International Journal of Current Research and Review
ISSN: 2231-2196 (Print)ISSN: 0975-5241 (Online)
Bootstrap Slider

Indexed and Abstracted in: SCOPUS, Crossref, CAS Abstracts, Publons, CiteFactor, Open J-Gate, ROAD, Indian Citation Index (ICI), Indian Journals Index (IJINDEX), Internet Archive, IP Indexing, Google Scholar, Scientific Indexing Services, Index Copernicus, Science Central, Revistas Medicas Portuguesas, EBSCO, BOAI, SOROS, NEWJOUR, ResearchGATE, Ulrich's Periodicals Directory, DocStoc, PdfCast, getCITED, SkyDrive, Citebase, e-Print, WorldCat (World's largest network of library content and services), Electronic Journals Library by University Library of Regensburg, SciPeople.

Search Articles

Track manuscript

Readers around the world

Full Html

IJCRR - vol 05 issue 19, October, 2013

Pages: 97-102

Date of Publication: 19-Oct-2013


Print Article   Download XML  Download PDF

SUPERNUMERARY RENAL ARTERIES

Author: Flossie Jayakaran, Sayee Rajangam

Category: Healthcare

Abstract:Renal arteries show a range of variations in origin and distribution to the kidney, with variable distributions and caliber of the vessels on each side. As these have serious implications in transplant surgery and renal imaging, it is imperative to examine the variations possible and also to have a common nomenclature for the variations seen. Standard textbooks note that variations are seen in about 30% of the population with a range of 9-76%1 and hence it was deemed necessary to add to the existing knowledge of variations in the patterns of the renal artery. 3 kidneys with variable arterial supplies have been described and the variations have been discussed here. A review of literature also showed that the nomenclature of the arteries varied from one study to another. An attempt has been made here to rationalize the terminology for ease of discussion and comparison.

Keywords: Supernumerary arteries, polar arteries, renal segmental arteries, lateral splanchnic arteries

Full Text:

INTRODUCTION

Variations in renal vessels are expected, especially as the incidence of variation has been reported as 9-76%1. Variations are gaining greater importance due to MR angiography and transplantation of kidneys from live donors.  Standard textbooks comment that while 70% of kidneys show a single artery, 30% of kidneys show supernumerary vessels2. This assumes importance for interpretation of radiological material, transplantation and in preventing erroneous interpretation of pyelogram among other serious consequences.  Perusal of literature on the topic showed that a number of workers have reported variations of arterial patterns as well as variations in nomenclature of these arteries, using terms such as additional /anomalous /accessory /abnormal /aberrant arteries.  The presence of kidneys with variable blood vessels, among the anatomy prosection specimens in the Department, triggered a review of literature and a study to investigate possible patterns of renal vessels.

MATERIAL AND METHODS

3 isolated kidneys, 1 right and 2 left kidney, which were used for student prosection showed renal vessels that could be termed ‘anomalous/aberrant/accessory’. 

The 3 kidneys that made up this material were a pair of kidneys (1a and 1b) with an intact segment of the abdominal aorta and a segment of the inferior vena cava (Fig 1 and 2).  The next specimen was an isolated left kidney with its vessels intact but not connected to an aorta or inferior vena cava (Fig 2).  The specimens were photographed after clearing the connective tissue around the hilum and investigating the extra-hilar course of the arteries that supplied each kidney. The kidneys and the arteries entering it were not subjected to any further dissection.

RESULTS

Kidney 1a (Fig.1) was supplied mainly by the right renal artery which divided 2.5 cm from the aorta into 4 segmental branches before reaching the hilum of the right kidney (Fig.1: 1-4).  3 of these branches were anterior branches, (Fig.1: 1-3), and entered the hilum anterior to the pelvis of the ureter. One (Fig.1: 4) traveled behind the pelvis of the ureter to enter the hilum.  An additional artery (Fig. 1: 5) arose from the aorta 2 cm above the right renal artery and entered the kidney at the upper end of the hilum, posterior to the upper part of the pelvis of the ureter.

Kidney 1b (Fig.2) was supplied by the left renal artery, which branched outside the hilum into 2 branches.  Each of the 2 branches divided again into 2 arteries, but at varying distances from the hilum.  All 4 branches entered the hilum behind the right renal vein and in front of the pelvis of the ureter. (Fig. 2: 3-6).  3 additional arteries branched from the aorta to supply the left kidney: two above and one below the left renal artery.  The highest one (Fig. 2: 1) pierced the medial border of the kidney 0.5 cm above the hilum. The second one (Fig 2: 2) entered the upper part of the hilum behind the renal pelvis.  The third additional artery (fig 2: 7) entered the kidney at the lower part of the hilum behind the renal pelvis. Altogether 7 arterial branches were noted.

