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Saudi Journal of Kidney Diseases and Transplantation
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ORIGINAL ARTICLE  
Year : 2017  |  Volume : 28  |  Issue : 2  |  Page : 292-297
Anatomical study of renal and accessory renal arteries


1 Department of Anatomy, Grant Government Medical College, Mumbai, Maharashtra, India
2 Department of Anatomy, Shri Bhausaheb Hire Government Medical College, Dhule, Maharashtra, India

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Date of Web Publication23-Mar-2017
 

   Abstract 

In recent years, more conservative methods of surgery of the renal artery are coming up. Hence, a precise knowledge of renal vasculature has become a necessity. Knowledge of the existence of accessory renal arteries is important; otherwise, they may get inadvertently damaged during renal surgery. Furthermore, their presence must be considered while evaluating a donor’s kidney for possible renal transplantation. The study may also be useful to clinicians performing invasive techniques, vascular surgeries, other uro-radiological procedures, and in cases of trauma. Keeping this in mind, this study was conducted on 530 adult cadavers. A total of 1060 kidneys obtained from these cadavers were dissected and accessory renal arteries were looked for; 24.99% of the specimens showed the presence of accessory renal arteries. In 20.75%, one accessory renal artery was found, and in 4.24% of specimens, two accessory renal arteries were seen.

How to cite this article:
Jamkar AA, Khan B, Joshi DS. Anatomical study of renal and accessory renal arteries. Saudi J Kidney Dis Transpl 2017;28:292-7

How to cite this URL:
Jamkar AA, Khan B, Joshi DS. Anatomical study of renal and accessory renal arteries. Saudi J Kidney Dis Transpl [serial online] 2017 [cited 2019 Aug 23];28:292-7. Available from: http://www.sjkdt.org/text.asp?2017/28/2/292/202760

   Introduction Top


The advent of more conservative methods in renal surgery has necessitated a more precise knowledge of renal vasculature. Anson and Kurth[1] in 1955 have quoted “experience shows that super-numerary arteries and veins represent the rule in renal vasculature, not the exception.” Being “end arteries,” ligation or accidental injury to renal artery may lead to renal infarcts. This observation is important during renal transplants for a complete and accurate anastomosis with all the arteries of the donor kidney. Kem2 et al in 2005 have reported two relatively young patients with significant hypertension, both having an accessory renal artery. The presence of variant renal arteries may also be associated with other underlying renal pathological conditions such as hydronephrosis.


   Subjects and Methods Top


The study was based on dissection of 1060 adult cadaveric kidneys (620 male and 440 female) from Western India. Ethical Committee approval was obtained. Comprehensive dissection was carried out, and observations on the origin and course of the renal artery were made. The presence of accessory renal arteries and their relation to the main renal artery was noted. The specimens were colored by standard color code after applying gelatin suspension, and color photographs were obtained.


   Results Top


The number of renal arteries observed on the right and left side in males and females is shown in [Table 1]. When males and females were considered together, single renal artery was seen in 77.35% on the left side and in 72.64% of specimens on the right side. Similarly, two renal arteries were present in 18.86% of specimens on the left side [Figure 1] and in 22.64% of specimens on the right side [Figure 2]. Furthermore, three renal arteries were present in 3.77% of specimens on the left side, whereas the incidence on the right side was 4.71% [Figure 3].
Table 1: Incidence of renal arteries in the present study.

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Figure 1: Specimen showing left accessory artery.

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Figure 2: Specimen showing a right accessory artery.

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Figure 3: Photograph showing three renal arteries on the right side.

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The observed values were analyzed statistically. Chi-square value for the right side was 13.44, and P value was 0.0012 (P <0.05), whereas Chi-square value for the left side was 15.02, and P value was 0.0005 (P <0.05). Hence, statistically, it proved that the accessory renal arteries, number wise, are significantly more common in both right as well as the left side.

The comparison of total accessory renal arteries observed in males and females in the present study is shown in [Figure 4].
Figure 4: Incidence of accessory renal arteries in the present study.

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The relationship of the accessory renal arteries to the main renal artery was noted and is shown in [Table 2]. Most of the accessory renal arteries were placed superiorly [Figure 5]. Some of the specimens showed both superior and inferior accessory renal arteries.
Table 2: Relation of accessory renal arteries to main renal artery.

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Figure 5: Photograph showing a superior accessory artery.

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   Discussion Top


The incidence of a number of renal arteries was compared with previous studies [Table 3].
Table 3: Variations in renal arteries in various studies (Figures in %).

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According to Standring[3] and Moore and Persaud,[4] kidney receives a single renal artery in about 70% and 75% of cases, respectively. In the present study, single renal artery was observed in 74.99% of cases [Table 1]. The incidence of accessory renal artery according to Standring[3] is about 30%. In the present study, the incidence of accessory renal artery was 24.99% [Table 1]. Decker and Du Plessis[5] have quoted that there is an accessory renal artery in 15% and 20% of cases on the right and left side, respectively. When all accessory renal arteries were taken into consideration in the present study, higher figures were noted on the right side (27.35%) than on the left side (22.63%) [Table 1].

