A Unique Case of Incomplete Bifid Ureter and Associated Arterial Variations

Introduction. Urogenital and vascular anomalies, including a left duplex kidney and a left aberrant renal artery that gave rise to the left ovarian artery, were observed in a 77-year-old female cadaver during a routine dissection. Description. A left aberrant renal artery, which gave rise to the left ovarian artery, was observed originating from the aorta 4 cm below the left renal artery. Two independent contributions to a bifid ureter were found originating from the hilum of the left kidney. These two contributions descended 12.4 cm and 10.6 cm, respectively, posterior to the left aberrant renal artery and lateral to the left ovarian artery before uniting anterior to the psoas major muscle to descend 12.7 cm to the bladder. Significance. While the duplex kidney is a relatively common congenital anomaly that can be asymptomatic, it can also potentially be associated with compression of renal vasculature or the ureter. Ureteral compression can then result in several pathologies including reflux, urinary tract infection (UTI), ureteropelvic junction obstruction, or hydronephrosis. Compression of renal and ovarian vasculature can result in altered blood flow to the kidney and ovary, potentially causing fibrosis, atrophy, or organ failure. Current imaging techniques alone are insufficient for correct diagnostics of such complications, and they must be supplemented with a thorough understanding of the respective anatomical variations.

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Results of a three-year follow-up after endovascular therapy with multilayer flow modulator in complex thoracoabdominal aortic aneurysm: A case report

Vascular ◽

10.1177/1708538120933516 ◽

2020 ◽

pp. 170853812093351

Author(s):

Nazım Kankılıç ◽

Mehmet S Aydın

Keyword(s):

Case Report ◽

Aortic Aneurysm ◽

Renal Artery ◽

Medical Center ◽

Left Kidney ◽

Thoracoabdominal Aortic Aneurysm ◽

Aortic Aneurysms ◽

Left Renal Artery

Objectives Studies on the short-, medium and long-term effects of flow guiding stents are still limited. In this case report, we present three-year follow-up of the multilayer flow modulator stent in a 55-year-old patient with Crawford Type 2 thoracoabdominal aortic aneurysm. Methods A 55-year-old male patient with Crawford Type 2 thoracoabdominal aortic aneurysm had applied to our medical center. The aneurysm involved coeliac truncus and superior mesenteric artery and extended to the renal artery ostia. Multilayer flow modulator stent was successfully placed, and follow-up CT (Computed tomography) angiographic examination images recorded intermittently (36 months). Results After three years, it was observed that the left renal artery was thrombosed and the left kidney went to atrophy. Other major vascular branches were observed to be open. During this time, the aneurysm was completely closed with thrombus, but the diameter of the aneurysm continued to increase. Conclusions Multilayer flow modulator stents are safe in complex aortic aneurysms. The device increases the thrombus load in the aortic aneurysm and maintains the flow of the main vascular branches. But re-interventions, dilatation of the aneurysm sac and visceral branch obstructions are still challenging for multilayer flow modulator stents.

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Renal artery stenosis of atherosclerotic etiology – the single kidney surgical recurrence 12 years after nephrectomy

Romanian Medical Journal ◽

10.37897/rmj.2016.3.13 ◽

2016 ◽

Vol 63 (3) ◽

pp. 251-254

Author(s):

Maria Daniela Tănăsescu ◽

◽

Marcel Pălămar ◽

Mihai Ovidiu Comşa ◽

Alexandru Mincă ◽

...

Keyword(s):

