EMBRYOLOGY &

SONOAPPEARANCE OF
KIDNEYS

The permanent kidney (metanephros) is the third in

a
series of excretory organs in the human embryo,
forming
after the pronephros and mesonephros. In the
seventh
menstrual week, the metanephros begins to develop
from two sources: the metanephric diverticulum
(ureteric
bud) and the metanephric mass of intermediate
Mesoderm.

The ureteric bud is an outgrowth from

the mesonephric duct, near its
entrance into the cloaca. It elongates
and branches in a dichotomous
pattern, giving rise to the ureter, renal
pelvis, calyces, and collecting tubules.
Through
interaction
with
the
metanephric mesoderm, the ureteric
bud induces the formation of nephrons.

In early embryonic life, the kidneys are

located in the pelvis, but they
ascend to their adult position by the
11th menstrual week. At this
gestation, the kidneys start to produce
urine.

By the ninth menstrual week, the cloaca

(caudal part of hindgut) is divided by the
urorectal septum into the rectum posteriorly
and the urogenital sinus anteriorly. The urinary
bladder, the female urethra, and most of the
male urethra develop from the urogenital sinus
and the surrounding splanchnic mesenchyme.
Initially, the bladder is continuous with the
allantois, but this structure soon constricts and
becomes a fibrous cord, the urachus

In the first trimester the fetal kidneys are

best
examined
by
transvaginal
sonography. The kidneys are seen as oval,
hyperechoic structures in the paravertebral
regions, with a small, central sonolucent
area caused by fluid in the renal pelvis By
12 to 13 weeks of gestation, the kidneys
could be visualized in 99% of cases with
combined transabdominal and transvaginal
sonography.

In the second trimester the kidneys often

appear as isoechoic structures adjacent to the
fetal spine on transabdominal . As the fetus
matures,
corticomedullary
differentiation
becomes more obvious, especially in the third
trimester The renal pyramids orient in anterior
and posterior rows and are hypoechoic relative
to the renal cortex. In the third trimester the
renal cortex is isoechoic or slightly hyperechoic
to liver and spleen. With fat deposition in the
perinephric region, an echogenic border
develops, and the kidney becomes better
delineated.
Normal fetal lobations are often visible and give
the kidneys an undulating contour.

The renal/abdominal circumference ratio

remains constant at 0.27 to 0.30
throughout pregnancy.
The calyces are not normally visualized, but
some fluid is typically seen in the renal
pelvis. The highly characteristic renal pelvic
echo
The normal ureter is 1 to 2 mm in diameter
and is not normally visible
By using transvaginal sonography, the
bladder can be seen as early as 11 weeks
of gestation

Amniotic Fluid Volume

Evaluation of amniotic fluid volume
(AFV) provides important information
about fetal renal function