Int J Anat Res 2014, 2(1):270-72. ISSN 2321-4287 270

Original Article

A STUDY ON BRANCHING PATTERN OF RENAL ARTERIESVatsala A R *1, Ajay K T 2, G F Mavishettar 3, Sangam 4.

ABSTRACT

Address for Correspondence: Dr. Vatsala A R, Assistant Professor, Dept of Anatomy, JJM MedicalCollege, Davangere-577004, Karnataka, India. Mobile: +91 -9844548877 E-Mail: drvatsala_ar@yahoo.com

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*1 Assistant professor, Anatomy, 2 Associate professor, Physiology, 3 Professor and Head, Anatomy, 4 Statistician, Community Medicine. JJM Medical College, Davangere, Karnataka, India -577004.

Renal artery variations are becoming more important due to the gradual increase in interventional radiologicalprocedures, urological and vascular operations, and renal transplantation. In the present study out of 80kid-neys 40(50%) kidneys showed the presence of additional renal arteries. The results are statistically significant.The presence of additional renal arteries was found unilaterally in 14 cadavers and bilaterally in 6 cadavers. In10 kidneys additional artery towards the superior pole (Superior polar artery) was observed and in 10 kidneysinferior polar arteries were seen. And superior and inferior polar arteries both are present in 20 kidney speci-mens. In 40 kidney specimens we were found duplicated renal arteries. This multiple renal artery variations areof great clinical significance to radiologists, nephrologists and urologists in imaging and urological procedures.KEYWORDS: Renal artery; Superior polar artery; Inferior polar artery.

INTRODUCTION

International Journal of Anatomy and Research,Int J Anat Res 2014, Vol 2(1):270-72. ISSN 2321- 4287

Received: 17 Feb 2014Peer Review: 17 Feb 2014 Published (O):30 March 2014Accepted: 21 Feb 2014 Published (P):30 March 2014

International Journal of Anatomy and ResearchISSN 2321-4287

www.ijmhr.org/ijar.htm

The kidneys are one of the vital organs in thehuman body. It receives rich blood supply, nearly25% of the cardiac output pass through therenal arteries to be filtered by the kidneys. Theseare end arteries with no anastomosis. Variationsin the number and arrangement of the renalvessels are extremely common [1]. The pairedrenal arteries arise from the aorta just below theorigin of the superior mesenteric artery andtakes 20% of cardiac output. Near the hilum ofthe kidney, each renal artery divides intoanterior and posterior branch, which in turndivides into a number of segmental arteriessupplying the different renal segments.Classically, a single renal artery supplies eachkidney. Variations in the number and arrange-ment of the renal vessels are extremelycommon. The so called aberrant or accessoryarteries were in fact, normal segmentalarteries.

As the invasive interventions such as renal trans-plantation, interventional radiologic proceduresand urologic operations increase, awareness ofthe possible variations of the renal arteries isnecessary for adequate surgical management inthe aforementioned specialties [2]. Knowledgeof the variations of renal vascular anatomy hasimportance in exploration and treatment ofrenal trauma, renal transplantation, renovascu-lar hypertension, renal artery embolization,angioplasty or vascular reconstruction forcongenital and acquired lesions, surgery forabdominal aortic aneurysm and conservative orradical renal surgery. The advent of moreconservative methods in renal surgery hasnecessitated a more precise knowledge of renalvascularisation and its importance in partial andtotal renal transplantation surgeries[3]. Theobjectives of present study are to study theorigin, course of renal arteries and to study theaberrant and accessory renal arteries.

Int J Anat Res 2014, 2(1):270-72. ISSN 2321-4287 271

MATERIALS AND METHODS

Specimen No. 1:

Specimen No. 2:

A total 40 formalin fixed cadavers irrespectiveof sex of cadavers constituted the material forthe study, during routine abdominal dissectionconducted for medical undergraduates of SSInstitute of Medical Sciences and ResearchCentre, Davangere. The kidneys and theirarteries were explored and variations inmorphological patterns of renal arteries werenoted. During the course of dissection, variousabdominal viscera were removed and preservedas specimens for teaching purposes. Renal veinswere also reflected for proper visualization ofsegmental patterns of renal arteries.Variations of renal artery:Renal artery variations including their number,source and course are very common.Irregularities the most common being anadditional or accessory artery arising above orbelow the usual renal artery and entering in toupper pole or lower pole named as superior andinferior polar artery respectively. And the arteryother than the main renal artery was enteringin to the hilum named as a duplicated renalartery [4]. During development, the kidneysinitially lie in the pelvic cavity. As the embryogrows they ascend to reach the lumbar region.When they are present in the pelvic cavity, theytake their blood supplies from branches of iliacarteries, and as they ascend their blood suppliesalso shift from the iliac arteries to the abdominalaorta [5]. Presence of abnormal number, site andaccessory (superior polar & inferior polar artery)arteries are due to the persistence of embryonicvessels which are formed during the ascent ofthe kidney. It is essential for surgeons to bear inmind the possibility of such additional superiorpolar arteries before performing anytransplantation surgeries, as kidneytransplantation with multiple renal arteries hasa chance of rejection, tubular necrosis, or poorgraft function [6].

OBSERVATIONSSpecimen No. 1: Superior polarartery present in left kidneyalong with normal renal artery.

