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Types of renal artery and accessory renal artery described in enhanced renal CT scan. Different accessory renal arteries with renal CT scan. (a) No accessory renal artery (NAR); (b) main renal artery branches outside the renal hilum (MRAB); (c) the accessory renal artery (ARA).
Source publication
Objective:
To assess the correlation between renal artery anatomy and blood pressure in Undiagnosed Hypertension and Diagnosed Hypertension.
Methods:
The renal artery CT scanning imaging data and laboratory data of 3000 inpatients and outpatients were collected retrospectively in 4 centers of China. Morphometric parameters were assessed using th...
Citations
... Accurate assessment of accessory renal arteries is crucial before surgical procedures, such as renal transplantation or endovascular aneurysm repair, as it can help prevent postoperative complications and iatrogenic injuries [2]. Additionally, accessory renal arteries have associations with conditions like refractory hypertension and transient pulmonary edema, among other medical issues [3]. ...
Background
The presence of accessory renal arteries is a common variation of the renal artery and is important for surgical planning. These arteries are typically reported to originate from the abdominal aorta, common iliac artery, or mesenteric arteries, but there have been no reports of accessory renal arteries originating from the lumbar artery.
Case presentation
A dynamic enhanced scan of the kidneys with virtual reality display showed two blood supply vessels to the left kidney. One vessel originated from the abdominal aorta and supplied the upper and middle portions of the kidney, while another vessel originated from the left lumbar artery and supplied the lower portion of the kidney.
Conclusion
This case highlights a rare variation of the renal artery, where an accessory renal artery originates from the lumbar artery. Understanding such variations is crucial in surgery to avoid complications.
... 4 A recent study done by Shen et.al found the prevalence of the accessory arteries ranged from 14.8% to 17.1% and was an independent factor of hypertension in the hypertensive patients. 5 Many reports suggest a correlation of the diameter of the renal artery has more influence ...
... Furthermore, Shen et al.5 reported the prevalence of accessory renal arteries and early branches to be 15.3% and 14.3%, respectively which is quite similar to our study with 19.35% and 16.1 % respectively. However, a very small prevalence (6.3%) was seen in a study done by Regmi et al.18 ...
Introduction: Among various causes of hypertension, only 1 to 2% is renovascular hypertension which may be characterized by the various reasons in renal vascular supply. Multi-detector computed tomography is used to know about the details of the vascular structures in patients. This study aims to evaluate the renal arteries in hypertensive patients. Methods: A prospective observational study was conducted among 93 hypertensive patients. Contrastenhanced computed tomography of the abdomen and pelvis was conducted, and measurements were obtained from the axial section of the maximum intensity projection image. Data were analyzed using SPSS version 23.0. Independent t-test and Pearson’s Correlation were used. The level of statistical significance was set at p<0.05. Results: The study found mean lengths for the right and left main renal arteries to be 40.33±10.26 mm and 32.36±9.55 mm, and diameters were 4.31±0.86 mm and 4.16±0.81 mm. No significant sex-based differences were observed. However, a significant age-related difference was noted in the length (p=0.012) and diameter (p=0.036) of the right main artery within the 20 to 29 and 80 to 89 years age groups. Weak correlations were observed between left renal artery length and age (r=0.221, p=0.33) and mean right renal artery diameter and age (r=-0.218, p=0.036). Prevalence of accessory renal arteries and early branches was 19.35% and 16.10% respectively. Conclusions: This study found that there were no statistically significant differences in renal arteries dimensions of hypertensive patients with different age groups and genders. Although the proportion of early renal artery branching and accessory arteries are found to be similar to previous studies there may be other associated factors for all hypertensive patients who don’t have early renal branches or accessory arteries.
... Secondary hypertension caused by the presence of accessory renal arteries is a controversial subject in the medical literature because there are studies confirming this association and studies that have found no association [13][14][15]. Thus, although renal arteries are related to higher blood pressure in middle-aged patients with primary hypertension, a recent retrospective study concluded that an accessory renal artery is an independent risk factor for developing increased blood pressure [16]. ...
Background:
Secondary hypertension is a relatively rare condition most commonly caused by renovascular disease due to atherosclerotic vascular disease or fibromuscular dysplasia. Although accessory renal arteries are frequent, to date, only six cases of secondary hypertension determined by their existence have been reported.
