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Accessory renal vessels at the upper and lower pole of the kidney: a cadaveric study with clinical implications

Hlaing KP, Das S, Sulaiman IM, Abd-Latiff A, Abd-Ghafar N, Suhaimi FH, et al.

Bratisl Lek Listy, 2010;111(5):308-10.
PMID: 20568426

The renal artery is known to exhibit variations in its number and position. The present study was performed on 50 cadaveric kidneys to observe the topographical anatomy of the accessory renal arteries (ARA) entering the upper or lower poles of the kidney. Out of 50 kidney cadaveric specimens (irrespective of sex) studied, 2 kidneys (4%) showed the presence of ARA. The presence of ARA was observed on the left and right kidneys, respectively. In one left kidney, we observed in addition to the usual renal artery, an ARA near the lower pole of the kidney which divided into anterior and posterior branches. Another right kidney specimen exhibited the presence of single and double ARA at the upper and the lower poles, respectively. The presence of ARA, both at the upper and lower poles is a rare entity. No medical history of the cadavers was available to corroborate the clinical findings. Additional renal vessels may signify a developmental defect. Anatomical knowledge of the variations in the renal vascular supply may be important for abdominal imaging studies and surgical operations involving renal transplantations. The present study discusses in detail the anatomical features and clinical implications of ARA located at both the upper and lower poles of the kidney (Fig. 2, Ref. 15). Full Text (Free, PDF) www.bmj.sk.

Matched MeSH terms: Renal Artery/abnormalities*
Re: Intrarenal and extrarenal autonomic nervous system redefined: A. Lusch, R. Leary, E. Heidari, M. A. Liss, Z. Okhunov, A. Perez-Lanzac De Lorca, J. Huang, J. Wikenheiser and J. Landman. J Urol 2014; 191: 1060-1065

Das S, Suhaimi FH

J Urol, 2014 Oct;192(4):1299-300; discussion 1300.
PMID: 25043648 DOI: 10.1016/j.juro.2014.04.100
Matched MeSH terms: Renal Artery/innervation*
A triple-curve catheter for selective arteriography

Ang AH, Lambeth JT

Med J Malaya, 1971 Mar;25(3):215-7.
PMID: 4253250
Matched MeSH terms: Renal Artery/radiography
Fulltext Fluid structure interaction of renal arteries of abdominal aorta subjected to single and double stenosed complication

Adi Azriff Basri, S.M Abdul Khader, Cherian Johny, Raghuvir Pai B, Mohammed Zuber, Zainuldin Ahmad, et al.

Malaysian Journal of Medicine and Health Sciences, 2020;16(108):35-41.
MyJurnal

Introduction: In this study, Renal artery (RA) stenosis of Single Stenosed (SS) and Double Stenosed (DS) with the condition of Normal Blood Pressure (NBP) and High Blood Pressure (HBP) were investigated using the aid of Fluid Structure Interaction (FSI) approach. Methods: Numerical analysis of 3D model patient’s specific abdominal aorta with RA stenosis was conducted using FSI solver in software ANSYS 18. Results: The results of velocity profile, pres- sure drop, time average wall shear stress (TAWSS), Oscillatory shear index (OSI) and total deformation of SS and DS with the condition of NBP and HBP were compared in terms of blood flow and structural wall tissue behaviour. The results concluded SS-NBP produced the highest value of velocity profile, TAWSS and OSI parameter compared to the others. Meanwhile, SS-HBP indicates the highest value pressure drop. On the other hand, SS-HBP and DS-HBP have a higher distribution of deformation contour and also maximum VMS compared to SS-NBP and DS-HBP. Conclusion: With the aid of FSI approach, this studied has proven that the existence of SS at RA location has a higher impact on the velocity magnitude, higher pressure drop, higher TAWSS and OSI value compared to the DS case. This is due to a high concentration of pressure acting at the narrow blood vessel of SS compared to DS cases which most of the blood flow will pass to the lower part of abdominal aorta.

