Urinary organs: development and congenital defects

Abstract

According to the latest reports on the congenital malformations, factors of hereditary genesis account for 23–40 % of cases, 50–51 % are of multiple factor origin, and 2–5 % are due to teratogenic effects. In the overall structure of congenital defects, the impaired urinary system makes up from 30 to 50 % and occupies leading places depending on territorial characteristics. The article discusses embryonic development of the kidneys and presents a brief analysis of the classification of urinary system malformations. The mechanisms of fine processes of nephrogenesis at the mole­cular le­vel are subject to the activity of structural genes, transcription factors, growth factors and other active substances. The major role belongs to the genes homeobox F13 and O14 (HOXA13 and HOXD14), which regulate the activity of groups of structural genes. The mecha­nism of inheritance of these genes, as a rule, is multifactorial or sex-linked, and most often it is polygenic. The paper considers risk factors for the development of urinary malformations in gene­ral, and particular the risk factors for anomalies of urinary system in Chernivtsi region depending on the territorial characteri­stics. In the mountainous regions of Chernivtsi region, the risk of develo­ping congenital urinary malformations increased in pregnant women under the age of 20, during the third pregnancy, with the presence of hypamnion and utero-placental insufficiency. In the foothill areas, frequent urinary abnormalities were detected by prenatal screening in pregnant women aged 20–24, during the second pregnancy, accompanied by utero-placental insufficiency and cord entanglement. The risk of developing anomalies of the urinary system in lowland areas increased in pregnant women under the age of 20, with a third pregnancy. Such a pregnancy was often accompanied by hypamnion and cord entanglement. Abnormalities of the urinary system were often diagnosed in male fetuses, regardless of where the pregnant woman lived. In the development of urinary system abnormalities, the factors acting in the perinatal period are of great importance, namely: chronic utero-placental insufficiency, hypamnion, gestosis of varying severity, mother’s urinary infections during pregnancy lead to chronic fetal hypoxia, which is further followed by the formation of congenital urinary malformations.

Keywords

• congenital defects
• urinary system
• fetuses
• children
• risk factors
• review