Histologia del riñon
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Transcript of Histologia del riñon
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Dra. Carolina Barrientos Saavedra.
Médico Patólogo.
Universidad Católica Santo Toribio de Mogrovejo- USAT
2013
HISTOLOGIA DEL RIÑON
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Retroperitoneales
12x6x3cm
Hilio: arteria renal, vena renal, uréter
CORTEZA
MEDULA
SENO
RENAL
Es una extensión del
hilio más profunda en el
riñón llena de grasa.
CORTEZA
MEDULA
CALICES
Pirámide
renal
Columnas
corticales de
bertin
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Médula = 6 a 12 regiones en
forma de pirámide
La base de cada pirámide
constituyes: BORDE
CORTICOMEDULAR.
Vértices
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LOBULO RENAL: 1.-Una pirámide renal
2.-Arco cortical
3.- Sus columnas corticales
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TIPOS DE NEFRONA
(15%)
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Grafico de nefrona cortical y yuxtamedular.
CCD, Cortical collecting duct;
CNT, connecting tubule;
CTAL, cortical thick ascending limb;
DCT, distal convoluted tubule;
IMCDi, initial inner medullary collecting duct;
IMCDt, terminal inner medullary collecting duct;
MTAL, medullary thick ascending limb;
OMCD, outer medullary collecting duct;
PCT, proximal convoluted tubule;
PST, proximal straight tubule;
TL, thin limb of loop of Henle.
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A, Renal cortex
B, Renal medulla
C, Renal papilla
D, Minor calyx
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CORPUSCULO RENAL= GLOMERULO+CAPSULA DE
BOWMAN
CORPUSCULO RENAL
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CORPUSCULO DE MALPHIGI
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Corpúsculo Renal Se encuentran exclusivamente en la corteza , y por ellos se debe el aspecto granular de la misma.
Cada uno se compone de un ovillo capilar, el glomérulo, rodeado por una cápsula de dos capas, la
cápsula de Bowman.
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Glomérulo normal. Observe la celularidad del penacho. Las flechas señalan núcleos de células
epiteliales patrietales recubriendo la cápsula de Bowman. In vivo el espacio de Bowman es más
estrecho de lo que se ve en los cortes procesados de manera convencional.
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Aproximación esquemática de un capilar glomerular.
La MBG (flechas rojas). El núcleo de un podocito flecha verde. Los núcleos de las células endoteliales
se suelen evidenciar hacia la parte mesangial del capilar (flecha azul)
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Schematic drawing of a cross-
section of a glomerulus,
including the afferent and
efferent arterioles, the macula
densa cells of the early distal
tubule, the glomerular capillaries,
mesangial cells, and podocytes.
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Imagen histológica del riñon donde apreciamos la heterogeneidad general de la imagen y donde se
observa en la parte superior la cortical y en la parte inferior áreas de la medular. En la zona central
apreciamos una arteria que corresponde a ramos arciformes que se encuentran en el seno del
parénquima renal.
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HISTOLOGIA RENAL
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Se observa otro detalle de la cortical del riñón donde apreciamos un corpúsculo renal, donde se
aprecian sus detalles histológicos habituales. En la imagen se aprecia el aparato yuxtaglomerular y
algunos de los tubos renales periglomerulares.
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GLOMERULOS El penacho está formado por lóbulos de capilares.
La arteriola aferente da origen a 4 - 8 capilares,
cada uno de los cuales se subdivide para formar
un lóbulo.
La superficie de la célula endotelial está cargada
negativamente por la presencia de una
glucoproteína, la podocalixina (sialoproteína).
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The capsule (arrow) of the kidney is composed of dense connective tissue with collagen fibers. It is
easily removed in the preparation of histologic specimens and, therefore, not all micrographs will exhibit
the capsule. Beneath the capsule is the renal cortex with its tubules, many of which are sectioned
transversely, and numerous renal corpuscles (arrowheads).
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Entre los corpusculos hay una zona que parece rayas. La estructura en la corteza que contiene
estos túbulos se conoce como un rayo medular (los túbulos colectores y las porciones rectas de los
túbulos proximales y distales)
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Renal Corpuscles (arrows) shown here, it is difficult to determine the vascular and urinary poles. The
simple squamous epithelium of the outer, or parietal, layer of Bowman's capsule (at the arrows)
encloses the glomerulus. Many of the tubules (arrowheads) in the vicinity of the renal corpuscle can be
identified as proximal tubules.