Unilateral double renal vessels were reported by Mohammed[6] in 2012. Bilateral duplication of renal vessels was reported by Bordei et al[7] in 2004 and by Mir et al[8] in 2008. The same was also observed in the present study [Figure 6]. Bilateral triple renal arteries were observed by Pestemalci et al[9] in 2009. Anson et al[10] and Reis and Esenther[11] have noted four arteries on the right as well as the left side. A maximum number of arteries were observed by Carson.[12] He has reported five arteries on the left side. In the present study, maximum of three renal arteries was found [Figure 3].
Figure 6: Photograph showing bilateral doubled renal arteries.

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The anatomic relation of these accessory renal arteries to the main renal artery was looked for. Sykes[14] has noted that inferior accessory renal arteries are more common. However, Olsson[16] has stated that superior accessory renal arteries are common. The present study showed a higher percentage of superior accessory renal arteries [Table 2].

The diversity of vascular pattern can be explained on the basis of its development. The kidney that initially develops in the sacral region gradually ascends up. As it starts ascending, newer renal arteries start developing from the aorta. With the appearance of newer arteries, the caudal branches normally involute and disappear. A less complete reduction results in extra-renal branching or in multiple arteries arising independently from the aorta. Due to this unique character of the kidney, this unusual pattern of vascular distribution is observed.

The study conclusively proved the complex nature of renal vascular distribution in the population of Western India. This emphasizes the necessity of the knowledge of renal vasculature to a surgeon operating on the kidney. With the advent of laparoscopic renal surgeries and donor nephrectomies, it becomes mandatory for the surgeon to understand the abnormality or variations in the renal vasculature. If this is not identified, it may jeopardize the renal transplantation. The detailed information of the vasculature will reduce the chance of hemorrhage due to accidental trauma to accessory renal artery. This can avoid unwanted postoperative morbidity and mortality.

Conflict of interest:

None declared.

 
   References Top

1.
Anson BJ, Kurth LE. Common variations in the renal blood supply. Surg Gynecol Obstet 1955;100:157-62.  Back to cited text no. 1
    
2.
Kem DC, Lyons DF, Wenzl J, Halverstadt D, Yu X. Renin-dependent hypertension caused by nonfocal stenotic aberrant renal arteries: Proof of a new syndrome. Hypertension 2005; 46:380-5.  Back to cited text no. 2
    
3.
Standring S. Gray’s Anatomy. The Anatomical Basis of Clinical Practice. 40th ed. Edinburg: Churchill & Livingstone; 2008. p. 1231, 1233.  Back to cited text no. 3
    
4.
Moore KL, Persaud TV. The Developing Human – Clinically Oriented Embryology. 6th ed. Philadelphia: W.B. Saunders Co.; 1999. p. 311.  Back to cited text no. 4
    
5.
Decker GA, Du Plessis DJ. Lee Mc’Gregor’s synopsis of surgical anatomy. Indian Edition. 12th ed. Bombay: K.M. Varghese Co.; 1986. p. 289-300.  Back to cited text no. 5
    
6.
Mohammed AM, Abdalrasol RG, Abdalhai KA, Hamad MG. Accessory renal vessels. Acta Inform Med 2012;20:196-7.  Back to cited text no. 6
    
7.
Bordei P, Sapte E, Iliescu D. Double renal arteries originating from the aorta. Surg Radiol Anat 2004;26:474-9.  Back to cited text no. 7
    
8.
Mir NS, Ul Hassan A, Rangrez R, et al. Bilateral duplication of renal vessels: Anatomical, medical and surgical perspective. Int J Health Sci (Qassim) 2008;2:179-85.  Back to cited text no. 8
    
9.
Pestemalci T, Mavi A, Yildiz YZ, Yildirim M,Gumusburun E. Bilateral triple renal arteries. Saudi J Kidney Dis Transpl 2009;20:468-70.  Back to cited text no. 9
[PUBMED]  [Full text]  
10.
Anson BJ, Richardson GA, Minear WL.Variations in the number and arrangement of renal vessels- a study of blood supply of four hundred kidneys. J Urol 1936;36:211.  Back to cited text no. 10
    
11.
Reis RH, Esenther G. Variations in the pattern of renal vessels and their relation to the type of posterior vena cava in man. Am J Anat 1959; 104:295-318.  Back to cited text no. 11
    
12.
Carson WJ. Anomalous renal vessels and their surgical significance. West J Surg Gynecol Obstet 1932;40:597.  Back to cited text no. 12
    
13.
Adachi B. Das Arteriensystem der Japaner II. Kyoto, Tokyo: Maruzen Publishing Co.; 1928. p. 73-8.  Back to cited text no. 13
    
14.
Sykes D. The arterial supply of the human kidney with special reference to accessory renal arteries. Br J Surg 1963;50:368-74.  Back to cited text no. 14
    
15.
Geyer JR, Poutasse EF, Cleveland MD. Incidence of multiple renal arteries on aortography. J Am Med Assoc 1962;182:120-5.  Back to cited text no. 15
    
16.
Olsson CA. Campbell’s Urology. 5thed., Vol. I. Philadelphia: W.B. Saunders Co.; 1986. p. 311.  Back to cited text no. 16
    

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Correspondence Address:
Anand A Jamkar
Grant Government Medical College, Mumbai
India
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DOI: 10.4103/1319-2442.202760

PMID: 28352010

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    Figures

  [Figure 1], [Figure 2], [Figure 3], [Figure 4], [Figure 5], [Figure 6]
 
 
    Tables

  [Table 1], [Table 2], [Table 3]



 

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    Abstract
   Introduction
   Subjects and Methods
   Results
   Discussion
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