组织学与胚胎学：第20章 泌尿系统(Urinary System)

Wednesday,April19,2023SHUJia120-274页泌尿系统(UrinarySystem)组成：肾输尿管膀胱尿道功能：生成和排尿调节体内水和电解质分泌活性物质Wednesday,April19,2023SHUJia2肾动、静脉肾输尿管膀胱尿道Wednesday,April19,2023SHUJia3肾纤维膜,皮质,髓质(锥体),髓放线,皮质迷路,肾小叶,肾柱,肾叶肾单位(Nephron):肾小体(血管球+肾小囊)+肾小管泌尿小管(UriniferousTubule):肾小管+集合小管Wednesday,April19,2023SHUJia4肾Wednesday,April19,2023SHUJia5Wednesday,April19,2023SHUJia6肾叶Wednesday,April19,2023SHUJia7肾的组织结构

被膜:致密结缔组织实质:泌尿小管和间质

血管球迷路肾小体肾小囊曲部肾单位近端小管直部髓放线肾小管细段髓袢或远端小管直部髓质曲部迷路集合小管泌尿小管位于位于位于Wednesday,April19,2023SHUJia8Wednesday,April19,2023SHUJia9肾切片Wednesday,April19,2023SHUJia10肾皮质Wednesday,April19,2023SHUJia11Wednesday,April19,2023SHUJia12Wednesday,April19,2023SHUJia13Wednesday,April19,2023SHUJia14肾髓质Wednesday,April19,2023SHUJia15肾单位肾小体+肾小管肾结构和功能单位Wednesday,April19,2023SHUJia16肾单位Wednesday,April19,2023SHUJia17血管球(Glomerulus)

肾小囊(RenalCapsule)肾小体(RenalCorpuscle)血管极、尿极Wednesday,April19,2023SHUJia18肾小体Wednesday,April19,2023SHUJia19血管球Wednesday,April19,2023SHUJia20肾单位Wednesday,April19,2023SHUJia21肾小体Wednesday,April19,2023SHUJia22入、出球微动脉有孔毛细血管，隔膜、基膜厚血管(球内)系膜血管球Wednesday,April19,2023SHUJia23Wednesday,April19,2023SHUJia24血管系膜

基质+细胞基质：富含Ⅳ型胶原纤维和蛋白多糖；支持毛细血管袢Wednesday,April19,2023SHUJia25系膜细胞(MesangialCell)形态:多突起，核小染色深，溶酶体和吞噬体，微丝微管，粗面内质网Wednesday,April19,2023SHUJia26功能:合成基质，参与基膜更新与修复吞噬基膜内免疫复合物支持毛细血管，调节血流量分泌血小板激活因子等Wednesday,April19,2023SHUJia27血管系膜Wednesday,April19,2023SHUJia28血管系膜Wednesday,April19,2023SHUJia29近端肾小管起始部膨大凹陷外层扁平，与近曲小管上皮相续内层足细胞(Podocyte)突起之间为裂孔，覆有裂孔膜肾小囊(RenalCapsule)Wednesday,April19,2023SHUJia30足细胞Wednesday,April19,2023SHUJia31足细胞Wednesday,April19,2023SHUJia32Wednesday,April19,2023SHUJia33Wednesday,April19,2023SHUJia34血管球基膜形成与更新摄取滤液成分支撑毛细血管收缩足细胞功能Wednesday,April19,2023SHUJia35有孔内皮、基膜和足细胞裂孔膜唾液酸糖蛋白分子筛选择性滤过滤过膜(FiltrationMembrane)Wednesday,April19,2023SHUJia36Wednesday,April19,2023SHUJia37Wednesday,April19,2023SHUJia38滤过膜Wednesday,April19,2023SHUJia39毛细血管基膜、系膜与足细胞Wednesday,April19,2023SHUJia40滤过膜Wednesday,April19,2023SHUJia41滤过膜Wednesday,April19,2023SHUJia42Wednesday,April19,2023SHUJia43Wednesday,April19,2023SHUJia44肾小管近端小管＋细段＋远端小管近/远端小管：曲部+直部Wednesday,April19,2023SHUJia45最长、粗单层锥体形，嗜酸性，细胞间分界不清，侧突，核近基底，游离面刷状缘，基部纵纹，Na＋、K＋-ATP酶，吞饮小泡重吸收和分泌(H＋、氨、肌酐和马尿酸)近端小管(ProximalTubule)Wednesday,April19,2023SHUJia46近曲小管上皮Wednesday,April19,2023SHUJia47Wednesday,April19,2023SHUJia48近曲小管PAS染色Wednesday,April19,2023SHUJia49近曲小管Wednesday,April19,2023SHUJia50Wednesday,April19,2023SHUJia51近曲小管Wednesday,April19,2023SHUJia52近端小管重吸收示意图Wednesday,April19,2023SHUJia53单层扁平上皮，弱嗜酸性水和离子易通过细段(ThinSegment)Wednesday,April19,2023SHUJia54Wednesday,April19,2023SHUJia55单层立方上皮，染色浅核近腔面,基部纵纹明显，Na＋、K＋-ATP酶,直部有T-H(酸性糖)蛋白,水不能通过受醛固酮和抗利尿激素的调节远端小管(DistalTubule)Wednesday,April19,2023SHUJia56Wednesday,April19,2023SHUJia57Wednesday,April19,2023SHUJia58近曲小管远曲小管Wednesday,April19,2023SHUJia59Wednesday,April19,2023SHUJia60近曲小管远曲小管管腔小、不规则大、规则管壁厚、细胞大薄、细胞小胞质染色嗜酸性强嗜酸性弱细胞界线不清楚较清楚刷状缘有无基底纵纹不明显明显肾小管特点Wednesday,April19,2023SHUJia61肾小管和集合小管结构特点比较