Kidney 2 was an isolated left specimen.  A single left renal artery divided before the hilum into 2 branches.  The upper branch of the renal artery (Fig. 3: 1) after giving off a branch (presumably to the left suprarenal gland) pierced the anterior surface of the kidney below the upper pole. The lower branch (Fig.3:2) divided into 3 arteries (Fig 3: 2a, 2b, 2c), 2 of which, (2a and 2b), entered the hilum at the middle and lower end of the hilum respectively, while the last branch, (2c), given off posteriorly, entered the middle of the hilum behind the pelvis of the ureter.

DISCUSSION

Standard text books of Anatomy describe a pair of renal arteries that arise from the abdominal aorta at the level of the vertebral disc between L1 and L2.  Each artery divides into 5 segmental arteries (superior, antero-superior, antero-inferior, inferior and posterior) that supply the 5 segments of the kidney3. The right artery is longer, often higher and runs behind the Inferior Vena cava (IVC) and behind the right renal vein.  The left renal artery is slightly lower, behind the corresponding vein and crossed by the Inferior Mesenteric Vein. In 70% of cases, one artery branches to supply each kidney2.  These arteries show variability of caliber, in the degree of obliquity and the precise relations.

The kidneys in this report had normal renal arteries as described in standard text books. They also had additional arteries arising from the aorta, above and below the renal artery (Kidney 1A and B).  Kidney 1a had 4 arteries from the renal artery which entered the hilum to possibly supply 4 vascular renal segments, with the supernumerary artery (5) directly from the aorta (Fig.1: 1a:5) supplying the 5th vascular segment.  Since no dissection was done this could be an informed comment on its area of supply. 5 vascular renal segments have been described in textbooks for each kidney2.

Kidney 1b had 7 branches supplying the left kidney of which one pierced the surface outside the hilum of the left kidney and could be called a polar artery2 (Fig 2: 1). The 6 vessels that entered the left hilum included the 4 branches of the left renal artery proper (Fig 2: 3-6) and 2 accessory vessels2 from the aorta (2 and 7) that may be supplying the posterior vascular segment.  These (1, 2 and 7) would be the persistent lateral splanchnic arteries that supply the kidney as it ascends out of the pelvis during development2, though Hlaing et al8 reported this phenomenon as pertaining to arteries that supply the lower pole only.

Kidney 2 had a normal left renal artery from the aorta.  However, the segmental branch to the upper pole was not through the hilum as is normally seen, but piercing the anterior surface of the upper pole and could be called Upper polar artery1 or Superior renal polar artery2.  Polar arteries have been described as arising from anomalous/accessory arteries 6 or from the renal artery proper2. In this study, the artery supplying the upper pole in Kidney 2 arose from the normal left renal artery.  3 segmental branches of the left renal artery were seen entering the hilum instead of the expected 4 arteries.  The possibility remains that further branching of the artery may occur within the kidney parenchyma.

Supernumerary arteries are relatively common (an incidence of 30%2), and had raised concerns that their narrow calibers may contribute to renal ischemia and increase the risk of hypertension – an event which has since been reported to show no statistical significance5.  These arteries represent persistent embryonic lateral splanchnic arteries which grow in sequence from the aorta to supply the kidney as it ascends from the pelvis4.  These arteries may arise from the aorta, coeliac trunk, superior mesenteric artery, inferior mesenteric artery and the aorta near its bifurcation2. Often called accessory renal arteries, the supernumerary arteries to the lower pole may be clinically important as they may obstruct the pelvi-ureteric junction resulting in hydronephrosis.

Supernumerary arteries are reported to be present in 30% of kidneys2, though other reports mention 40%6, 24%5, 20%7 and 4%8.  It is reported to be more commonly seen on the left side1 where they enter the lower pole7.  In kidney 2 of this report, there are 3 additional arteries to the left kidney, one of which pierces the anterior surface and 2 which enter through the hilum.

Variations in the renal arteries have serious consequences for surgeons and radiologists as has been elaborated in several reports1, 5-8.  Consistency of nomenclature therefore is required in the description of variations.  It is suggested that the following nomenclature for supernumerary arteries may be used to reduce confusion.

i) Hilar arteries enter the kidney at the hilum irrespective of their origin.

ii) Extrahilar do not enter the kidney through the hilum and irrespective of their origin, may be called (a)‘perforating’ if it perforates any surface of the kidney, or (b) ‘polar’, if it supplies the upper and/or lower poles7.  Kidneys 1b and 2 may therefore be said to have a perforating polar artery each to the upper poles of the respective kidneys.  Saritha et al called the extrahilar arteries as ‘accessory’ vessels, distinguishing polar accessory vessels from hilar accessory vessels.