Specimen No. 2: Inferior polar arteries arepresent in both kidneys.Specimen No. 3:

Specimen No. 3: Duplicated renal arteries arepresent.RESULTS AND DISCUSSIONIn present study (Figure 1) out of 80 kidney speci-mens in 10(12.5%) kidneys we observed supe-rior polar artery which is the branch of abdomi-nal aorta. A branch originating directly from therenal artery (superior renal polar branch) wasobserved on the right hand side in 26 kidneys(17.2%) and in 19 on the left-hand side (13.5%)(Saldarriaga et al., 2008) [7]. Sampaio et al., [8]1992 observed superior polar artery origin fromthe aorta in 6.8% of kidneys. Bordei et al., 2007reported that in 5 out of 54 cases (9.25%) thesupplementary renal artery entered the kidneythrough the superior pole.

Vatsala A R et al., A STUDY ON BRANCHING PATTERN OF RENAL ARTERIES.

Int J Anat Res 2014, 2(1):270-72. ISSN 2321-4287 272

CONCLUSION

Vatsala A R et al., A STUDY ON BRANCHING PATTERN OF RENAL ARTERIES.

Budhiraja et al., [9] 2008 observed that 10.7%of cases the superior polar artery originated di-rectly from the abdominal aorta as an additionalrenal artery. The present study is slightly higherthan the above mentioned data.In present study out of 80 kidney specimens10(12.5%) kidney specimens inferior polar arterywas arising from the abdominal aorta (figure 2)and in one case it was arising from the renalartery. The vessel originated from the aortabelow the level of the corresponding renal vein(Hilel Nathan et al., [5] 1958; Janschek et al., [6]2004) was found inferior polar artery in 16 cases.In present study (figure 3) out of 80 kidneyspecimens in 40(50%) kidney specimensduplicated renal artery was arising from theabdominal aorta. Bordei et al., (2004) studiedrenal vascularisation and reported 54 cases ofdouble renal arteries supplying one kidney andoriginating from aorta. Of the 54 cases, six caseswere bilateral. In about 28 cases, supplementaryrenal artery entered the kidney through thehilum. Incidence of multiple arteries has beenreported to be 20.2% and 19% on right and leftsides, respectively by Janschek et al., [6] 2004.However Saldarriaga et al., [7] (2008) reported97(24.9%) out of 390 kidneys having additionalarteries; 87 (22.3%) had one additional arteryand 10 (2.6%) had two additional arteries. It issuggestive of higher incidence of presence ofdouble renal arteries.

Here in the present study we observed thepresence of superior and inferior renal polarartery in 12.5% of cases respectively and bothwere present simultaneously in 25% of cases. Inmost of the cases they were arising from theabdominal aorta except in one case inferiorrenal polar artery was arising from the renalartery. Duplicated renal arteries were observedin 50% of cases and arising from abdominalaorta. This high incidence of presence ofadditional renal arteries are significant in theinvasive interventions such as renal transplan-tation, interventional radiologic procedures andurologic operations, renal artery embolization,angioplasty or vascular reconstruction forcongenital and acquired lesions. Polar ormultiple renal arteries to a normally positioned

kidney represents a failure of complete regres-sion of all primary vascular channels. These mul-tiple arteries may constrict infundibulum, ma-jor calyx or uretero pelvic junction. These arter-ies may pose altered haemo dynamics in renalphysiology. The evaluation of renal angiogramswill be difficult unless you know these anatomi-cal variations. More over renal arteries are func-tional end arteries, the ligation of which may leadto degeneration of that segment of kidney.These multiple arteries complicate the kidneytransplantation surgeries and may cause postoperative bleeding. The urologist must preserveeach multiple arteries to save the renal segmentsince they are end arteries. So prior to surgicalintervention renal angiogram is mandatory.Conflicts of Interests: NoneREFERENCES[1]. Bordei P, Sapte E, Iliescu D and Dina C. The

morphology and the surgical importance of thegonadal arteries originating from renal artery,Surgical and Radiologic Anatomy 2007; 29(5): 367–371.

[2]. Gupta V, Kotgirwar S, Trivedi S, Deopujari R andSingh V. Bilateral variation in renal vasculature.International Journal of Anatomical Variations2010; 3:53–55.

[3]. Hamilton WJ and Mossman HW (1979). In: Humanembryology. Mc Millan Press, New York, 4 392.

[4]. Harrison LH, Flye MW and Seigler HF. Incidence ofanatomical variants in renal vasculature in thepresence of normal renal function. Annals ofSurgery 1978;188:83–89.

[5]. Hilel Nathan MD. Observations on Aberrant RenalArteries Curving Around and Compressing the RenalVein Possible Relationship to OrthostaticProteinuria and to Orthostatic Hypertension.Journal of the American Heart Association1958;18:1131-1134.

[6]. Janschek EC, Rothe AU, Holzenbein TJ, Langer F,Brugger PC and Pokorny H et al., Anatomic basis ofright renal vein extension for cadaveric kidneytransplantation. Journal of Urology 2004;63: 660-4.

[7]. Saldarriaga B, Pinto SA and Ballesteros LE.Morphological expression of the renal artery. Adirect anatomical study in a Colombian half-castepopulation International Journal of MorphologicalSciences 2008;26(1);31-38.

[8]. Sampaio FJ and Passos MA. Renal arteries: anatomicstudy for surgical and radiological practice. Surgicaland Radiologic Anatomy 1992;4:113–117.

[9]. Budhiraja V, Rastogi R & Asthana AK. Variant originof superior polar artery and unusual hilar branchingpattern of renal artery with clinical correlation,India Folia Morphology 2008;70(1):24–28.

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