近曲小管远曲小管 细段 集合小管

部位 皮质 皮质放、锥迷、放、锥管径

较粗 较细 细 粗 管腔

较小不规则较大 小 大 细胞大小 较大 较小 小 形状

立方或锥体形立方形 扁平立方至柱状着色

深 浅 浅 色淡而明亮

分界

不清（侧突）清楚 清楚 核

核圆近基底部核圆居中突向管腔核圆居中深染

Wednesday,April19,2023SHUJia62肾单位袢(NephronLoop)又称髓袢，由近端小管直部、细段和远端小管直部构成“U”形结构Wednesday,April19,2023SHUJia63原尿（125ml/min）滤过原理血管球血压滤过孔径内皮和足细胞表面唾液酸糖蛋白基膜分子筛和硫酸肝素Wednesday,April19,2023SHUJia64两种肾单位浅表肾单位(CorticalNephron)髓旁肾单位(JuxtamedullaryNephron)Wednesday,April19,2023SHUJia65两种肾单位Wednesday,April19,2023SHUJia66浅表肾单位发生晚数量85%，体积小细段和髓袢短单个血供少尿液形成Wednesday,April19,2023SHUJia67髓旁肾单位特点相反与肾间质渗透压梯度形成和尿浓缩有关Wednesday,April19,2023SHUJia68集合小管(CollectingTubule)弓形直(皮、髓质)乳头管管径由细变粗，上皮由立方柱状高柱状Wednesday,April19,2023SHUJia69集合小管细胞分界清楚，胞质透亮，核居中集合管细胞：Na＋和水通道蛋白闰细胞：H＋-ATP酶和Cl-/HCO3-交换载体Wednesday,April19,2023SHUJia70重吸收及分泌受醛固酮和抗利尿激素调节功能Wednesday,April19,2023SHUJia71髓质Wednesday,April19,2023SHUJia72肾髓质Wednesday,April19,2023SHUJia73髓质Wednesday,April19,2023SHUJia74集合小管Wednesday,April19,2023SHUJia75肾小管各段模式图Wednesday,April19,2023SHUJia76肾小球旁器（球旁复合体）

