RESUMEN

BACKGROUND: Renal artery variations are clinically significant due to their implications for surgical procedures and renal function. However, data on these variations in Sudanese populations are limited. This study aimed to determine the prevalence and characteristics of renal artery variations in a Sudanese population. METHODS: A cross-sectional retrospective study was conducted in Khartoum state from October 2017 to October 2020. A total of 400 Sudanese participants who underwent abdominal CT scans were included. Data on demographic characteristics, kidney measurements, and renal vasculature were collected and analyzed using descriptive statistics and inferential tests. RESULTS: The mean age of participants was 46.7 ± 18 years, with a nearly equal gender distribution. Overall, renal artery variations were present in 11% of participants, with accessory renal arteries observed in 6% of the study population. Among those with accessory vessels, 50% were on the right side, 29.2% on the left, and 20.8% bilateral, distributed across hilar 29.2%, lower polar 29.2%, and upper polar 41.7% regions. No significant associations were found between accessory renal arteries and age or gender (p-value > 0.05). However, participants with accessory renal arteries exhibited significantly narrower width 5.0 ± 1.4 than those with no with accessory renal arteries 5.8 ± 1.1 (p-value 0.002) Early dividing renal arteries were found in 5% of participants, with nearly half being bilateral. No significant associations were found between the presence of early dividing renal arteries and demographic or renal measurements (p-value > 0.05). CONCLUSION: This study provides valuable insights into the prevalence and characteristics of renal artery variations in a Sudanese population. The findings contribute to our understanding of renal anatomy in this demographic and can inform clinical practice and surgical planning, particularly in renal transplantation and other renal procedures.

Asunto(s)

RESUMEN

A 60-year-old man underwent open surgery for chronic dissecting abdominal aorta accompanied with a horseshoe kidney. Through open laparotomy, the abdominal aortic aneurysm was exposed without revision of the horseshoe kidney. Cold ringer solution was infused to accessory renal arteries for renal protection. After supra-renal clamping, proximal anastomosis was then performed at the level just below the renal arteries. Abdominal cross clamp time at the level of the supra-renal arteries was 23 min. Median and right accessory arteries were reattached with an ischemic time of 73 and 103 min, respectively. Although serum creatine was elevated a preoperative level of 1.17 mg/dl to 3.63 mg/dl at postoperative day 2, that was gradually decreased to nearly preoperative level of 1.25 mg/dl at discharge. Postoperative enhanced CT demonstrated patency of the reattached accessory arteries. The patient was discharged without major complication on postoperative day 21. One year postoperatively, his follow-up course was uneventful without deterioration of renal function.

Asunto(s)

RESUMEN

A unique combination of triple abnormality in a willed male body donor dissection, with putative clinicopathological correlations during the subject's lifetime, is described in this case report. The subject had a three-piece artificial urinary sphincter surgically implanted around the proximal corpus spongiosum, left scrotal pouch and in the lower left abdominal wall, ostensibly for urinary incontinence during his lifetime, though the etiology of the latter was not immediately obvious. He also had a total of three accessory renal arteries involving both sides, complicated by bilateral diffuse renal atrophy from presumable glomerulosclerosis or nephrosclerosis-induced nephrotic syndrome. While each entity may not be so unique per se, each is not too common either. The combination of all three findings has not been described to date in the contemporary literature in a single male cadaver dissection. Only seven reports of artificial urinary sphincter studies on human cadaver subjects could be detected in contemporary literature, this being the eighth. Finally, there were no apparent etiopathological or pathogenetic mechanisms to explain the occurrence of each or the coexistence of all of them in a single male cadaveric subject. The artificial urinary sphincter was reviewed with respect to its characteristics, placement, and efficacy. An attempt was made to establish the cause-effect relationship between the artificial sphincter and urinary incontinence that necessitated the implant. Thereafter, a clinicopathological correlation was proposed in this case report to reconcile the concomitance of urinary incontinence, bilateral accessory renal arteries, and bilateral renal atrophy. An embryogenetic mechanism of the aberrant renal arteries was also suggested. Physician awareness from the standpoint of preoperative investigation of such cases was also highlighted.

RESUMEN

Primary aldosteronism (PA) is the most frequent form of secondary endocrine hypertension, which is characterized by excessive aldosterone secretion and suppressed renin. The currently recommended diagnostic algorithm is very clear, and the plasma aldosterone-to-renin ratio (ARR) is considered the first-line screening test. However, this indicator is influenced by many factors, some of which may cause false-negative results, consequently leading to underdiagnosed PA. Here, we report the rare case of a 38-year-old man who presented with bilateral accessory renal arteries and aldosterone-producing adenoma but had a negative ARR test result.

Asunto(s)

RESUMEN

Accessory renal arteries (ARAs) are embryonic remnants found in more than one-third of patients and occurring bilaterally in 10% of the population. Very few reports have documented such vessels arising near or at the level of the aortic bifurcation. Furthermore, the presence of ARAs has yet to be described in the context of atherosclerotic disease. Here, we present a unique case of large bilateral ARAs originating above the aortic bifurcation concurrent with symptomatic aortoiliac atherosclerotic disease. We highlight the embryologic and clinical significance of these vessels as well as discuss their potential role in accelerating atherosclerotic disease processes.

