Normal Anatomy and Histology of the Kidney: Importance for Kidney Tumors

  • Ziad M. El-Zaatari
  • Komal Arora
  • Mukul K. Divatia
  • Jae Y. RoEmail author


The knowledge of the normal anatomy and histology of the kidney is essential for the pathologist evaluating kidney tumors. Perturbations of normal kidney embryologic development can give rise to pediatric tumors, such as Wilms tumor, in addition to other renal anomalies. An understanding of gross and microscopic anatomy of normal kidney is requisite for accurate diagnosis and prognostic evaluation of malignant kidney tumors. Renal tumors can arise from the proximal tubules (e.g., clear cell and papillary carcinomas), distal nephron and collecting ducts (e.g., chromophobe, renal oncocytoma, and collecting duct carcinoma), or other normal microscopic components of the kidney (e.g., renal interstitial cell tumor, juxtaglomerular cell tumor). Guidelines for the gross examination of kidney tumor specimens have been laid out by the International Society of Urological Pathology (ISUP) and the College of American Pathologists (CAP) and are summarized in this chapter.


Kidney Embryology of the kidney Anatomy of the kidney Histology of the kidney Pathology of kidney tumors Tumors of the kidney Staging of kidney cancer 


  1. 1.
    Clapp W, Croker B. Kidney. In: Mills SE, editor. Histology for pathologists. Philadelphia: Lippincott Williams & Wilkins; 2012. p. 891–970.Google Scholar
  2. 2.
    Moore K, Persaud T. The developing human: clinically oriented embryology. 8th ed. Philadelphia: Saunders; 2003. p. 243–83.Google Scholar
  3. 3.
    Scott R, Maezawa Y, Kreidberg J, Quaggin S. Brenner and Rector’s the kidney. 10th ed. Philadelphia: Elsevier Health Sciences; 2015.Google Scholar
  4. 4.
    Van den Neuvel-Eibrink M, editor. Wilms tumor. Brisbane: Codon Publications; 2016.Google Scholar
  5. 5.
    Muir TE, Cheville JC, Langer DJ. Metanephric adenoma, nephrogenic rests, and Wilms’ tumor: a histologic and immunophenotypic comparison. Am J Surg Pathol. 2001;25:1290–6.CrossRefGoogle Scholar
  6. 6.
    Nordmark B. Double formations of the pelves of the kidney and ureters: embryology, occurrence and clinical significance. Acta Radiol. 1948;30:267–78.CrossRefGoogle Scholar
  7. 7.
    Siomou E, Papadopoulou F, Kollios K, et al. Duplex collecting system diagnosed during the first 6 years of life after a first urinary tract infection: a study of 63 children. J Urol. 2006;175(2):678–81.CrossRefGoogle Scholar
  8. 8.
    Fernbach S, Feinstein K, Spencer K, Lindstrom C. Ureteral duplication and its complications. Radiographics. 1997;17:109–27.CrossRefGoogle Scholar
  9. 9.
    Woolf AS, Price KL, Scrambler PJ, Winyard PJD. Evolving concepts in human renal dysplasia. J Am Soc Nephrol. 2004;15:998–1007.CrossRefGoogle Scholar
  10. 10.
    Emamian SA, Nielsen MB, Pedersen JF, Ytte L. Kidney dimensions at sonography: correlation with age, sex, and habitus in 665 adult volunteers. Am J Roentgenol. 1993;160(1):83–6.CrossRefGoogle Scholar
  11. 11.
    Tanagho E, Lue T. Chapter 1. Anatomy of the genitourinary tract. In: McAninch JW, Lue TF, editors. Smith and Tanagho’s general urology. New York: McGraw-Hill; 2013.Google Scholar
  12. 12.
    Bosnib S. Nonneoplastic diseases of the kidney. In: Bostwick DG, Cheng L, editors. Urologic surgical pathology. Philadelphia: Saunders Elsevier; 2014.Google Scholar
  13. 13.
    Hansen J. Netter’s clinical anatomy. 3rd ed. Philadelphia: Elsevier Health Sciences; 2014.Google Scholar
  14. 14.