Renal Artery ◽

Renal Artery Stenosis ◽

Left Kidney ◽

Secondary Hypertension ◽

Artery Stenosis ◽

The Other ◽

Left Renal Artery ◽

Arterial Blood ◽

The Moment ◽

The Right

Objectives. Renal artery stenosis, as main cause of renovascular secondary hypertension, is mainly caused by atherosclerosis of large vessels and is clinically characterized by resistant or malignant hypertension, impacting the kidney function to various degrees. The present article brings into attention the case of a patient which developed renal artery stenosis on the left kidney, the same condition occurring 12 years later on the right kidney. Material and method. Our patient was initially diagnosed at the age of 48 with complete occlusion of the left renal artery, for which left nephrectomy was performed, while the right artery was normal. Twelve years later she presents with renal artery stenosis on the right kidney, which is treat by stent-angioplasty. Results. After surgery, the patient’s evolution was positive, with amelioration of the laboratory values, in parallel to the arterial blood pressure. Discussions. The probability that, in the moment of diagnosis of renal artery stenosis with progressive evolution to occlusion caused by atherosclerosis, the other artery would be normal, both seen by ultrasonography and angiography, while years later to develop stenosis, is minimal. Up to present, the literature holds little evidence of such similar cases. Conclusions. In the particular case of patients that were diagnosed with severe renal artery stenosis of atherosclerotic origin and had only one of the arteries affected, it is necessary to keep a permanent monitoring, justified by the risk of development of the same pathology to the other artery

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Bilateral lateral rotation of the kidneys with their hilum facing laterally (outwards) - Rare anatomical variations

Asian Journal of Medical Sciences ◽

10.3126/ajms.v6i5.12414 ◽

2015 ◽

Vol 6 (5) ◽

pp. 82-84

Author(s):

Vinu Gopinath ◽

RV Mookambika ◽

Velayudhan Nair ◽

Rema V Nair ◽

KG Mohandas Rao

Keyword(s):

Left Kidney ◽

Anatomical Variations ◽

Lateral Position ◽

Left Renal Artery ◽

Anterior Surface ◽

Medical Sciences ◽

Lateral Border ◽

Renal Vessels ◽

Male Cadaver ◽

Renal Hilum

Among the variations of the renal system, abnormalities of structure and position of kidney along with the variations of renal vessels are reported most frequently. However, reports on rotational abnormalities and abnormal positions of renal hilum are scanty. During routine dissection of the posterior abdominal wall, laterally rotated kidneys with laterally facing hila were observed in about 60-year-old male cadaver. On right side, the hilum was more on the anterior surface of the organ and right renal vein was emerging almost from the middle of the anterior surface at the lateral edge of the hilum. However, the hilum of the left kidney was observed along the lateral border of the organ and left renal artery was crossing transversely anterior to the kidney forming a loop to reach the hilum. It was also observed that because of the lateral position of the hilum, the renal vessels and pelvis where passing over the anterior surface of the kidney. Rotational variations and abnormal locations of renal hilum are of importance in surgical procedures like percutaneous nephrectomy. Further clinical and surgical importance of the case is discussed in the paper.DOI: http://dx.doi.org/10.3126/ajms.v6i5.12414 Asian Journal of Medical Sciences Vol.6(5) 2015 82-84

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Total occlusion of the abdominal aorta in a patient with renal failure and refractory hypertension: a case report

Monaldi Archives for Chest Disease ◽

10.4081/monaldi.2011.205 ◽

2015 ◽

Vol 76 (1) ◽

Author(s):

Cinzia Perrino ◽

Laura Scudiero ◽

Maria Piera Petretta ◽

Gabriele Giacomo Schiattarella ◽

Mario De Laurentis ◽

...

Keyword(s):

Renal Failure ◽

Renal Artery ◽

Abdominal Aorta ◽

Left Kidney ◽

Fatal Outcome ◽

Left Renal Artery ◽

Refractory Hypertension ◽

Total Occlusion ◽

Delay In Diagnosis ◽

The Right

Total occlusion of the abdominal aorta is unusual, and potentially catastrophic. It occurs in patients with advanced atherosclerotic occlusive disease, and can cause severe ischemic manifestations, depending on the site of obstruction. Prompt and appropriate diagnostic and therapeutic approaches are important whenever this condition is suspected, in order to avoid a fatal outcome. The development of a complex network of collaterals may prevent the manifestation of acute ischemic phenomena, and cause a delay in diagnosis and treatment. Here we report the clinical case of a 59-year-old man who was referred to our Department for evaluation of renal failure and refractory hypertension. Ultrasonography and 99mTc-DTPA scintigraphy showed a shrunken, non-functioning left kidney, while CT angiography and aortography showed the complete occlusion of the aorta from below the right renal artery down to the bifurcation of both common iliac arteries, with a critical stenosis of the origin of the right renal artery, an occlusion of the left renal artery as well as of the origin of the inferior mesenteric artery. The patient was referred to the surgery department for aorto-bifemoral bypass surgery and re-implantation of the right renal artery.

