Maldevelopment of the Human Kidney and Lower Urinary Tract. An Overview

This chapter focuses on the maldevelopment of human kidney and lower urinary tract, which include the ureter and urinary bladder. Renal malformations are the major cause of chronic renal failure in children. With advances in technology, babies with minimal renal function can be dialyzed from birth and toddlers can receive kidney transplants from the age of one year. The chapter describes the possible causes of human kidney and lower urinary tract malformations, which can be classified into two categories: (1) mutations, and possibly polymorphisms, of genes expressed during development, and (2) environmental influences on development, which can be further subdivided into changes that originate outside the fetus, such as alterations of maternal diet, and changes within the fetus that disrupt normal development, such as impairment of normal fetal urinary flow due to physical obstruction of the urinary tract. Human kidney or lower urinary tract malformation are reported in association with teratogens—angiotensin converting enzyme inhibitors, drugs used to treat high blood pressure cocaine, corticosteroids, ethanol, gentamycin, glucose, nonsteroidal anti-inflammatory drugs, and vitamin A and its derivatives.