    Amin MB, editor-in-chief. American Joint Committee on Cancer (AJCC) Cancer staging manual. 8th ed. Chicago: Springer International Publishing; 2017.Google Scholar
  15. 15.
    Klatte T, Ficarra V, Gratzke C, et al. A literature review of renal surgical anatomy and surgical strategies for partial nephrectomy. Eur Urol. 2015;68(6):980–92.CrossRefGoogle Scholar
  16. 16.
    Alexander R, Sung M, Cheng L. Lymphadenectomy in urologic oncology: pathologic considerations. Urol Clin North Am. 2011;3(4):483–95.CrossRefGoogle Scholar
  17. 17.
    Mehta V, Mudaliar K, Ghai R, et al. Renal lymph nodes for RCC staging: appraisal of 871 adult nephrectomies with microscopic examination of hilar fat. Arch Pathol Lab Med. 2013;137(11):1584–90.CrossRefGoogle Scholar
  18. 18.
    Ross M, Pawlina W. Histology: a text and atlas with correlated cell and molecular biology. 5th ed. Philadelphia: Lippincott Williams & Wilkins; 2006. p. 646–85.Google Scholar
  19. 19.
    Moch H, Amin MB, Argani P, Cheville J, Delahunt B, Martignoni G, Medeiros LJ, Srigley JR, Tan PH, Tickoo SK. Renal cell tumors. In: Moch H, Humphrey PA, Tomas MU, Reuter VE, editors. WHO classification of tumours of the urinary system and male genital organs. Lyon: IARC; 2016.Google Scholar
  20. 20.
    Cairns P. Renal cell carcinoma. Cancer Biomark. 2011;9(1–6):461–73.CrossRefGoogle Scholar
  21. 21.
    Moll R, Hage C, Thoenes W. Expression of intermediate filament proteins in fetal and adult human kidney: modulation of intermediate filament patterns during development and in damaged tissue. Lab Investig. 1991;65:74–86.PubMedGoogle Scholar
  22. 22.
    Oosterwijk E, van Muijen GNP, Oosterwijk-Wakka JC, et al. Expression of intermediate-sized filaments in developing and adult human kidney and in renal cell carcinoma. J Histochem Cytochem. 1990;38:385–92.CrossRefGoogle Scholar
  23. 23.
    Kumar S, Choudhary GR, Nanjappa B, Bal A. Benign medullary fibroma of the kidney: a rare diagnostic dilemma. J Clin Imaging Sci. 2013;3:43–6.CrossRefGoogle Scholar
  24. 24.
    Magro G, Lopes M, Giannone G. Benign fibromatous tumor (fibroma) of the kidney: a case report. Pathol Res Pract. 1998;194:123–7.CrossRefGoogle Scholar
  25. 25.
    Schmidt-Nielsen B. The renal pelvis. Kidney Int. 1987;31(2):621–8.CrossRefGoogle Scholar
  26. 26.
    Beckwith JB. National Wilms tumor study: an update for pathologists. Pediatr Dev Pathol. 1998;1:79–84.CrossRefGoogle Scholar
  27. 27.
    Bonsib SM. The renal sinus is the principal invasive pathway: a prospective study of 100 renal cell carcinomas. Am J Surg Pathol. 2004;28:1594–600.CrossRefGoogle Scholar
  28. 28.
    Jeong SU, Park JM, Shin SJ, Lee J, Song C, Go H, Cho NH, Ro JY, Cho YM. Prognostic significance of macroscopic appearance in clear cell renal cell carcinoma and its metastasis-predicting model. Pathol Int. 2017;67(12):610–9.CrossRefGoogle Scholar
  29. 29.
    Trpkov K, Grignon DJ, Bonsib SM, Amin MB, Billis A, Lopez-Beltran A, Samaratunga H, Tamboli P, Delahunt B, Egevad L, Montironi R, Srigley JR. Handling and staging of renal cell carcinoma. The International Society of Urological Pathology Consensus (ISUP) conference recommendations. Am J Surg Pathol. 2013;37:1505–17.CrossRefGoogle Scholar

Copyright information

© Springer Nature Switzerland AG 2020

Authors and Affiliations

  • Ziad M. El-Zaatari
    • 1
  • Komal Arora
    • 1
  • Mukul K. Divatia
    • 1
  • Jae Y. Ro
    • 1
    Email author
  1. 1.Department of Pathology and Genomic MedicineHouston Methodist Hospital, Weill Medical College of Cornell UniversityHoustonUSA

Personalised recommendations