Matched MeSH terms: Renal Artery; Renal Artery Obstruction
Fulltext Pengaruh umur, kumpulan etnik dan antropometri badan ke atas aras osteokalsin dan telopeptida terminal-C kolagen jenis 1 serum dalam kalangan lelaki

Kok-Yong Chin, Soelaiman, Ima-Nirwana, Isa Naina Mohamed, Wan Zurinah Wan Ngah

Jurnal Sains Kesihatan Malaysia, 2014;12(1):7-13.
MyJurnal

Penanda kadar pusing ganti tulang (PPT) adalah berguna dalam penilaian status kesihatan tulang. Namun, pengaruh umur, kumpulan etnik dan antropometri badan terhadap aras PPT dalam kalangan lelaki masih belum jelas. Kajian ini bertujuan untuk menentukan pengaruh faktor-faktor tersebut terhadap aras PPT, iaitu aras osteokalsin (OC) dan telopeptida terminal-C kolagen jenis 1 (CTX-1) dalam kalangan lelaki Cina dan Melayu berumur 20 tahun dan ke atas (N = 407) di Lembah Klang. Subjek dikumpulkan melalui kaedah persampelan bertujuan. Ketinggian, berat badan dan indeks jisim badan subjek telah diukur. Darah mereka diambil pada waktu pagi untuk analisis aras OC dan CTX-1 serum dengan asai imunoserap terangkai enzim. Hasil kajian menunjukkan aras OC dan CTX-1 adalah lebih tinggi secara signifi kan dalam kalangan lelaki Melayu berbanding dengan lelaki Cina (p < 0.05). Aras OC dan CTX-1 adalah paling tinggi dalam kalangan lelaki berumur 20-29 tahun, dan kemudiannya menurun secara signifi kan berbanding dengan dekad sebelumnya dalam kalangan lelaki berumur 30-39 tahun (p < 0.005). Perbezaan aras kedua-dua PPT ini adalah tidak signifi kan di antara lelaki berusia 30-39 tahun dengan lelaki yang lebih tua (> 40 tahun dan ke atas) (p > 0.005). Aras OC berkorelasi secara signifi kan dan negatif dengan berat dan indeks jisim tubuh subjek dan korelasi ini adalah signifi kan untuk lelaki 20-39 tahun sahaja (p < 0.05). Aras CTX-1 tidak berkorelasi dengan antropometri badan subjek (p > 0.05). Secara kesimpulannya, aras PPT dalam kalangan lelaki di Malaysia boleh dipengaruhi oleh faktor umur, kumpulan etnik dan antropometri badan. Faktor-faktor ini seharusnya diambil kira dalam penilaian status kesihatan tulang lelaki berdasarkan aras PPT.

Matched MeSH terms: Renal Artery Obstruction
Fulltext Multiple variations of the right renal vessels

Nayak BS

Singapore Med J, 2008 Jun;49(6):e153-5.
PMID: 18581008

Multiple variations of the right renal and testicular vessels were found during routine dissection in a 65-year-old male cadaver. The cadaver was healthy and did not have any other anomalies. The variations found were: presence of three right renal arteries, origin of the right inferior suprarenal artery from the middle right renal artery, two right renal veins, origin of the right testicular artery from the inferior right renal artery and the termination of the right testicular vein into the right renal vein. A sound knowledge of vascular variations in relation to the right kidney and right suprarenal gland is important in kidney transplantation and suprarenal surgery.

Matched MeSH terms: Renal Artery/abnormalities*
Common celiaco-mesenterico-phrenic trunk and renal vascular variations

Nayak S

Saudi Med J, 2006 Dec;27(12):1894-6.
PMID: 17143371

The knowledge of vascular variations like other anatomical variations, is important during the operative, diagnostic, and endovascular procedures in abdomen. This report describes multiple variations in the upper abdominal vessels as found during the routine dissection in a 60-year-old male cadaver. The variations found were; presence of a celiaco-mesenterico-phrenic trunk, a common inferior phrenic trunk, 2 right renal arteries originating from abdominal aorta, 2 suprarenal arteries originating from the lower right renal artery, 3 right renal veins opening separately into inferior vena cava, and termination of right testicular vein into the lowest vein among the 3 right renal veins. The existence of a celiaco-mesenterico-phrenic trunk has not been reported yet. Although, other variations reported in this case exist as individual variations, a concomitant variation of them has not been reported yet. The knowledge of such variations is quite useful in planning any upper abdominal surgery.