Case summary:
We describe a case of a 39-year-old female who came to the emergency department with an urgent hypertensive crisis and hypertensive encephalopathy. Despite normal renal arteries, the computed tomography angiography revealed an inferior polar artery with 50% stenosis of its diameter. Conservative treatment with amlodipine, indapamide and perindopril was adopted, leading to blood pressure control within one month.
Conclusion:
To the best of our knowledge, there are controversies regarding accessory renal arteries as a potential etiology for secondary hypertension, but the seven similar cases already described, along with the current case, could reinforce the necessity of more studies concerning this subject.
... Are bilateral accessory renal arteries related to the non-suppressed renin or renindependent hypertension? A retrospective analysis of 3000 patients' renal artery CT imaging data showed that the accessory renal artery (ARA) was a risk factor for hypertension [20]. In fact, as early as 2005, David et al. proposed a new syndrome of renin-dependent hypertension caused by non-stenotic accessory renal arteries [21]. ...
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.
Background
This case‐control study aimed to determine whether there were differences between patients with essential hypertension with accessory renal arteries (ARAs) and those without ARAs.
Methods and Results
The enrolled patients with essential hypertension were divided into the ARA group (n=200) and control group without ARAs (n=238). After propensity matching, 394 patients (197 in each of the 2 groups), were included. The 24‐hour BP (4.33/2.43 mm Hg) and daytime BP (4.48/2.61 mm Hg) of patients in the ARA group were significantly higher than those of the control group ( P <0.05). The flow‐mediated dilation was lower in the ARA group (5.98±2.70 versus 5.18±2.66; P <0.05). In correlation analysis, the horizontal plasma aldosterone concentration had the highest correlation with 24‐hour, daytime, and nighttime systolic BP ( r =0.263, 0.247, and 0.243, respectively; P <0.05) and diastolic BP ( r =0.325, 0.298, and 0.317, respectively; P <0.05). As for multivariate regression analysis, plasma aldosterone concentration was a significant risk factor for elevated 24‐hour, daytime, and nighttime systolic BP (β=0.249 [95% CI, 0.150–0.349], 0.228 [95% CI, 0.128–0.329], and 0.282 [95% CI, 0.187–0.377], respectively; P <0.05) and elevated diastolic BP (β=0.289 [95% CI, 0.192–0.385], 0.256 [95% CI, 0.158–0.353], and 0.335 [95% CI, 0.243–0.427], respectively; P <0.05). Direct renin concentration was also a risk factor for 24‐hour and daytime BPs, whereas heart rate was a risk factor correlated with 24‐hour, daytime, and nighttime diastolic BP (all P <0.05). For the mixed‐effects model for repeated measures, the results were similar to results of the multivariate regression analysis (all P <0.05).
Conclusions
ARAs could contribute a higher BP of patients with essential hypertension and might promote the development of essential hypertension. The mechanism might be related to overactivation of the renin‐angiotensin‐aldosterone system and sympathetic nervous system.
Background:
Resistant hypertension (RHT) is a major health care concern affecting 20 to 30% of hypertensive patients and increasing cardiovascular risk. Recent renal denervation trials have suggested a high prevalence of accessory renal arteries (ARA) in RHT. Our objective was to compare the prevalence of ARA in RHT vs. non-resistant hypertension (NRHT).
Methods:
Eighty-six patients with essential hypertension who benefited from an abdominal CT-scan or MRI during their initial workup were retrospectively recruited in 6 French ESH (European Society of Hypertension) centers. At the end of a follow-up period of at least 6 months, patients were classified between RHT or NRHT. RHT was defined as uncontrolled blood pressure despite the optimal doses of three antihypertensive agents of which one is a diuretic or similar, or controlled by ≥ 4 medications. Blinded independent central review of all radiologic renal artery charts was performed.
Results:
Baseline characteristics were: age 50±15 years, 62% males, BP 145±22/87±13mmHg. Fifty-three (62%) patients had RHT and 25 (29%) had at least one ARA. Prevalence of ARA was comparable between RHT (25%) and NRHT patients (33%, P=0.62), but there were more ARA per patient in NRHT (2±0.9) vs. RHT (1.3±0.5, P=0.05), and renin levels were higher in ARA group (51.6±41.7 mUI/L vs. 20.4±25.4 mUI/L, P=0.001). ARA were similar in diameter or length between the 2 groups.
Conclusions:
In this retrospective series of 86 essential hypertension patients, we found no difference in the prevalence of ARA in RHT and NRHT. More comprehensive studies are needed to answer this question.