RESUMEN

BACKGROUND: The purpose of this study was to assess the relationship between renal artery cross-section area and kidney volume with consideration of anatomical variants of renal arteries, sexual dimorphism and lateralisation. MATERIALS AND METHODS: Two hundred and two patients, 104 women and 98 men, aged 57.3 ± 16 years were examined using computed tomography angiography (CTA) of abdominal aorta for various reasons. The cross-section areas of renal arteries were measured automatically with a vessel tracking programme and summed up on each side in case of the presence of additional renal arteries. The kidneys were measured manually. RESULTS: Additional renal arteries (ARA) were found in 68 (33.7%) patients. Fifty-three (77.9%) of them had one, 11 (16.2%) two and 4 (5.9%) three ARAs. Bilateral ARAs occurred in 10 cases (14.7% patients with ARA). Proximal branching of renal artery occurred in 36 (8.4%) renal arteries. The cross-section area of the largest renal artery depended on the number of ipsilateral renal arteries. Mean cross-section area of the main left renal artery was larger than on the right side (28.52 mm2 vs. 25.36 mm2, p < 0.01) in the whole analysed group. Strong sexual dimorphism in renal artery cross-section area was observed (p < 0.01) in favour of men (31.3 mm2 in men and 22.9 mm2 in women). Mean total renal artery cross-section area has positively correlated with kidney volume (p < 10-13) in both sexes with Pearson correlation value of 0.5. CONCLUSIONS: The cross-section area of renal arteries correlated positively with kidney volume in both sexes. Presence of ARAs does not influence the sum of cross-section areas of renal arteries. In case of a difference between left and right renal artery cross-section area with symmetrical kidneys, it is necessary to look for ARA.

Asunto(s)

RESUMEN

PURPOSE: To evaluate the incidence of acute renal failure and chronic kidney disease due to occlusion of accessory renal arteries during endovascular aneurysm repair of infrarenal abdominal aortic aneurysm. MATERIAL AND METHODS: We retrospectively reviewed the course of 181 patients (mean age, 71, SD ± 9  years) who underwent EVAR of infrarenal abdominal aortic aneurysm. The renal vessel anatomy was analyzed in all pre- and postoperative CT scans. Diameter and origin of accessory renal arteries were evaluated. Renal function was determined by pre- and postoperative serum creatinine and eGFR levels. Long-term follow-up (>3 months) of patients was available in 121 cases (66.9%). Acute kidney injury and chronic kidney failure were defined according to guidelines of "Kidney Disease: Improving Global Outcomes" (KDIGO). RESULTS: In 65 of 181 patients (33.9%), 82 accessory renal arteries were identified preoperatively. In 19 of 181 patients (10.5%), one or more accessory renal arteries were covered and subsequently occluded by the implanted stent-graft device. Neither acute kidney injury (10.3% vs 12.5%; p = .785) nor chronic kidney disease (10.7% vs 15.38%; p = .452) was detected significantly more often in patients with covered accessory renal artery. The only significant predictor of acute kidney injury was the preoperative serum creatinine level (1.12 mg/dl vs. 0.98 mg/dl; p = .03). Significant predictors for chronic kidney disease were preoperative serum creatinine, eGFR, and impaired renal function (p < .001). CONCLUSION: Coverage of accessory renal artery due to stent-graft does not lead either to temporary acute kidney injury after endovascular aneurysm repair or to chronic kidney disease. LEVEL OF EVIDENCE: Level II b.

Asunto(s)

RESUMEN

INTRODUCTION: Isolated infrarenal abdominal aortic dissection is a rare clinical entity. Most cases are treated by endovascular techniques, and open surgery is seldom necessary. CASE DESCRIPTION: We present a rare case of spontaneous symptomatic infrarenal aortic dissection with leading symptom right leg ischemia. We opted for abdominal surgery as the attempt for open surgical fenestration of the dissecting flap exit through right femoral access was unsuccessful. Dacron vascular prosthesis was implanted with aortoiliofemoral bypass on the right side. One of the two accessory right renal arteries was ligated, which led to a confined zone of renal ischemia. Upon follow-up, complete restoration of the renal parenchyma was observed; kidney function remained unaffected. CONCLUSION: By infrarenal abdominal aortic dissection with accessory renal arteries, abdominal surgery with selective clamping is a reliable therapeutic approach allowing maximal preservation of renal blood flow. HIPPOKRATIA 2019, 23(4): 186-189.

RESUMEN

INTRODUCTION: Catheter-based renal sympathetic denervation is an emerging therapy for resistant hypertension (RHTN) patients, resulting in a significant blood pressure reduction. The presence of accessory renal arteries and anomalous branching patterns are reported in approximately 20-27 % of patients. However, accessory renal arteries, when smaller than 4 mm in diameter, they are out of the inclusion criteria for renal denervation therapy. For this reason patients with evidence of accessory renal arteries have been excluded in previous clinical trials. Recent data suggest that accessory renal arteries may play an important role in non-response therapy when they do not receive renal denervation treatment. CASE REPORT: In this report, we present the outcome of a patient with resistant hypertension and an anomalous right renal artery, having undergone denervation of both principal and accessory renal arteries. The renal ablation by radiofrequency energy of a distant accessory renal artery resulted in a safe procedure with no clinical complications. CONCLUSION: Consistent with literature the RDN of all, main and accessory renal arteries, was effective in decreasing patient blood pressure while decreasing the need for antihypertensive medication.

Asunto(s)

RESUMEN

The renal anatomy and its development is complex. This complexity is associated with numerous variations. Each renal variation has its own clinical and surgical importance. There is a good correlation between the ascent of the kidney, the level of its origin and number of the renal arteries. Any anomaly in the renal artery development may be due to a delay in the kidney ascension and it can lead to an ectopic kidney. Ectopic kidneys are more frequent in males and they are observed commonly on the left side. In the present study, we came across a rare case of a unilateral right renal ectopia and bilateral multiple renal arteries, with 5 renal arteries on the right side and 2 on the left side. The renal veins were 3 on the right side and two on the left side, with the retro aortic left renal vein, which were observed during the routine dissection of a male cadaver. This observation would be of immense importance for surgeons, interventional radiologists, nephrologists and vascular surgeons.