Terms such as aberrant, abnormal and anomalous do not convey precise information and may therefore be unsuitable in a scientific context, as each artery, whether it arises from the aorta or other vessels, does supply a specific segment of the kidney.  All segmental arteries are end arteries supplying a resectable unit/renal segment and do not show significant anastomosis with other vessels.  They are therefore not aberrant, abnormal or anomalous1.

CONCLUSION

The present study has reported the presence of additional branches to the kidneys from the abdominal aorta and the renal artery.  These variations in the organization of neurovascular structures at the renal hilum will provide valuable information to surgeons and radiologists before procedures are undertaken. A scheme for nomenclature of supernumerary vessels has also been suggested in this report.

References:

  1. Talovic E, Kulenovic A, Voljevica A, Kapur E. Review of Supernumerary Renal Arteries by Dissection Method. Acta Medica Academica 2007; 36: 59-69
  2. Standring S, (ed) Gray’s Anatomy 40th ed. 2008. Churchill Livingstone Elsevier, UK
  3. Moore KL, Dalley AF, Agur AMR. Clinically Oriented Anatomy. 6th ed. 2010 Lippincott Williams and Wilkins, India
  4. Snell R S. Clinical Anatomy by Regions. 8th ed.  2008   Lippincott Williams and Wilkins, USA.
  5. Gupta A, Tello R. Accessory Renal Arteries Are Not Related to Hypertension Risk:  A Review of MR Angiography Data.  Am J of Roentgenology 2004; 182: 1521-1524
  6. Madhyastha S, Suresh R, Rao R. Multiple Variations of Renal Vessels. Indian J of Urology: Case Report 2001; 17 (2):164-65
  7. Saritha S, Jyothi N, Praveen Kumar M, Supriya G. Cadaveric Study of Accessory Renal Arteries and its Surgical Correlation. Int J Res Med Sci 2013; 1 (1): 19-22
  8. Hlaine KPP, Das S, Sulaiman IM, Latiff AA, Ghafar NA, Suhaimi FH, Othman F. Accessory Renal Vessels at the Upper and Lower Pole of the Kidney: A Cadaveric Study with Clinical Implications. Bratisl  Lek  Listy 2010; 111(5): 308-10

Research Incentive Schemes

Awards, Research and Publication incentive Schemes by IJCRR

Best Article Award: 

One article from every issue is selected for the ‘Best Article Award’. Authors of selected ‘Best Article’ are rewarded with a certificate. IJCRR Editorial Board members select one ‘Best Article’ from the published issue based on originality, novelty, social usefulness of the work. The corresponding author of selected ‘Best Article Award’ is communicated and information of award is displayed on IJCRR’s website. Drop a mail to editor@ijcrr.com for more details.

Women Researcher Award:

This award is instituted to encourage women researchers to publish her work in IJCRR. Women researcher, who intends to publish her research work in IJCRR as the first author is eligible to apply for this award. Editorial Board members decide on the selection of women researchers based on the originality, novelty, and social contribution of the research work. The corresponding author of the selected manuscript is communicated and information is displayed on IJCRR’s website. Under this award selected women, the author is eligible for publication incentives. Drop a mail to editor@ijcrr.com for more details.

Emerging Researcher Award:

‘Emerging Researcher Award’ is instituted to encourage student researchers to publish their work in IJCRR. Student researchers, who intend to publish their research or review work in IJCRR as the first author are eligible to apply for this award. Editorial Board members decide on the selection of student researchers for the said award based on originality, novelty, and social applicability of the research work. Under this award selected student researcher is eligible for publication incentives. Drop a mail to editor@ijcrr.com for more details.