Matched MeSH terms: Renal Artery/abnormalities*
Fulltext Novel technique using amplatzer AVP I stent in management for giant renal artery pseudoaneurysm

Sarmukh S, Putera MP, Tan KL, Chew LG

Urol Case Rep, 2021 Mar;35:101515.
PMID: 33318942 DOI: 10.1016/j.eucr.2020.101515

Renal artery pseudoaneurysm (RAP) is an uncommon vascular lesion. Early detection and treatment of renal artery pseudoaneurysm is important because it can rupture and lead to life-threatening hemorrhage. Recent advances in endovascular interventions can prevent potentially challenging open surgery. We describe a case 66 year old patient who presented with a painful abdominal lumbar mass. CT scan show a giant renal artery pseudoaneurysm. We discuss management of giant renal artery pseudoaneurysm, both open surgery and endovascular surgery. Endovascular arterial embolization and stent techniques is feasible. However, open surgical treatment remains to be most effective and radical method in emergency setting.

Matched MeSH terms: Renal Artery
Urogenital Vascular Anomalies with Bilateral Kinking of Ureter: A Case Report

Tadipi S, Sadashiv R, Muralidharan S, Pimid M

Malays J Med Sci, 2015 Nov;22(6):67-70.
PMID: 28223889

Variations in the urogenital vascular anomalies in the abdomen are very common. However, they warrant attention due to their importance in operative, diagnostic, and endovascular procedures. During routine dissection of abdomen in a male cadaver, unique urogenital vascular anomalies were observed. On the right side, the right renal artery was found to be originated from the abdominal aorta at the level of L2 and divided into five branches; the right testicular artery and inferior suprarenal artery originated from the lower branch. We also observed, accessory renal artery arising from abdominal aorta at the level of L3 and double renal veins on right side. On the left side, we found left renal artery originating from the abdominal aorta at the level of L2 and divided into two branches. Double testicular (medial and lateral) arteries were also observed. In addition to these vascular variations, bilateral kinking of ureter at the pelviureteric junction was also observed. Although the variations in the origin of urogenital vessels in the abdomen are common, deeper understanding of the urogenital vascular variations and their relations to adjacent structures is significant during surgical and radiological procedures.

Matched MeSH terms: Renal Artery
Secondary hypertension: a condition not to be missed

Sukor N

Postgrad Med J, 2011 Oct;87(1032):706-13.
PMID: 21746730 DOI: 10.1136/pgmj.2011.118661

Hypertension is a chronic disorder which often entails debilitating cardiovascular and renal complications. Hypertension mostly arises as a complex quantitative trait that is affected by varying combinations of genetic and environmental factors. Secondary hypertension has been encountered with increasing frequency. The common causes of secondary hypertension include renal parenchymal disease, renal artery stenosis, primary aldosteronism, phaeochromocytoma, and Cushing's syndrome. The detection of a secondary cause is of the utmost importance because it provides an opportunity to convert an incurable disease into a potentially curable one. Early identification and treatment will provide a better opportunity for cure, prevent target organ damage, reduce socioeconomic burden and health expenditure associated with drug costs, and improve patients' quality of life. Hence, it is a condition not to be missed.

Matched MeSH terms: Renal Artery Obstruction/complications*
Malignant hypertension in a child with phakomatosis pigmentovascularis type II b

Kanaheswari Y, Hamzaini AH, Wong SW, Zulfiqar A

Acta Paediatr, 2008 Nov;97(11):1589-91.
PMID: 18671691 DOI: 10.1111/j.1651-2227.2008.00971.x

Phakomatosis pigmentovascularis (PPV) is a rare congenital syndrome characterized predominantly by cutaneous vascular malformations and pigmentary naevi. The most frequently reported form, Type II b, is associated with systemic involvement. Sturge-Weber Syndrome (SWS) with concomitant glaucoma, Klippel-Trenaunay Syndrome (KTS) and naevus of Ota have been frequently described, but there have only been two case reports with asymptomatic renal anomalies.

Matched MeSH terms: Renal Artery Obstruction/complications*
Evaluation of live renal donors with three-dimensional contrast-enhanced magnetic resonance angiography in comparison to catheter angiography

Tan SP, Bux SI, Kumar G, Razack AH, Chua CB, Lee SH, et al.

Transplant Proc, 2004 Sep;36(7):1914-6.
PMID: 15518697

Catheter angiography is traditionally used to determine renal arterial anatomy in live renal donors. Three-dimensional (3D) contrast-enhanced magnetic resonance imaging (MRA) has been suggested as a noninvasive replacement. We assessed the possibility of using MRA in live renal donors in Malaysia.

