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Samenvatting Nier morfologie
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Samenvatting nier morfologie prof Roskams
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INHOUDHoofdstuk 1: inleiding ....................................................................................................................................... 3
Urinair stelsel ................................................................................................................................................ 3
Opbouw .................................................................................................................................................... 3
Functie ...................................................................................................................................................... 3
Hoofdstuk 2: nieren .......................................................................................................................................... 4
Anatomie ...................................................................................................................................................... 4
Topografie................................................................................................................................................. 4
Macroscopie ............................................................................................................................................. 4
Medulla................................................................................................................................................. 5
Cortex ................................................................................................................................................... 5
Nierlobben ................................................................................................................................................ 5
Bloedvaten ................................................................................................................................................... 5
Lymfevaten ................................................................................................................................................... 6
Bezenuwing .................................................................................................................................................. 6
Nefronen ...................................................................................................................................................... 7
Algemene organisatie ................................................................................................................................ 7
Glomerulus ............................................................................................................................................... 7
Vaatstructuur ........................................................................................................................................ 8
Glomerulaire basale membraan ............................................................................................................. 8
Visceraal epitheel .................................................................................................................................. 8
Mesangium ........................................................................................................................................... 9
Pariëtaal epitheel .................................................................................................................................. 9
Proximale tubulus ..................................................................................................................................... 9
Lus van Henle ............................................................................................................................................ 9
Distale tubulus ........................................................................................................................................ 10
Juxtaglomerulair apparaat........................................................................................................................... 10
Structuur ................................................................................................................................................. 10
Functie .................................................................................................................................................... 11
Verzamelbuizen .......................................................................................................................................... 11
Interstitium ................................................................................................................................................. 11
Hoofdstuk 3: ureter, nierbekken en nierkelken................................................................................................ 12
Topografisch en macroscopisch aspect ........................................................................................................ 12
Histologie.................................................................................................................................................... 12
Mucosa ................................................................................................................................................... 12
Muscularis............................................................................................................................................... 13
1
, Adventitia ............................................................................................................................................... 13
Hoofdstuk 4: urineblaas .................................................................................................................................. 14
