embriologi ginjal
TRANSCRIPT
![Page 1: Embriologi Ginjal](https://reader033.vdocuments.net/reader033/viewer/2022061113/545e2d0eb1af9f5a338b4780/html5/thumbnails/1.jpg)
Embriologi Ginjal
dr. Rohmania Setiarini
![Page 2: Embriologi Ginjal](https://reader033.vdocuments.net/reader033/viewer/2022061113/545e2d0eb1af9f5a338b4780/html5/thumbnails/2.jpg)
O The nephrogenic cord develops into three sets of nephric structures: the pronephros, mesonephros, and metanephros.
![Page 3: Embriologi Ginjal](https://reader033.vdocuments.net/reader033/viewer/2022061113/545e2d0eb1af9f5a338b4780/html5/thumbnails/3.jpg)
O3 embryonic kidneys (from intermediate mesoderm)- O Pronephros- transient (week 3-5),
nonfunctional, 5-7 paired segments.
![Page 4: Embriologi Ginjal](https://reader033.vdocuments.net/reader033/viewer/2022061113/545e2d0eb1af9f5a338b4780/html5/thumbnails/4.jpg)
Pronephros
Develops by the differentiation of mesoderm within the nephrogenic cord to form pronephric tubules and the pronephric duct.*
![Page 5: Embriologi Ginjal](https://reader033.vdocuments.net/reader033/viewer/2022061113/545e2d0eb1af9f5a338b4780/html5/thumbnails/5.jpg)
Pronephros
The pronephros is the cranialmost nephric structure and is a transitory structure that regresses completely by week 5.
The pronephros is not functional in humans.
![Page 6: Embriologi Ginjal](https://reader033.vdocuments.net/reader033/viewer/2022061113/545e2d0eb1af9f5a338b4780/html5/thumbnails/6.jpg)
O Mesonephros- transient (week 4- month 4), excretory organ while metanephros begins development. O Formation of nephric ducts/wolffian
ducts precedes development of mesonephric tubules.
O Small number of elements from mesonephros persist to form reproductive tract.
O Males- efferent ductules of testes, epididymis and vas- wolfian origin.
O Females- nonfunctional mesosalpingeal structures.
![Page 7: Embriologi Ginjal](https://reader033.vdocuments.net/reader033/viewer/2022061113/545e2d0eb1af9f5a338b4780/html5/thumbnails/7.jpg)
Mesonephros
![Page 8: Embriologi Ginjal](https://reader033.vdocuments.net/reader033/viewer/2022061113/545e2d0eb1af9f5a338b4780/html5/thumbnails/8.jpg)
Mesonephros
Develops by differentiation of mesoderm within the nephrogenic cord to form mesonephric tubules and the mesonephric duct (wolffian duct).*
![Page 9: Embriologi Ginjal](https://reader033.vdocuments.net/reader033/viewer/2022061113/545e2d0eb1af9f5a338b4780/html5/thumbnails/9.jpg)
Mesonephros Most of the mesonephric tubules regress, but the
mesonephric duct persists and opens into the urogenital sinus. *
The mesonephros is functional for a short period.
![Page 10: Embriologi Ginjal](https://reader033.vdocuments.net/reader033/viewer/2022061113/545e2d0eb1af9f5a338b4780/html5/thumbnails/10.jpg)
O
![Page 11: Embriologi Ginjal](https://reader033.vdocuments.net/reader033/viewer/2022061113/545e2d0eb1af9f5a338b4780/html5/thumbnails/11.jpg)
Develops from an outgrowth of the mesonephric duct (called the ureteric bud) and from a condensation of mesoderm within the nephrogenic cord called the metanephric mesoderm.
Metanephros
![Page 12: Embriologi Ginjal](https://reader033.vdocuments.net/reader033/viewer/2022061113/545e2d0eb1af9f5a338b4780/html5/thumbnails/12.jpg)
O
O Metanephros- definitive kidneysO Form as ureteric buds (from distal end of nephric
duct)O Penetrates metanephric mesenchyme at 28 days to
begin nephron formation- lobulated appearance.O Metanephric mesoderm forms nephron or excretory
unit (glomerulus, proximal tubule, loop of Henle, distal tubule)- form from metanephric mesenchyme.
O Older nephrons on inner part of kidney, newer at periphery.
![Page 13: Embriologi Ginjal](https://reader033.vdocuments.net/reader033/viewer/2022061113/545e2d0eb1af9f5a338b4780/html5/thumbnails/13.jpg)
O
![Page 14: Embriologi Ginjal](https://reader033.vdocuments.net/reader033/viewer/2022061113/545e2d0eb1af9f5a338b4780/html5/thumbnails/14.jpg)
The metanephros begins to form at week 5 and is functional in the fetus at about week 10.
It develops into the definitive adult kidney.