Matched MeSH terms: Renal Artery/anatomy & histology
Bilateral internal carotid artery occlusions a cause of transient ischemic attack

Zulkifli A

Med J Malaysia, 1979 Sep;34(1):52-4.
PMID: 542153
Matched MeSH terms: Renal Artery Obstruction/complications
Age variations in the internal radii of human arteries

Sengupta BN

Med J Malaya, 1971 Dec;26(2):139-43.
PMID: 4260862
Matched MeSH terms: Renal Artery/anatomy & histology
Fulltext Primary arteritis of aorta causing renal artery stenosis and hypertension

Danaraj TJ, Wong HO, Thomas MA

Br Heart J, 1963 Mar;25(2):153-65.
PMID: 14024854

The evidence presented by the nine cases described in this paper indicates that primary arteritis of the aorta is a single clinico-pathological entity of which Takayashu's syndrome is a part. Different segments of the aorta may be affected resulting in a variety of symptom complexes. In this series, the mode of presentation was hypertension consequent on renal artery stenosis. Early diagnosis is important and surgical treatment is indicated to relieve the hypertension which carries an immediately serious prognosis.

Matched MeSH terms: Renal Artery Obstruction*
Alpha1A- and alpha1D-adrenoceptors are the major functional subtypes of renal alpha1-adrenoceptors in streptozotocin-induced diabetic and normal Sprague-Dawley rats

Armenia, Sattar MA, Abdullah NA, Khan MA, Johns EJ

Auton Autacoid Pharmacol, 2008 Jan;28(1):1-10.
PMID: 18257746 DOI: 10.1111/j.1474-8673.2007.00412.x

1 The present study investigated the effect of streptozotocin-induced diabetes on alpha(1)-adrenoceptor subtypes in rat renal resistance vessels. 2 Studies on renal haemodynamics were carried out 7 days after the last streptozotocin. Changes in renal blood flow were recorded in response to electrical stimulation of the renal nerve (RNS) and a range of adrenergic agonists; noradrenaline (NA), phenylephrine (PE) and methoxamine (MTX), either in the absence or the presence of nitrendipine (Nit), 5-methylurapidil (MEU), chlorethylclonidine (CEC) or BMY 7378. 3 In non-diabetic animals, Nit, MEU and BMY 7378 significantly attenuated renal vasoconstriction induced by adrenergic agonists, while CEC showed a significant accentuation in RNS-induced responses without having a significant effect on responses to adrenergic agonists. In diabetic rats, renal vasoconstriction was also significantly reduced in Nit-, MEU- and BMY 7378-treated groups and CEC potentiated RNS-induced contractions caused a change similar to that observed in non-diabetic rats. BMY 7378 significantly (P < 0.05) attenuated the PE- and MTX-induced vasoconstrictions but did not cause any significant (P > 0.05) alteration in the RNS- and NA-induced responses. 4 The results showed functional co-existence of alpha(1A)- and alpha(1D)-adrenoceptors in the renal vasculature of SD rats irrespective of the presence of diabetes. A possible minor contribution of prejunctional alpha-adrenoceptor subtype has also been suggested in either experimental group, particularly possible functional involvement of alpha(1B)-adrenoceptor subtypes in non-diabetic SD rats.

Matched MeSH terms: Renal Artery/drug effects; Renal Artery/metabolism*; Renal Artery/physiopathology
Fulltext Multiple renal arteries with an ascending upward renal Vein of the right kidney: a case report

Al-Shibli S.M.

International Medical Journal Malaysia, 2014;13(1):57-60.
MyJurnal

As it is known; the majority of the human subjects has two renal arteries arising from the abdominal aorta; each will supply one kidney but in 30% of individuals, certain variations can be found. Accessory renal arteries constitute the most common and clinically important of these variations. For our case report, we are presenting one of these different variations that can be found in the blood supply of the kidneys. During dissecting the abdomen of an approximately 65 years-old male cadaver, multiple variations were found. There were double right renal arteries with prehilar branching of the upper renal artery. We found also that the right renal vein ascended upwards obliquely before ending in the lateral aspect of the inferior vena cava. Variation in the renal vessels is relatively common, especially multiple renal arteries, and can go smoothly without any abnormalities with the function of the kidney, but in some situations like renal transplantations, vascular reconstructions, and various surgical and radiological diagnostic techniques, the study of the anatomy of these variations is of crucial importance to decrease the patient morbidity during surgical procedures.

