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A Report of Anomalous Renal Blood Supply

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A Report of Anomalous Renal Blood Supply Case Report Copyright©2013, Iranian society of anatomical sciences. All rights reserved. A report of anomalous renal blood supply Mohammad Reza Darabi, Ph.D.1*, Alireza Shams, Ph.D.2 Saeed Babaei, Ph.D.1, Ali Faraji3 1. Department of Anatomy, Arak University of medical sciences, Arak, Iran 2. Department of Anatomy, Alborz University of medical sciences, Karaj, Iran 3. Shahid Beheshti University of medical sciences, International branch, student of medicine, Tehran, Iran *Corresponding author, E‐mail address: [email protected] Received: March 2013 Accepted: May 2013 Mohammad Reza Darabi received his M.Sc. and Ph.D. in Anatomical Sciences from Isfahan University of Medical Sciences. He has been an Associate Professor in the Department of Anatomy at Arak University of Medical Sciences since 2012. His special interests include fertility and infertility, intracytoplasmic sperm injection, embryo freezing and vitrification. Abstract Vascular variations and the accidental cutting of veins and arteries potentially create problems during surgery and medical treatment. The surgeon's awareness of a vascular variation in the kidneys is essential during renal surgery and transplantation, color Doppler imaging, gonadal surgery and in the presence of an abdominal aortic aneurism. This awareness can improve the patient's recovery process. The Surgical Department should implement a study of these variations and their statistics in order to present them to students to increase their awareness of such variations. During a routine dissection of the abdominal region of a 35-year-old Iranian male cadaver, we observed right accessory renal vessels. The most common variation of the renal artery is the presence of an accessory renal artery that is upward and on the right side, crossing the inferior vena cava anteriorly toward the kidney. This variation occurs in approximately 30% of cases. This case report highlights the importance of awareness of renal artery variations in the event surgical procedures are performed in this area of the body. Key words: Cadaver, Renal artery, Male, Anomaly To cite this paper: Darabi MR, Shams A, Babaei S, Faraji A. A report of anomalous renal blood supply. Anat Sci J 2013; 10 (2): 105-9. Introduction There are numerous reports about variations that and multi-detector computer tomography to exist in aortic branches. These variations present locate aortic and renal variations prior to a problems for surgeons unaware of their existence nephrectomy, a renal transplant, and in cases of [1]. Physicians must use angiography, arteriography an aortic aneurism [2-4]. Anatomical Sciences Journal 2013, Vol 10, No 2, Pages 105-109 106 M.R. Darabi, et al There is one renal artery for each kidney in the hilar or accessory renal artery which enters 70% of cases. This artery varies with regards to the kidney from the hilum and accompanies the its diameter, level and origin in each person. The main renal artery. The second type is a polar or renal artery is a large artery that originates at the aberrant accessory renal artery that directly enters level of the second lumbar vertebrae, slightly the kidney by penetrating through the renal below the superior mesenteric artery from the capsule near the renal pole [7]. lateral side of the abdominal aorta that crosses the These arteries are considered to be persistent corresponding crus of the diaphragm at right embryonic lateral splanchnic arteries that angles to the aorta. The right renal artery is anteriorly cross the ureter, subsequently causing longer than the left artery and originates from an ureteric obstruction and hydronephrosis. Rarely, aorta more superior than the left one. It crosses an accessory renal artery may divide from the posterior to the inferior vena cava, head of the coeliac trunk, superior mesenteric, aortic pancreas and second part of the duodenum to bifurcation or common iliac arteries [5,12]. reach the hilum of the kidney. Because of the Nayak, in a case report study, has reported the lower position of the right kidney, the right renal presence of three renal arteries for the right artery has a straight course and is located a little kidney, one which originated from the anterior inferiorly. The left renal artery lies behind the left aspect and two from the lateral aspect of the renal vein, body of the pancreas and splenic vein, abdominal aorta. In the embryonic period, the and may anteriorly cross the inferior mesenteric accessory renal arteries are considered to be vein. Each renal artery is divided into four or five aberrant renal arteries that have originated directly branches near the hilum, mostly located from aorta, supply a small part of kidney [13]. anteriorly between the renal vein and posteriorly During the 6-9th week of pregnancy the to the renal pelvis with one branch located behind definitive kidney arise in the sacral region and the pelvis. The suprarenal gland is supplied partly migrate upward extraperitoneally