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Published on: June 23, 2015
Developmental renal pathology: its past, present, and future
1University of Miami, School of Medicine, Jackson Children's Hospital, Department of Pathology, 1611 NW 12 Avenue, Miami, FL 33184, USA. mrodrig2@med.miami.edu
Insights
Congenital anomalies of the kidney and urinary tract cause 40% of childhood end-stage renal failure. This review covers developmental renal lesions, embryology, and advances in diagnosis and treatment for better prognoses.
Area of Science:
- Pediatric Nephrology
- Developmental Biology
- Medical Genetics
Background:
- Congenital anomalies of the kidney and urinary tract (CAKUT) are a leading cause of pediatric end-stage renal failure.
- Understanding CAKUT is crucial for managing childhood kidney diseases.
Purpose of the Study:
- To provide a comprehensive overview of developmental renal lesions in children.
- To review embryology, pathology, and postnatal development of the kidney.
- To discuss recent advances and future directions in diagnosing and treating CAKUT.
Main Methods:
- Review of historical references and current literature on CAKUT.
- Analysis of embryological and pathological aspects of renal development.
- Discussion of diagnostic modalities like fetal ultrasonography and molecular biology.
Main Results:
- CAKUT encompasses a wide spectrum of conditions, including renal agenesis, dysplasias, polycystic kidney diseases, and vesicoureteral reflux.
- Advances in fetal ultrasonography and molecular biology offer improved diagnostic capabilities.
- Pharmacogenetics presents promising future avenues for enhanced prognosis.
Conclusions:
- CAKUT represents a significant burden in pediatric renal failure.
- Integrated approaches combining embryology, pathology, and modern diagnostics are essential.
- Future research in pharmacogenetics holds potential for personalized treatments and improved outcomes for affected children.
Abstract:
Congenital anomalies of the kidney and urinary tract are responsible for approximately 40% of cases of childhood end-stage renal failure in the United States. This article describes the spectrum of developmental renal lesions in children (including renal agenesis, dysplasias, hereditary hydronephrosis, autosomal recessive and dominant polycystic kidneys, vesicoureteral reflux, diabetic embryopathy, some teratogenic drugs affecting renal development, and syndromes associated with renal dysplasias). The article quotes some historic references that established the foundation for further studies; reviews the embryology, pathology, postnatal renal development, and its possible consequences of renal function; as well as recent advances in fetal ultrasonography and molecular biology with some novel treatment and diagnostic modalities. Finally, an attempt is made to predict several future avenues in pharmacogenetics that are being built currently and that will allow a better prognosis for many children with congenital renal conditions.
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