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Effect of somatostatin on renal water handling in the dog

Canadian Journal of Physiology and Pharmacology ◽

10.1139/y82-090 ◽

1982 ◽

Vol 60 (5) ◽

pp. 655-663 ◽

Cited By ~ 9

Author(s):

Theodore Mountokalakis ◽

Mortimer Levy

Keyword(s):

Renal Artery ◽

Left Kidney ◽

Left Renal Artery ◽

Water Diuresis ◽

Intraarterial Infusion ◽

Water Excretion ◽

Arterial Perfusion ◽

Water Handling ◽

Arterial Inflow ◽

The Face

When somatostatin was infused into the left renal artery of anaesthetized, hydropenic dogs in doses ranging from 1 to 10 μg/min, it produced an increased flow of a more dilute urine from the ipsilateral kidney. Similar infusions in dogs undergoing a maximal water diuresis had no effect. If aqueous antidiuretic hormone (ADH) was administered intravenously into water-loaded dogs prior to the intraarterial infusion of somatostatin, this latter peptide was able to produce an augmented flow of a more dilute urine from the ipsilateral kidney. If the left kidney was made to excrete a concentrated urine in the face of maximal water loading by restricting arterial perfusion, then the infusion of somatostatin had no effect on urinary dilution, though this peptide could increase water excretion in hydropenic dogs when the left kidney was similarly restricted as to arterial inflow. In dogs undergoing a water diuresis that were given cyclic AMP (4 mg/min) into the left renal artery, a decrease in ipsilateral water excretion was observed. The subsequent infusion of somatostatin produced no urinary dilution. We conclude that somatostatin increases renal water excretion by antagonizing the ADH effect on the renal tubule, and that this event probably occurs at a pre-cAMP site within the cell.

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Anatomy of Inferior Mesenteric Artery in Fetuses

Scientifica ◽

10.1155/2016/5846578 ◽

2016 ◽

Vol 2016 ◽

pp. 1-5

Author(s):

Ayesha Nuzhat

Keyword(s):

Renal Artery ◽

Mesenteric Artery ◽

Inferior Mesenteric Artery ◽

Left Kidney ◽

Lumbar Vertebra ◽

Left Renal Artery ◽

Accessory Renal Artery ◽

Medical College ◽

Group I ◽

Group Ii

Aim. To analyze Inferior Mesenteric Artery in fetuses through its site of origin, length, diameter, and variation of its branches.Method. 100 fetuses were collected from various hospitals in Warangal at Kakatiya Medical College in Andhra Pradesh, India, and were divided into two groups, group I (second-trimester fetuses) and group II (third-trimester fetuses), followed by dissection.Result.(1) Site of Origin. In group I fetuses, origin of Inferior Mesenteric Artery was at third lumbar vertebra in 33 out of 34 fetuses (97.2%). In one fetus it was at first lumbar vertebra, 2.8%. In all group II fetuses, origin of Inferior Mesenteric Artery was at third lumbar vertebra.(2) Length. In group I fetuses it ranged between 18 and 30 mm, average being 24 mm except in one fetus where it was 48 mm. In group II fetuses the length ranged from 30 to 34 mm, average being 32 mm.(3) Diameter. In group I fetuses it ranged from 0.5 to 1 mm, and in group II fetuses it ranged from 1 to 2 mm, average being 1.5 mm.(4) Branches. Out of 34 fetuses of group I, 4 fetuses showed variation. In one fetus left colic artery was arising from abdominal aorta, 2.9%. In 3 fetuses, Inferior Mesenteric Artery was giving a branch to left kidney, 8.8%. Out of 66 fetuses in group II, 64 had normal branching. In one fetus left renal artery was arising from Inferior Mesenteric Artery, 1.5%, and in another fetus one accessory renal artery was arising from Inferior Mesenteric Artery and entering the lower pole of left kidney.Conclusion. Formation, course, and branching pattern of an artery depend on development and origin of organs to attain the actual adult position.