Topografisch en macroscopisch aspect ........................................................................................................ 14
Histologie.................................................................................................................................................... 14
Hoofdstuk 5: urethra....................................................................................................................................... 15
Mannelijk.................................................................................................................................................... 15
Pars prostatica ........................................................................................................................................ 15
Pars membranacea.................................................................................................................................. 15
Pars spongiosa ........................................................................................................................................ 15
Lacunes van Morgagni en klieren van Littré ............................................................................................. 15
Vrouwelijk .................................................................................................................................................. 15
Urinevorming .............................................................................................................................................. 16
2
, NIER: HISTOLOGIE
HOOFDSTUK 1: INLEIDING
URINAIR STELSEL
OPBOUW
- 2 nieren
- 2 bijnieren
- 2 ureters
- 1 urethra
- Blaas
FUNCTIE
- Endocrien
o Secretie EPO → °RBC
o Secretie renine → regulatie bloeddruk en homeostase extracellulair vocht
o Metabolisme vitamine D
- Excretoir
o Bloed zuiveren van metabole afvalproducten
o Homeostase extracellulair vocht
o Vorming urine
▪ Filtratie
▪ Secretie
▪ Reabsorptie
3
,HOOFDSTUK 2: NIEREN
ANATOMIE
TOPOGRAFIE
- Retroperitoneaal
- Omgeven door:
o 1: capsula fibrosa (binnenste)
o 2: capsula adiposa (buitenste)
▪ < vet
o 3: fascia van Gerota
- Nieren thv T12-L3
o Rechter (halve wervel) lager gelegen dan linker door ligging van de lever
o Ventraal op m. transversus abdominis en m. quadratus lumborum
o Mediaal op m. psoas major
o Hilus rechts: VCI
o Hilus links: aorta abdominalis
- Bijnieren thv T11-T12
MACROSCOPIE
Vorm
- Boonvormig
- 115-170 g (man > vrouw)
- Linker nier > rechter nier
Concaaf (mediaal)
- Nierhilus
o < ureter
o < a. renalis
o < v. renalis
o < lymfevaten
o < zenuwen
o Gaat uitmonden in niersinus
- Niersinus
o < hilus
o < kelk
o < pyelon → uitmonden ureter
o Vethoudend compartiment
Convex
- Fibreus bindweefselkapsel (kan makkelijk verwijderd worden van onderliggend nierparenchym)
o Uitmonden in sinus
o Sommige delen niet omgeven door kapsel → rechtstreeks in contact met sinusaal vetweefsel
4
,MEDULLA
- Radiair gestreept
- < piramiden
o < nierpapil
▪ Monden uit in pyelon
▪ Toppen °area cribosa
▪ Uitmonden van ductus papillares
▪ Omgeven door calyx minor → versmelten tot calyx maior
- Bevloeiing door vasa recta + spiraalarteries (> a. interlobaris)
CORTEX
- Zuilen van Bertin
o Corticaal weefsel tussen de piramiden onderling
- Corticale labyrinth
o Corticaal weefsel tussen kapsel en basis van de piramiden
o < glomerulus
o < pars convoluta proximale en distale tubulus
o < tubuli colligentes
o < begin van ductuli colligentes
o < a. en v. interlobulares
o < arteriolen
o < venulen
o < capillairen en lymfevaten
- Voortzetting van medullaire streping → mergstralen van Ferrein
o < pars recta proximale en distale tubulus
o < ductuli colligentes
o < bloedvaten die behoren tot meer perifere nefronen
NIERLOBBEN
- Deel nierparenchym dat draineert via papil
- < medullaire piramiden, omgeven door cortex
- Unilobair (monopapillair) <-> multilobair
BLOEDVATEN
- Bloed via afferente arteries naar nierlichaampje → ultrafiltratie
- Netwerk van fijne capillairen
Bloed aanvoeren
- A. renalis (°op aorta abdominalis)
o Tak voor bijnieren
o Tak voor ureter
o Ventrale tak
▪ Superior segmentaire arterie
▪ Anterior superior segmentaire arterie
▪ Anterior inferior segmentaire arterie
▪ Inferior segmentaire arterie
o Dorsale tak
5
, ▪ Posterior segmentaire arterie
- 5 segmentaire arteries
- A. interlobaris (thv sinus)
- A. arcuata (thv basis piramiden)
o Parallel met nier thv cortico-medullaire junctie
o Eindigen op midden van lobus
o Eindarterie → geen anastomose
- Interlobulaire arteries
o Loodrecht op aa. arcuatae
o Radiair doorheen cortex
o Eindarterie → geen anastomose
- Afferente arteriolen
o Aansluiten op glomerulus
- Netwerk van capillairen < cluwen
- Papillen van medulla worden minder goed bevloeid → gevoelig voor O2-tekort
Bloed afvoeren
- Efferente arteriolen
o Subscapulaire (opp) nefronen: kort → °corticaal peritubulair netwerk
▪ Opname uit capillairen (van gereabsorbeerde stoffen)
▪ Capillairen °vv stellatae in perifere cortex → uitmonden in interlobulaire venen
▪ Korte lus van Henle → tot buitenste zone medulla
o Juxtamedullaire nefronen: lang → °vasa recta
▪ Vormen samen een tegenstroomsysteem = rete mirabile → uitmonden in v. arcuata
▪ Behouden van hyperosmolaliteit
▪ Lange lus van Henle → tot tegen papillen (binnenste)
o (midcorticale nefronen)
▪ Intermediaire structuur en lengte lus van Henle
- V. interlobaris
o Samenkomen van v. arcuata + v. interlobularis
- V. renalis (thv hilus)
- V. cava inferior
LYMFEVATEN
- Lymfedrainage volgens bloedvaten
o Lymfevaten °in adventitia van aa. interlobulares
o Lymfe draineren naar hilaire en para-aortale lymfeklieren
- Lymfedrainage in nierkapsel
o Naar oppervlakkig deel van de niercortex
o Lymfe draineren naar hilaire lymfeklieren (ander systeem vervoegen thv hilus)
BEZENUWING
- Orthosympathisch systeem
- Volgen verloop van arterie
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