to a lumbar by one or more branches from the renal artery site just below the suprarenal gland. As the and is named the inferior suprarenal artery [5,6]. kidneys migrate, they are vascularized by a To the best of our knowledge, no accessory succession of transient aortic sprouts that arise renal arterial variation has been reported in Iran. at progressively higher levels. Successive renal The renal artery variation differs among various arteries thus degenerate and are replaced. The races with a frequency of 37% in Africans, 35% final pairs of arteries in this series form in the in Caucasians, and 17% in Hindus according to upper lumbar region and become the definitive cadaver and anatomical studies [7]. A study of 40 renal arteries. Occasionally, a more inferior pair cadavers during a 5-year period has reported the of renal arteries persist as accessory renal presence of an accessory renal artery in 20% of arteries [14]. Robert et al. have shown that renal cases. In 5% of cases, this accessory renal artery tissue can be partly conserved in case of renal is bilateral [8]. The numbers of accessory renal infarction during total nephrectomy if vascular arteries reported has increased by the use of variation of the segmental renal arteries is newer radiological methods, vascular and detected [15]. Because renal diseases are urologic surgery, and renal transplant [9] Thus, in incident, renal surgery is recommended for other studies, 15% of the kidneys had evidence of most of the related patient. Stent implantation accessory renal arteries [10,11]. and balloon angioplasty are used for the There are two types of accessory renal arteries, treatment of renal artery disease, but these Anat Sci J 2013, Vol 10, No 2 Anomalous renal blood supply 107 methods may be negatively affected by the Discussion presence of arterial variations [16]. Physician An accessory renal artery is an additional artery awareness of renal vascular variation can that enters into the kidney through the hilum or potentially increase the chance of recovery of one of the poles. The accessory renal artery treatment and decrease the chance of usually originates from the aorta slightly above hemorrhage. Therefore knowledge of the or below the renal artery [18]. However, the presence of vascular variations is of utmost different origin and variations of the renal artery importance prior to beginning treatment. have been shown by a study on the development of mesonephric arteries. These Case Report arteries form a nutrient arterial plexus that A 35-year-old Iranian male cadaver fixed by originates from the lateral side of the aorta Grant's method of dissection and legally (distance between C6-L3) which is named the received by the Anatomy Department at Arak arteriosum urogenitale plexus and supplies the University of Medical Sciences was dissected. kidneys, adrenal and gonadal glands. One In the cadaver, the renal position was in its mesonephric artery remains, whereas the natural location however an accessory right remainder degenerate. The remaining renal artery and vein were observed. This artery mesonephric artery is responsible for arterial was a polar artery of approximately 5 cm in supply of the kidney. Failure in development of length that originated from the lateral side of mesonephric arteries causes accessory renal the aorta, just below the right renal artery. The formation [7]. artery anteriorly crossed the inferior vena cava In this case report study, the accessory renal and entered the renal tissue from the lower pole artery crossed the inferior vena cava and of the right kidney by penetration through the anteriorly entered into the renal parenchyma by renal capsule (Figure 1). The renal vessels on penetrating through the renal capsule (Figure 1). the left side were normal and no variation was Statistical and case report studies of aberrant seen during dissection. Some have reported the and accessory renal arteries have shown that existence of a variant left renal artery detected their diagnoses are important before renal by angiography [17]. surgeries. Awareness about the occurrence of a vascular variation can potentially prevent hemorrhage, complications and mortality. Although the accessory renal artery is not a current variation, rarely it may give rise to the right and left testicular arteries. In order to diminish clinical complications this artery must be detected before any surgery by using different radiographic techniques [12,19]. It has been shown that accessory renal obstruction may have not any important clinical signs and symptoms related to renal impairment even in Figure 1: Posterior abdominal wall that includes the patients with moderate renal insufficiency. In accessory renal artery (1), accessory renal vein (2), right renal vein (3), abdominal aorta (4), inferior mesenteric other words each kidney may tolerate removal artery (5), inferior vena cava (6), right ureter (7), and right of an accessory renal artery without any testicular vein (8). obvious infarction that could be detected by Anat Sci J 2013, Vol 10, No 2 108 M.R.
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