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Effect of acetylcholine, atropine, and physostigmine on renal function in the dog

American Journal of Physiology-Legacy Content ◽

10.1152/ajplegacy.1964.206.3.492 ◽

1964 ◽

Vol 206 (3) ◽

pp. 492-498 ◽

Cited By ~ 59

Author(s):

Arthur J. Vander

Keyword(s):

Renal Artery ◽

Renal Plasma Flow ◽

Left Kidney ◽

Urine Volume ◽

Indirect Evidence ◽

Urine Osmolality ◽

Sodium Concentration ◽

Sodium Reabsorption ◽

Left Renal Artery ◽

Parasympathetic Innervation

Acetylcholine (1–500 µg/min), atropine (.002–.12 mg/kg min), or physostigmine (.01–.08 mg/min) was infused directly into the left renal artery of anesthetized dogs, and right and left kidney functions were compared. Acetylcholine produced variable changes in glomerular filtration rate (–30 to +55%), but always increased renal plasma flow (4–115%), sodium excretion (20–365 µm/min), potassium excretion (1–56 µm/min), and urine volume (.25–3.1 ml/min). Filtration fraction, urine osmolality, and medullary sodium concentration were always reduced. These changes could all be reversed or prevented by atropine. Stop-flow studies failed to demonstrate any distal tubular inhibition of sodium reabsorption by acetylcholine. Neither atropine nor physostigmine, when infused into the renal artery by itself, produced any changes in renal hemodynamics or electrolyte excretion. These data demonstrate that acetylcholine can decrease renal arteriolar resistance and inhibit tubular sodium reabsorption. They also provide indirect evidence which supports, but does not prove, the hypothesis that the kidney lacks parasympathetic innervation.

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SYSTEMIC VASCULITIS WITH LESION OF LARGE VESSELS AS A CAUSE OF ART ERIAL HYPERT ENSION IN A PATIENT OF YOUNG AGE

The Clinician ◽

10.17650/1818-8338-2018-12-1-43-50 ◽

2018 ◽

Vol 12 (1) ◽

pp. 43-50

Author(s):

D. Yu. Andriyashkina ◽

N. A. Demidova ◽

N. А. Shostak ◽

D. A. Somov ◽

М. A. Laperishvili

Keyword(s):

Renal Artery ◽

Superior Mesenteric Artery ◽

Female Patient ◽

Mesenteric Artery ◽

Left Kidney ◽

Celiac Trunk ◽

Heterozygous Mutation ◽

Left Renal Artery ◽

Moderate Activity ◽

Negative Consequences

Objective:to analyze and present a clinical case of late diagnosis of Takayasu’s arteritis in a young female patient with long-term arterial hypertension.Materials and methods.The female patient G., born in 1989, had noted elevated arterial pressure (AP) of 150/90 mm Hg since she was 14. At 21 the following diagnosis was stated: Fibro-muscular dysplasia, stenosis of the left renal artery. Stenosis of the celiac trunk. Aneurisms of the branches of the superior mesenteric artery; prosthesis of the left renal artery was performed. Since the beginning of 2016, the patient has noted elevated AP of 200/110 mm Hg despite continuing hypotensive therapy. Diagnosis of Nonspecific aortoarteritis was proposed in May of 2017. Methylprednisolone therapy was administered: 250 mg No. 2 intravenously, Prednisolone: 25 mg a day orally. Due to signs of decreased blood flow to the left kidney, in August of 2017 extracorporeal repeat prosthesis of the left renal artery, bypass of the right middle renal artery with reversed autovein were performed.Results.During examination in October of 2017, the patient complained of weakness, frequent elevated AP of 200/110 mm Hg. In blood test: hemoglobin 106 g/l, erythrocyte sedimentation rate 38 mm/h, C-reactive protein 25 mg/l. A heterozygous mutation in the methylenetetrahydropholate reductase, a heterozygous mutation in the factor V gene (G1691A) were identified. Homocysteine level was normal, infection and oncological pathology were excluded. The following diagnosis was made: Takayasu»s arteritis type IV affecting the aorta and its branches, moderate activity. Occlusion of the celiac trunk. Aneurisms of the branches of the superior mesenteric artery. Critical stenosis of the left renal artery. Thrombosis of the aorto-renal prosthesis. Hypoplasia of the left kidney. Prednisolone 50 mg a day, metoprolol 50 mg a day, valsartan 160 mg a day, acetylsalicylic acid 100 mg a day were prescribed.Conclusion.The presented clinical observation shows the importance of comprehensive examination of young patients complaining of elevated AP for many years. Due to untimely diagnosis and absence of pathogenetic therapy, the patient suffered negative consequences of surgical treatment.