Metanephros
![Page 15: Embriologi Ginjal](https://reader033.vdocuments.net/reader033/viewer/2022061113/545e2d0eb1af9f5a338b4780/html5/thumbnails/15.jpg)
The fetal kidney is divided into lobes in contrast to the definitive adult kidney, which has a smooth contour.
Metanephros
![Page 16: Embriologi Ginjal](https://reader033.vdocuments.net/reader033/viewer/2022061113/545e2d0eb1af9f5a338b4780/html5/thumbnails/16.jpg)
Two Systems:*
Development of the Metanephros
Collecting System* Excretory (Nephron)
System*
![Page 17: Embriologi Ginjal](https://reader033.vdocuments.net/reader033/viewer/2022061113/545e2d0eb1af9f5a338b4780/html5/thumbnails/17.jpg)
Development of the Collecting System
The ureteric bud initially penetrates the metanephric mesoderm, and then undergoes repeated branching to form the ureters, renal pelvis, major calyces, minor calyces, and collecting ducts.
![Page 18: Embriologi Ginjal](https://reader033.vdocuments.net/reader033/viewer/2022061113/545e2d0eb1af9f5a338b4780/html5/thumbnails/18.jpg)
Development of the Collecting System
The ureteric bud initially penetrates the metanephric mesoderm, and then undergoes repeated branching to form the ureters, renal pelvis, major calyces, minor calyces, and collecting ducts.
![Page 19: Embriologi Ginjal](https://reader033.vdocuments.net/reader033/viewer/2022061113/545e2d0eb1af9f5a338b4780/html5/thumbnails/19.jpg)
Development of the Excretory System The inductive influence of the collecting ducts
causes the metanephric mesoderm to differentiate into metanephric vesicles which later give rise to primitive S-shaped renal tubules, which arecritical to nephron formation.
![Page 20: Embriologi Ginjal](https://reader033.vdocuments.net/reader033/viewer/2022061113/545e2d0eb1af9f5a338b4780/html5/thumbnails/20.jpg)
Development of the Excretory System
The S-shaped renal tubules differentiate into the distal convoluted tubule, loop of Henle, proximal convoluted tubule, and Bowman's capsule.
![Page 21: Embriologi Ginjal](https://reader033.vdocuments.net/reader033/viewer/2022061113/545e2d0eb1af9f5a338b4780/html5/thumbnails/21.jpg)
Development of the Excretory System
Tufts of capillaries called glomeruli protrude into Bowman's capsule.
![Page 22: Embriologi Ginjal](https://reader033.vdocuments.net/reader033/viewer/2022061113/545e2d0eb1af9f5a338b4780/html5/thumbnails/22.jpg)
O
![Page 23: Embriologi Ginjal](https://reader033.vdocuments.net/reader033/viewer/2022061113/545e2d0eb1af9f5a338b4780/html5/thumbnails/23.jpg)
Development of the Excretory System
Nephron formation is complete at birth, but functional maturation of nephrons continues throughout infancy.
![Page 24: Embriologi Ginjal](https://reader033.vdocuments.net/reader033/viewer/2022061113/545e2d0eb1af9f5a338b4780/html5/thumbnails/24.jpg)
Ascent of the Kidneys The fetal metanephros is located at vertebral level
S1-S2, whereas the definitive adult kidney is located at vertebral level T12-L3.
The change in location results from a disproportionate growth of the embryo caudal to the metanephros.
![Page 25: Embriologi Ginjal](https://reader033.vdocuments.net/reader033/viewer/2022061113/545e2d0eb1af9f5a338b4780/html5/thumbnails/25.jpg)
Ascent of the Kidneys
During the ascent, the kidneys rotate 90°causing the hilum, which initially faces ventrally, to finally face medially.
![Page 26: Embriologi Ginjal](https://reader033.vdocuments.net/reader033/viewer/2022061113/545e2d0eb1af9f5a338b4780/html5/thumbnails/26.jpg)
Blood Supply of the Kidneys
During the ascent of the kidneys, the kidneys receive their blood supply from arteries at progressively higher levels until the definitive renal arteries develop at L2.
Arteries formed during the ascent may persist and are called supernumerary arteries.
Supernumerary arteries are end arteries. Therefore, any damage to them results in necrosis of kidney parenchyma.
