SCHOOL OF MEDICINE AND HEALTH SCIENCES

LEOPARDS HILL CAMPUS

LECTURE NOTES IN EMBRYOLOGY OF

THE UPPER TRACT OF THE URINARY SYSTEM

By

Prof Kasonde Bowa

MSc,M.Med,FRCS,FCS,FACS,DPH,MPH,FCMS(Z)

Programme: MBChB
Course: Human Anatomy
Code: BMHA 211
Module: Module 4 The Upper Tract
Topic: The Embryology of the Upper Tract

Embryology of Upper Tract

The development of the Upper Tract of the Urinary System takes place like all other body
systems from the 4th week to the 8th week. This development can be divided into the
development of the Kidney and the development of the Ureter.

Kidney:
In contrast to the Ureter the Kidney develops from the solid mesodermal layer. The
mesoderm has 3 layers as may be recalled.Namely the paraxial mesoderm, the intermediate
mesoderm and the lateral plate mesoderm.The paraxial mesoderm gives rise to the vertebral
column and the lateral plate mesoderm to the muscles of the body wall /or the trunk.The
intermediate mesoderm gives rise to the kidney and the Gonads.

a.Making of the Kidney

The kidney develops in three phase namely the Pronephros(Primitive kidney), the
Mesonephros (intermediate Kidney) and the Metanephros(Definitive Kidney). From the 3rd
week of development the intermediate Mesoderm forms a primitive kidney tissue called the
Pronephros.This regress and in about the 4th week an intermediate kidney forms called the
Mesonephros.This changes use to become the reproductive tubes. By the 5 th week the
definitive Kidney called the Metanephros forms.

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b.Migration of the Kidney

In the 6th week the Metanephros, and the stimulation of the Metanephric bud from the
Urogenital sinus merge.With the Metanephros as the solid kidney and the Metanephric bud
as the branching tubular system.these organs are located in the Pelvis. By the 7 th week the
trunk begins to lengthen, with its vessels.This leads to the upward migration of the Kidney
until it reaches the lumbar area in the tenth week.During this processes it crosses with the
Gonads and their tubes which are migrating downwards.

It is not uncommon to find when this development fails to take place, in clinical practice
between an undescended Testis and Pelvic Kidney in a patient.

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Embryology of the Ureter

The Ureter develops from the tubular structure of the Cloaca or the Urogenital Sinus.The
Cloaca is the joint hollow organ which eventually separates into the Urogenital Sinus
anteriorly (This becomes the Bladder) and the Anorectal tube posteriorly.

This occurs from the 4th to the 8th week of development.Unlike the Kidney the Ureter
develops from the endoderm and from a hollow structure.The posterior part of the Urogenital
Sinus develops a tube called the Metanephric or Ureter bud.This stimulates the formation of
a mesenchymal condensation which is called the Metanephric cap, which is mentioned
earlier.

The metanephric bud and the Metanephros, eventually merge creating a tubular
communication which becomes the internal urinary system joining the Nephron to the
Calyceal system.

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Occassionally this process of fusion of the Metanephric bud and the Metanephros fails this
leads to a condition called a Polycystic kidneys disease.The Nephron produces urine which
has no exit, therefore multiple cysts form in the kidney as shown below.

Application to Life

The Urinary system is one body system which most of us will be aware off, even as children
growing up in our local communities. In many ways we will had some experience with this in
or day to day experience.

1.Urine and Health- in the African tradition anything coming from the body is sacred and
contains secrets of that particular individual. The health, wealth and success of an individual
is protected by protecting these body effluent. When these materials fall into the hands of
enemies of the tribe, clan or family a curse can be unleashed onto that group for generation.
The reserve of this , therefore, is that in many African portions body fluids may be added to
pass on health, wealth or success from one person to the other. This is not so far from the
truth, which is that when a person is in good health the urine will have a certain colour and
when in ill health the urine colour will change.

2.Hospital Urine- you may recall growing up and falling ill from time to time.During this
espisodes of ill health you will remember that your whole room smells like a hospital.If you
have been up and down the hospital most of them have the smell of medicines. So when to
will have been of some treatment, a lot of the tablets when broken down will pass through
the Kidneys and be removed through the kidneys. You may have noticed that the urine
changes colour and smells like you are at a hospital.

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3.Sweet Urine- if you were ever in Boarding school you will be familiar with “Zigoro”. This is
plain water with lots of sugar.this is the common “ energy “ of students in boardingschool.If
you spilled this drink on the floor long after it is dried you will see a map of soldier ants
attracted by the dried sugar on the floor..

When a person has high levels of Sugar in their blood some it will be filter out in the urine
and if the pass urine on the floor it will attract a lot of ants. You have had a member of your
family with Diabetes Mellitus (Sugar Disease).You may recall seeing something like this.

4.Smell of Urine- if you went to boarding school where you slept on Bunk beds.You could
always tell if your room mate was bed wetting, because of the chemicals contained in urine
which area cleaned out by the kidney such as Urea and Ammonia.

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Everybody would shun the bedwetter and he would sleep alone in the corner.This is a good
reminder of the Urinary System and its work in the body.

Application to Medicine

1.Renal Hypertension- One common problem in the community is High Blood pressure.This
may occur if the kidneys are not working properly.The JGA which we have seen will try to
increase Renal blood flow to improve Renal Function and this results in Kidney induced high
Blood pressure.

2.Renal Failure- When the Kidney fails to do its work properly and does not filter out the
blood.It will fail to remove harmful chemical components, then a patient can come to hospital
because of Renal Failure. They may have swelling of the face, weakness, tiredness and low
blood levels(Anemia).

To help them to leave a better life they will need to be given Dialysis treatment. This is a big
machine that does the work that the Nephron of the Kidney does.
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3.Urinary Stones-

In the Urinary system some of the particles can precipitated and coalesce to for stones in the
Urinary system.Commonly the patients will some to the hospital with severe shotting
pain.this pain is on and off or called colicky pain.They will often have blood in the urine and
may have some fever.This condition needs emergency treatment.