Matched MeSH terms: Renal Artery
Fulltext Renin dependent hypertension caused by accessory renal arteries

Chan PL, Tan FHS

Clin Hypertens, 2018;24:15.
PMID: 30410790 DOI: 10.1186/s40885-018-0100-x

Background: Hypokalemia in the presence of hypertension is often attributed to primary hyperaldosteronism as a cause of secondary hypertension, however secondary hyperaldosteronism may present similarly. Accessory renal arteries are variants in the vascular anatomy which are often thought to be innocuous but in some circumstances can cause renovascular hypertension leading to secondary hyperaldosteronism.
Case presentation: We report 2 cases of hypertension with secondary hyperaldosteronism associated with accessory renal arteries. Both patients presented with hypokalemia and further investigations revealed hyperaldosteronism with unsuppressed renin levels. Imaging studies showed the presence of accessory renal artery.
Conclusion: Accessory renal arteries are a potential cause renovascular hypertension which can be detected via CT angiography or magnetic resonance angiography. Hormonal evaluation should be undertaken to determine whether its presence contributes to hypertension in the patient as targeted treatment such as aldosterone antagonist can be initiated. Surgical intervention or renal denervation may be considered in resistant cases.

Matched MeSH terms: Renal Artery
Chronic administration of sodium nitrite prevents hypertension and protects arterial endothelial function by reducing oxidative stress in angiotensin II-infused mice

Ling WC, Mustafa MR, Vanhoutte PM, Murugan DD

Vascul Pharmacol, 2018 03;102:11-20.
PMID: 28552746 DOI: 10.1016/j.vph.2017.05.003

AIM: Endothelial dysfunction accompanied by an increase in oxidative stress is a key event leading to hypertension. As dietary nitrite has been reported to exert antihypertensive effect, the present study investigated whether chronic oral administration of sodium nitrite improves vascular function in conduit and resistance arteries of hypertensive animals with elevated oxidative stress.
METHODS: Sodium nitrite (50mg/L) was given to angiotensin II-infused hypertensive C57BL/6J (eight to ten weeks old) mice for two weeks in the drinking water. Arterial systolic blood pressure was measured using the tail-cuff method. Vascular responsiveness of isolated aortae and renal arteries was studied in wire myographs. The level of nitrite in the plasma and the cyclic guanosine monophosphate (cGMP) content in the arterial wall were determined using commercially available kits. The production of reactive oxygen species (ROS) and the presence of proteins (nitrotyrosine, NOx-2 and NOx-4) involved in ROS generation were evaluated with dihydroethidium (DHE) fluorescence and by Western blotting, respectively.
RESULTS: Chronic administration of sodium nitrite for two weeks to mice with angiotensin II-induced hypertension decreased systolic arterial blood pressure, reversed endothelial dysfunction, increased plasma nitrite level as well as vascular cGMP content. In addition, sodium nitrite treatment also decreased the elevated nitrotyrosine and NOx-4 protein level in angiotensin II-infused hypertensive mice.
CONCLUSIONS: The present study demonstrates that chronic treatment of hypertensive mice with sodium nitrite improves impaired endothelium function in conduit and resistance vessels in addition to its antihypertensive effect, partly through inhibition of ROS production.

Matched MeSH terms: Renal Artery/drug effects*; Renal Artery/metabolism; Renal Artery/physiopathology
Fulltext Infected aneurysm after returning from Southeast Asia: think Burkholderia pseudomallei!

Auvens C, Neuwirth C, Piroth L, Blot M

BMJ Case Rep, 2019 May 22;12(5).
PMID: 31122956 DOI: 10.1136/bcr-2018-228856

Melioidosis is a protean disease which is endemic to Southeast Asia and northern Australia. Here, we report a case of infected aortic aneurysm due to Burkholderia pseudomallei in an immunocompetent man 6 months after a trip to northern Malaysia. This patient initially received inappropriate surgical and antibiotic treatment, leading to a peri-prosthetic aortic infection with lumbar spondylitis and contiguous psoas muscle abscess. This case highlights the difficulty of diagnosing melioidosis given its diverse clinical manifestations and the limits of routine microbiological methods to identify B. pseudomallei Melioidosis should be considered a possible diagnosis in individuals with unexplained fever subsequent to travel in an endemic area.

Matched MeSH terms: Renal Artery*

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