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Bilateral Vascular Variations at the Renal Hilum: A Case Report

Case Reports in Vascular Medicine ◽

10.1155/2012/968506 ◽

2012 ◽

Vol 2012 ◽

pp. 1-4

Author(s):

Naveen Kumar ◽

Ashwini P. Aithal ◽

Anitha Guru ◽

Satheesha B. Nayak

Keyword(s):

Renal Artery ◽

Left Kidney ◽

Left Renal Artery ◽

Anterior Branch ◽

Precise Knowledge ◽

Renal Vessels ◽

Renal Hilum ◽

Aberrant Artery ◽

Vascular Structures ◽

The Right

Imaging technology with its advancement in the field of urology is the boon for the patients who require minimally invasive approaches for various kidney disorders. These approaches require a precise knowledge of the normal and variant anatomy of vascular structures at the hilum of the kidney in terms of their pattern of arrangement and division. The present paper describes a bilateral anomalous arrangement of the structures at the renal hilum as well as their peculiar branching pattern which is of clinical and surgical relevance. Multiple branching of the renal vessels was observed in both kidneys due to which the hila were congested. The right renal artery immediately after its origin divided into 2 branches. The upper branch represented an aberrant artery whereas the lower branch gave 5 divisions. The left renal artery also divided into 2 branches much before the hilum as anterior and posterior divisions. The anterior branch took an arched course and gave 6 branches. The posterior branch gave 3 terminal branches before entering the renal substance. In addition to anomalous hilar structures, normal architecture of both kidneys was altered and the hilum of the left kidney was found on its anterior surface.

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Bilateral accessory renal arteries in a fetus: importance for surgical and radiological practice

International Journal of Basic and Applied Sciences ◽

10.14419/ijbas.v4i3.4702 ◽

2015 ◽

Vol 4 (3) ◽

pp. 288

Author(s):

José Aderval Aragão ◽

Danillo Primo Andrade Santana ◽

Ellen Caroline da Conceição Brandão ◽

Viviane Freitas Andrade ◽

Marianna Ribeiro de Menezes Freire ◽

...

Keyword(s):

Kidney Transplantation ◽

Renal Artery ◽

Anatomical Variations ◽

Vascular Reconstruction ◽

Renal Arteries ◽

Left Renal Artery ◽

Multiple Renal Arteries ◽

Renal Vessels ◽

The Right ◽

Accessory Renal Arteries

Context: Knowledge of anatomical variations of the renal vessels is considered important, in view of the increasing use of kidney transplantation, vascular reconstruction and imaging methods.Objective: To report on a case of triple right renal artery, and double left renal artery and its clinical-surgical implications.Case report: In a female fetal cadaver of age 30 weeks, multiple renal arteries were observed: triple in the right and double in the left renal artery. All the arteries were hilar and originated from the lateral face of the abdominal aorta. The lengths of the triple renal arteries were 17, 10 and 12 mm respectively for the upper, middle and lower arteries. The lengths of the double arteries were 10 and 12 mm respectively for the upper and lower arteries. There was no extrarenal segmentation.Conclusion: Knowledge of possible variations in the renal arteries may be very useful for radiologists, urologists and vascular surgeons.

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