PROMENA VELIČINE GLOMERULA TOKOM RAZVOJA BUBREGA LJUDSKOG FETUSA

Abstract

INTRODUCTION Newborns adaptation on postnatal conditions includes significant morphological and functional renal changes. Every kidney contains a constant number of nephrons, at the end of the nephrogenesis period, which extends from week 8 to 34 of gestation. Mature juxtamedullary nephrons possess higher filtration capacity than primitive superficial nephrons, which have insufficient vascularization.

OBJECTIVE The objective of the study was to calculate an average glomerular diameter in cortical zones of the kidney during development, to define periods of their most intensive growth, and to record differences of glomerular size between different cortical zones.

METHOD A total of 30 human fetal kidneys aged from IV to X lunar months were analyzed. Stereological methods were used for calculating the average glomerular diameter in superficial, intermediate and juxtamedullary zone of the kidney cortex.

RESULTS Glomeruli in the superficial cortical zone had the lowest average diameter. The average glomerular diameter continually increased from IV lunar month (0.057±0.004 mm) to X lunar month (0.082±0.004 mm), with highly significant correlation with gestational age (r=0.755; p<0.01). The average glomerular diameter in the intermediate zone increased from 0.081±0.004 mm (IV lunar month) to 0.096±0.004 mm (X lunar month) with low linear correlation with gestational age (r=0.161). Juxtamedullary glomeruli were the biggest ones. Their average diameter, during the IV LM ranged from 0.093±0.006 mm to 0.101±0.004 mm. In the newborns (X lunar month), juxtamedullary glomeruli had spherical structures with an average diameter of 0.103±0.004 mm, and low negative correlation (r=-0.032) with gestational age. In the IV and V lunar months of gestation, there was significant difference (p<0.01; p<0.05) between the average glomerular diameter in the different zones of the kidney cortex.

CONCLUSION Superficial glomeruli had the smallest diameter, while juxtamedullary glomeruli were the largest. The average glomerular diameter increased during intrauterine development in all zones, most intensive in the X lunar month. There was a significant difference of the glomeruli between different cortical zones in the young fetuses. Such significant difference receded as gestational age increased.

Keywords: human fetus; development; glomerule; diameter; stereology