junction obstruction (UPJO)
Calyceal diverticulum
Hydrocalycosis
Megacalycosis
Infundibulopelvic stenosis
Collecting system abnormalities.
Dr.Hassaan Ali 2014
45. Usual cause of the most common abdominal
mass in children (hydronephrosis)
Male: Female = 2 : 1 (in child), left side
predominance
Episodic flank pain, flank mass, hematuria,
infection, nausea & vomiting, uremia.
UPJO (uretero pelvic junction
obstruction)
Dr.Hassaan Ali 2014
48. 4,5 : 1000
Origin failure of degeneration of 3rd & 4th
order branches of ureteral bud
In 1/3 patients stones will be form
Th/ : removal stones, drainage of pus,
marsupialization to the renal surface
CALYCEAL DIVERTICULUM
Dr.Hassaan Ali 2014
50. Rare
Involving vascular compression, cicatrization
or achalasia of the infundibulum
Rarely requires any intervention
HYDROCALICOSIS
Dr.Hassaan Ali 2014
54. May involve part or all of one or both kidney
Calyces quite large
No progressive functional deterioration
Maybe with dysplasia & lower tract anomalies
Common with vesicoureteral reflux
INFUNDIBULOPELVIC STENOSIS
Dr.Hassaan Ali 2014
55. Aberrant, Accessory, or Multiple Vessels
Renal Artery Aneurysm
Renal Arteriovenous Fistula
Dr.Hassaan Ali 2014
Anomalies of renal vasculature