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The flattened epithelial cells of Bowman's capsule rest on a basal lamina, which is continuous with the
basal lamina that encloses the cells of the tubular nephron. The urinary space of Bowman separates
the parietal layer of Bowman's capsule from the cells of the visceral layer (podocytes) and the capillary
loops of the glomerulus.
Espacio urinario
Capa parietal
MBG
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In this image of the renal corpuscle
PODOCITO
MBG
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A, Proximal tubule; B, Vascular pole; C, Glomerulus;D, Urinary (Bowman's) space
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The vascular pole of the renal corpuscle (A) in this micrograph can be distinguished. The arrowheads
Vascular pole. The endothelial cells lie just under the tips of the arrowheads, and the wall contains a
single layer of smooth muscle cells.
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La matriz mesangial también tiñe
con el PAS, al igual que las
membranas basales, debido a la
afinidad de este colorante por el
colágeno tipo IV. (PAS, X300)
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• Los podocitos son células muy diferenciadas que no se dividen.
• Prolongaciones citoplasmaticas (prolongaciones primarias o mayores)
• Prolongaciones secundarias (pedicelos).
• Pedicelos tienen un glucocalix compuesto por sialoproteinas (podocalixina y podoendina) de carga
negativa).
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Three cell types make up the glomerulus: endothelial (red), mesangial (blue) and the visceral
ipithelial cellor podocyte (yellow). Squamous epithelial cells of the Bowman capsule are easily
seen(green). The macula densa (black) is part of the distal tubule.
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SINDROME
NEFROTICO
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Con la tinción de plata las membranas basales se ven delgadas y lisas (flechas verdes). Las flechas
azules señalan núcleos de podocitos, el citoplasma es plano. Las flechas rojas marcan algunas áreas y
núcleos de células mesangiales. NO DEBE DE HABER MÁS DE DOS NÚCLEOS EN UN ÁREA
MESANGIAL, EN CORTES DELGADOS (2 A 3 MICRAS)
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TUBULOS
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TCP
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The proximal tubules (arrowheads) are the longest and most convoluted of the tubules and, as a
result, are the most numerous in sections through the renal cortex.
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TCP: C abundante, eosinofílico y un borde en
cepillo fácil de identificar. El tamaño
citoplasmático, la altura de las células y el
borde en cepillo (flechas) son más
prominentes en la primera porción del túbulo
contorneado proximal. (H&E, X400).
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ZONA CORTICAL RENAL. PREDOMINAN TCP. GLOMERULO EN EL EXTREMO SUPERIOR IZQ
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65-80% de Na+,Cl-,agua se reabsorbe
del ultrafiltrado glomerular y se
transporta al estroma por células del
Túbulo proximal.
El Na+ se bombea de forma activa por
la membranas basolaterales por una
bomba Na+ (ATPasa de Na+-K+).
El agua pasa por canales de
ACUAPORINA 1 ubicados en la
membrana basolateral.
Glucosa,aminoácidos,proteinas del
ultrafiltrado se reabsorben.
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Extremos
delgados del asa
de Henle
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Epitelio simple plano.
En las nefronas corticales tienen segmentos delgados de 1-2 mm de largo.
En las nefronas yuxtamedulares tienen segmentos mas largos de 9 a 10 mm (llegan hasta la papila renal).
Semejan capilares pero sus células son un poca más gruesas. La luz no tiene células hematológicas
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ts = thin segment, loop of Henle
dt = distal tubule (ascending thick segment, loop of Henle)
cd = collecting duct
MEDULA
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Túbulo distal- Túbulo contorneado distal
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Túbulo distal- Mácula densa
Es una placa celular alargada formada por células del túbulo distal, que en la transición entre la pars
recta y la pars convoluta (es decir entre las arteriolas aferente y eferente) está muy cerca de la región
mesangial extraglomerular.
