Cadaveric Study of Anatomical Variations of Renal Arteries

Introduction: Anatomical variations of renal artery are important to prevent complications during renal transplant surgery or renal angiography. Of this additional renal artery is the most common. Materials and methods: The present study was conducted in 80 kidneys of 40 adult human cadavers in Department of Anatomy, Siddhartha Medical College, Vijayawada over a period of 4 years (2017 to 2021) during educational dissections. Results: Accessory renal arteries are observed in the present study. Origins of these accessory renal arteries are noted along with their entry point into the kidneys. These results were compared with previous studies. Conclusion: Prior knowledge of these variations is important to prevent complications during surgical and angiographic interventions. Keywords: Renal arteries, Accessory renal artery, Aberrant renal artery, Upper pole, Lower pole, Hilum.

Isolated acute renal infarction in an obese patient

Background: Uncontrolled cardiovascular (CV) risk factors is been related to a higher incidence of atherosclerosis. Obesity itself could predispose to significant cardiac disease including arterial atheromatous leading to acute events. Case: A 46 years old obese patient who presented with left abdominal pain radiating to the left quadrant and left testicle. No significant abnormality was observed in the laboratories, but imaging showed left renal lower pole may be due to renal infarct (Figure 1), and CT-Angiography (CTA) of the abdomen showed infarction of the anterior two-thirds of the lower pole of the left kidney (Figure 2) secondary to occlusion of the supplying small inferior segmental artery and minimal atherosclerosis. Transthoracic Echocardiogram (TTE) showed a density in the LVOT may be artifact vs. calcification (Figure 3). A transesophageal echocardiogram (TEE) showed Grade III atherosclerotic changes of descending aorta (Figure 4), aortic arch, and a mobile plaque seen in the thoracic aorta. Conclusion: Cardiovascular risk factors have been associated with multiple vascular complications. Obesity as a single cardiovascular risk factor is associated with advanced arterial disease; our case is an example of an unstable atheromatous lesion causing thrombosis and ischemia in the kidney in a patient without another risk factor for thrombosis.

External validation of the T.O.HO. score as predictor of success after retrograde intrarenal surgery

Background To assess the effectiveness of T.O.HO. (Tallness, Occupied lesion, Houndsfield unit evaluation) score in predicting the retrograde intrarenal surgery (RIRS) success and to validate this scoring system. Methods The age, sex, previous stone surgery, hospitalization, surgery duration, postoperative complication, stone length, stone location, stone density, stone number, lateralization, presence of hydronephrosis, and presence of preoperative stent datas of 518 patients who underwent RIRS in our clinic between January 2013 and January 2021 were retrospectively assessed. The patients were divided into two groups as successful and unsuccessful. The T.O.HO scores of all patients were calculated. Results The success rate was 72.5%. Compared to the unsuccessful group, stone length and stone density were lower, surgery duration was shorter and there were less lower pole stones in the successful group (p<0.001). No significant difference was found between the two groups in terms of the other parameters. The T.O.HO. score was significantly lower in the successful group compared to the unsuccessful group (p<0.001). According to the multivariate logistic regression analysis, stone length (OR: 0.905; 95% Cl: 0.866-0.946; p<0.001), lower pole location (OR: 0.546; 95% Cl: 0.013-0.296; p<0.001), stone density (OR: 0.999; 95% Cl: 0.998-1; p=0.044) and the T.O.HO. score (OR: 0.684; 95%Cl: 0.554-0.844; p<0.001) were found as the independent risk factors for RIRS success. ROC curve analysis showed that the T.O.HO. score could predict the RIRS success with 7.5 cut-off point (AUC:0.799, CI: 0.76–0.839; p<0.001). Conclusion The T.O.HO. score can predict RIRS success with a high rate of accuracy.