![Page 27: Embriologi Ginjal](https://reader033.vdocuments.net/reader033/viewer/2022061113/545e2d0eb1af9f5a338b4780/html5/thumbnails/27.jpg)
Congenital Malformations
O Renal agenesisO UnilateralO Bilateral
O Renal hypoplasiaO Congenital cystic kidneys
O Types 1 -5O Horseshoe (fused) kidneysO Wilms tumor
![Page 28: Embriologi Ginjal](https://reader033.vdocuments.net/reader033/viewer/2022061113/545e2d0eb1af9f5a338b4780/html5/thumbnails/28.jpg)
Renal AgenesisO Absence of kidneys
O Unilateral (compatible with life)O Affects 1 in every 800-1500 peopleO May occasionally present with genitalia anomoliesO Trisomy of 18O Addition or partial trisomy of 13O Prenatal rubella infection
O Bilateral (incompatible with life)O 40% stillborn O Of those born alive 95% die within 24 hours of birthO Potter syndrome and associated oligohydramnios
![Page 29: Embriologi Ginjal](https://reader033.vdocuments.net/reader033/viewer/2022061113/545e2d0eb1af9f5a338b4780/html5/thumbnails/29.jpg)
Renal agenesis occurs when the ureteric bud fails to develop, thereby eliminating the induction of metanephric vesicles and nephron formation.
![Page 30: Embriologi Ginjal](https://reader033.vdocuments.net/reader033/viewer/2022061113/545e2d0eb1af9f5a338b4780/html5/thumbnails/30.jpg)
Renal Agenesis Unilateral renal agenesis is more common in males.
This situation is asymptomatic and compatible with life because the remaining kidney hypertrophies.
![Page 31: Embriologi Ginjal](https://reader033.vdocuments.net/reader033/viewer/2022061113/545e2d0eb1af9f5a338b4780/html5/thumbnails/31.jpg)
Bilateral Renal Agenesis
Causes oligohydramnios, which results in compression of the fetus, Potter syndrome, (deformed limbs, wrinkly skin, abnormal facial appearance [flattened nose, wide interpupillary space low set ears] and tapering fingers).
Infants with bilateral renal agenesis are usually stillborn or die shortly after birth.
![Page 32: Embriologi Ginjal](https://reader033.vdocuments.net/reader033/viewer/2022061113/545e2d0eb1af9f5a338b4780/html5/thumbnails/32.jpg)
Renal hypoplasiaO Incomplete development of kidneys
O Unilateral (compatible with life)O Bilateral (incompatible with life) if
condition is severeO Kidneys are small
O Decreased functional parenchyma
![Page 33: Embriologi Ginjal](https://reader033.vdocuments.net/reader033/viewer/2022061113/545e2d0eb1af9f5a338b4780/html5/thumbnails/33.jpg)
Congenital cystic kidneys
O Type 1O Polycystic kidneys found in infants
O Bilateral and results in early deathO Large renal pelvis and calyces
O Type 2O Cysts are variable in size and shapeO Usually unilateralO Affected kidney non functional
![Page 34: Embriologi Ginjal](https://reader033.vdocuments.net/reader033/viewer/2022061113/545e2d0eb1af9f5a338b4780/html5/thumbnails/34.jpg)
Congenital cystic kidneys (cont.)
O Type 3O Affected kidneys contain both normal
and abnormal tissueO Both kidneys involvedO Autosomal dominant gene
O Trisomy of 13-15, 18, 21, 22O Type 4
O Caused by urethral obstructionO If severe early death
O Type 5O Manifests during adult life, death by 50.O Autosomal dominant
![Page 35: Embriologi Ginjal](https://reader033.vdocuments.net/reader033/viewer/2022061113/545e2d0eb1af9f5a338b4780/html5/thumbnails/35.jpg)
Horseshoe (fused) kidney
O Fusion of two kidneys at their lower endO Tissue that connects kidneys =
isthmusO 1:400O Trisomy 13-15; 18, 21, Turner’s
syndrome, mosaicism
![Page 36: Embriologi Ginjal](https://reader033.vdocuments.net/reader033/viewer/2022061113/545e2d0eb1af9f5a338b4780/html5/thumbnails/36.jpg)
Renal Fusion
The most common type of renal fusion is the horseshoe kidney.
![Page 37: Embriologi Ginjal](https://reader033.vdocuments.net/reader033/viewer/2022061113/545e2d0eb1af9f5a338b4780/html5/thumbnails/37.jpg)
Renal Fusion A horseshoe kidney occurs when the inferior poles of
the kidneys fuse across the midline.
Normal ascent of the kidneys is arrested because the fused portion gets trapped beneath the inferior mesenteric artery.
Kidney rotation is also arrested so that the hilum faces ventrally.
![Page 38: Embriologi Ginjal](https://reader033.vdocuments.net/reader033/viewer/2022061113/545e2d0eb1af9f5a338b4780/html5/thumbnails/38.jpg)
Wilms TumorO Renal tumor of childrenO Characterized by rapid growth and
early metastasisO Mesodermal origin
O Metanephric tissue that have failed to differentiate into normal kidney tissue
![Page 39: Embriologi Ginjal](https://reader033.vdocuments.net/reader033/viewer/2022061113/545e2d0eb1af9f5a338b4780/html5/thumbnails/39.jpg)
Embryonic developmentO Urinary system, internal
reproductive organs and external genitaliaO Develop synchronously
at an early embryologic age(table 5.6)