En esta región las células de la pared tubular son más angostas y sus núcleos están más cerca, por lo
que la zona se observa densa en los preparados histológicos, esto le valió su nombre
La mácula densa en conjunto con las células mesangiales extraglomerulares y las células
yuxtaglomerulares forman el aparato yuxtaglomerular.
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Aparato yuxtaglomerular La mácula densa + células mesangiales extraglomerulares + células yuxtaglomerulares :
aparato yuxtaglomerular.
Las células yuxtaglomerulares (JG) (producen renina) aparecen en la pared de la arteriola
aferente cuando ésta se acerca al glomérulo, están en contacto con la mácula densa,
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MACULA DENSA
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El aparato yuxtaglomerular se evidencia aquí perfectamente. Flechas rojas señalan la mácula
densa en el túbulo recto distal, observe los núcleos apicales. Casi en contacto con las células
de la mácula densa está el mesangio extraglomerular, con las células Lacis o de
Goormaghtigh, señaladas con las flechas negras. Flecha verde marca la arteriola eferente y la
azul la aferente.
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Células Lacis (rodeadas por flechas negras), la
mácula densa (flechas rojas) y dos núcleos de
células peripolares, en ambos ángulos del polo
vascular del glomérulo (flechas azules)
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Tubo Colector
Los tubos colectores (la otra parte de la unidad funcional del riñón) comienzan en la corteza y
transcurren hacia la médula por los rayos medulares, mientras reciben aferentes de varias nefronas, los
tubos colectores de la médula interna se fusionan con otros tubos colectores. Hasta formar el conducto
papilar (también denominado de Bellini) que es la última porción que desemboca en la papila renal
formando el área cribosa.
El epitelio es cúbico simple con núcleo redondo y central.
Existen dos tipos celulares, las principales o claras (más abundantes) y las intercalares u oscuras.
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The classic simple cuboidal epithelium of collecting tubules (arrows). Although it is not possible to
distinguish by light microscopy between the two types of cells that form the tubules,
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Renal medulla
The larger tubules in this image are TC.
The smaller tubules are ascending thick
segments of loops of Henle.
Descending thin segments are also present but
not as conspicuous
ts = thin segment, loop of
Henle
dt = distal tubule (ascending
thick segment, loop of Henle)
cd = collecting duct
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The large structure with the lumen is a papillary duct (of Bellini). Its histologic features are similar to
that of the collecting tubules, with the exception of the taller epithelial lining. Papillary ducts offer a
classic example of simple columnar epithelium. These ducts open at the apex of the renal pyramid,
and urine flows from them into the minor calyx.
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tubos renales de la zona cortical todos ellos revestidos por un epitelio cuboide simple y revestidos por
células con núcleos redondos y regulares de localización central. Parte superior izquierda: pequeño capilar
sanguíneo. Como se puede apreciar entre los tubos apenas hay tejido conjuntivo de sustento.
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Both the descending (A) and ascending (B) thick segments of Henle's loop are located there. In addition,
the cortical portions of the collecting tubules (C) are also found in medullary rays
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TCP (A), TCD (B), here the ascending thick segment of Henle's loop.
TUBULO COLECTOR (C). Those structures that are lined by simple cuboidal epithelium and contain
blood cells in their lumen are the vasa recta (arrowheads)
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The collecting tubules ( arrows) are lined by simple cuboidal epithelium.
Collecting tubules respond to antidiuretic hormone (ADH, vasopressin) secreted from the
neurohypophysis and control the ionic concentration of urine by becoming permeable to water, which
results in the elaboration of a hypertonic urine. Henle's loop (arrowheads)
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The lightly stained structures are the papillary ducts (arrow) (epitelio cúbico simple).
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INTERSTICIO RENAL
En la corteza el intersticio es apenas perceptible.
Es el tejido de sosten que rodea túbulos,
capilares peritibulares, glomérulos y paquetes
vasculonerviosos. (H&E, X400).
En la médula hay progresivamente más tejido
intersticial al profundizar desde la corteza. (H&E,
X400).
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VASOS
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Renal vasculature, vascular dye injection
Dye injected into the vascular system highlights
blood vessels in this image of renal medulla.
Vasa recta are conspicuous.
Renal vasculature, vascular dye injection
image of renal cortex. Glomeruli are
conspicuous
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GRACIAS