(JuxtaglomerularComplex)球旁细胞＋致密斑＋球外系膜细胞Wednesday,April19,2023SHUJia77Wednesday,April19,2023SHUJia78Wednesday,April19,2023SHUJia79入球微动脉管壁内平滑肌细胞演变立方形，弱嗜碱性，PAS阳性分泌颗粒肾素和红细胞生成素促血管收缩，醛固酮分泌、红细胞增殖球旁细胞(JuxtaglomerularCell)Wednesday,April19,2023SHUJia80小鼠肾 猩红-乙基紫染色Wednesday,April19,2023SHUJia81大鼠肾Wednesday,April19,2023SHUJia82远端小管上皮演变高柱状，核近顶部，细胞间隙感受肾滤液内Na+浓度，传递信息→球旁细胞→肾素致密斑(MaculaDensa)Wednesday,April19,2023SHUJia83人肾Wednesday,April19,2023SHUJia84Wednesday,April19,2023SHUJia85小，有突起，染色浅，缝隙连接信息传递球外系膜细胞Wednesday,April19,2023SHUJia86球旁复合体功能：分泌肾素，调节血压和水盐平衡；Wednesday,April19,2023SHUJia87肾素血管紧张素转换酶醛固酮血管紧张素原血管紧张素Ⅰ血管紧张素Ⅱ远曲小管集合小管乳头管Wednesday,April19,2023SHUJia88肾间质皮质少，髓质多，肾乳头最多载脂间质细胞：有突起，胞质内含脂滴，合成分泌髓脂Ⅰ→肝内转化为髓脂Ⅱ→血管舒张，前列腺素等，形成间质血管内皮细胞分泌红细胞生成素Wednesday,April19,2023SHUJia89肾的血液循环肾A→叶间A→弓形A→小叶间A被膜cap

入球微A入球微A

髓旁血管球浅表血管球

直小A出球微A

直小V球后cap网肾V←叶间V←弓形V←小叶间V星形VWednesday,April19,2023SHUJia90肾血液循环特点肾动脉粗短,血流量占心输出量1/4，90％→皮质入球微动脉比出球微动脉粗,球内血压高两套毛细血管,过滤及重吸收直小血管与髓袢伴行,有利于原尿重吸收浓缩Wednesday,April19,2023SHUJia91Wednesday,April19,2023SHUJia92血管球球后cap网直小V直小A小叶间A小叶间V弓形A、VWednesday,April19,2023SHUJia93兔Wednesday,April19,2023SHUJia94Wednesday,April19,2023SHUJia95180L1.50L尿的形成Wednesday,April19,2023SHUJia96尿的吸收与浓缩Wednesday,April19,2023SHUJia97肾的其他功能内分泌合成和降解前列腺素:载脂细胞、系膜细胞、集合小管上皮细胞。扩血管激肽释放酶-激肽系统:前者由肾小管上皮产生；后者由集合小管上皮产生。扩血管利尿促红细胞生成素:球旁细胞，内皮细胞维生素D3的羟化Wednesday,April19,2023SHUJia98肾的淋巴管：肾内淋巴丛和被膜淋巴丛肾的神经：交感和副交感神经Wednesday,April19,2023SHUJia99排尿管道肾盂和肾盏:上皮,平滑肌输尿管：黏膜纵形皱襞,上2/3平滑肌内纵外环,外膜疏松膀胱:黏膜皱襞,上皮腔面细胞大,胞膜游离面厚,纵环纵三层平滑肌,外膜疏松尿道黏膜(变移上皮)、肌层和外膜Wednesday,April19,2023SHUJia100Wednesday,April19,2023SHUJia101输尿管肌层Wednesday,April19,2023SHUJia102人输尿管Wednesday,April19,2023SHUJia103人Wednesday,April19,2023SHUJia104Wednesday,April19,2023SHUJia105Wednesday,April19,2023SHUJia106Wednesday,April19,2023SHUJia107Wednesday,April19,2023SHUJia108松弛时Wednesday,April19,2023SHUJia109Wednesday,April19,2023SHUJia110质膜内褶与小泡Wednesday,April19,2023SHUJia1111.

肾和输尿管的发生1.1原基：

间介中胚层颈段

→生肾节→前肾尾段

→

生肾索→中肾、后肾一、泌尿系统的发生Wednesday,April19,2023SHUJia1121.2前肾生肾节

→

前肾小管

，前肾管→退化1.3中肾1)生肾索→中肾嵴→中肾

Wednesday,April19,2023SHUJia1132)中肾小管

→

大部分消失中肾管

→

通入泄殖腔

Wednesday,April19,2023SHUJia1141.4后肾原基：中肾管末端→