Best Article Award

A Study by Juna Byun et al. entitled "Study on Difference in Coronavirus-19 Related Anxiety between Face-to-face and Non-face-to-face Classes among University Students in South Korea" is awarded Best Article for Vol 12 issue 16
A Study by Sudha Ramachandra & Vinay Chavan entitled "Enhanced-Hybrid-Age Layered Population Structure (E-Hybrid-ALPS): A Genetic Algorithm with Adaptive Crossover for Molecular Docking Studies of Drug Discovery Process" is awarded Best article for Vol 12 issue 15
A Study by Varsha M. Shindhe et al. entitled "A Study on Effect of Smokeless Tobacco on Pulmonary Function Tests in Class IV Workers of USM-KLE (Universiti Sains Malaysia-Karnataka Lingayat Education Society) International Medical Programme, Belagavi" is awarded Best article of Vol 12 issue 14, July 2020
A study by Amruta Choudhary et al. entitled "Family Planning Knowledge, Attitude and Practice Among Women of Reproductive Age from Rural Area of Central India" is awarded Best Article for special issue "Modern Therapeutics Applications"
A study by Raunak Das entitled "Study of Cardiovascular Dysfunctions in Interstitial Lung Diseas epatients by Correlating the Levels of Serum NT PRO BNP and Microalbuminuria (Biomarkers of Cardiovascular Dysfunction) with Echocardiographic, Bronchoscopic and HighResolution Computed Tomography Findings of These ILD Patients" is awarded Best Article of Vol 12 issue 13 
A Study by Kannamani Ramasamy et al. entitled "COVID-19 Situation at Chennai City – Forecasting for the Better Pandemic Management" is awarded best article for  Vol 12 issue 12
A Study by Muhammet Lutfi SELCUK and Fatma COLAKOGLU entitled "Distinction of Gray and White Matter for Some Histological Staining Methods in New Zealand Rabbit's Brain" is awarded best article for  Vol 12 issue 11
A Study by Anamul Haq et al. entitled "Etiology of Abnormal Uterine Bleeding in Adolescents – Emphasis Upon Polycystic Ovarian Syndrome" is awarded best article for  Vol 12 issue 10
A Study by Arpita M. et al entitled "Estimation of Reference Interval of Serum Progesterone During Three Trimesters of Normal Pregnancy in a Tertiary Care Hospital of Kolkata" is awarded best article for  Vol 12 issue 09
A Study by Ilona Gracie De Souza & Pavan Kumar G. entitled "Effect of Releasing Myofascial Chain in Patients with Patellofemoral Pain Syndrome - A Randomized Clinical Trial" is awarded best article for  Vol 12 issue 08
A Study by Virendra Atam et. al. entitled "Clinical Profile and Short - Term Mortality Predictors in Acute Stroke with Emphasis on Stress Hyperglycemia and THRIVE Score : An Observational Study" is awarded best article for  Vol 12 issue 07
A Study by K. Krupashree et. al. entitled "Protective Effects of Picrorhizakurroa Against Fumonisin B1 Induced Hepatotoxicity in Mice" is awarded best article for issue Vol 10 issue 20
A study by Mithun K.P. et al "Larvicidal Activity of Crude Solanum Nigrum Leaf and Berries Extract Against Dengue Vector-Aedesaegypti" is awarded Best Article for Vol 10 issue 14 of IJCRR
A study by Asha Menon "Women in Child Care and Early Education: Truly Nontraditional Work" is awarded Best Article for Vol 10 issue 13
A study by Deep J. M. "Prevalence of Molar-Incisor Hypomineralization in 7-13 Years Old Children of Biratnagar, Nepal: A Cross Sectional Study" is awarded Best Article for Vol 10 issue 11 of IJCRR
A review by Chitra et al to analyse relation between Obesity and Type 2 diabetes is awarded 'Best Article' for Vol 10 issue 10 by IJCRR. 
A study by Karanpreet et al "Pregnancy Induced Hypertension: A Study on Its Multisystem Involvement" is given Best Paper Award for Vol 10 issue 09
Late to bed everyday? You may die early, get depression
Egg a day tied to lower risk of heart disease
88 Percent Of Delhi Population Has Vitamin D Deficiency: ASSOCHAM Report

List of Awardees

Awardees of COVID-19 Research

Woman Researcher Award

A Study by Neha Garg et al. entitled "Optimization of the Response to nCOVID-19 Pandemic in Pregnant Women – An Urgent Appeal in Indian Scenario" published in Vol 12 issue 09

A Study by Sana Parveen and Shraddha Jain entitled "Pathophysiologic Enigma of COVID-19 Pandemic with Clinical Correlates" published in Vol 12 issue 13

A Study by Rashmi Jain et al. entitled "Current Consensus Review Article on Drugs and Biologics against nCOVID-19 – A Systematic Review" published in Vol 12 issue 09

Emerging Researcher Award

A Study by Madhan Jeyaraman et al. entitled "Vitamin-D: An Immune Shield Against nCOVID-19" published in Vol 12 issue 09

Study by Dheeraj Kumar Chopra et al. entitled "Lipid-Based Solid Dispersions of Azilsartan Medoxomil with Improved Oral Bioavailability: In Vitro and In Vivo Evaluation" published in Vol 12 issue 19


RSS feed

Indexed and Abstracted in


Antiplagiarism Policy: IJCRR strongly condemn and discourage practice of plagiarism. All received manuscripts have to pass through "Plagiarism Detection Software" test before forwarding for peer review. We consider "Plagiarism is a crime"

IJCRR Code of Conduct: We at IJCRR voluntarily adopt policies on Code of Conduct, and Code of Ethics given by OASPA and COPE. To know about IJCRRs Code of Conduct, Code of Ethics, Artical Retraction policy, Digital Preservation Policy, and Journals Licence policy click here

Disclaimer: International Journal of Current Research and Review (JICRR) provides platform for researchers to publish and discuss their original research and review work. IJCRR can not be held responsible for views, opinions and written statements of researchers published in this journal.



Company name

International Journal of Current Research and Review (JICRR) provides platform for researchers to publish and discuss their original research and review work. IJCRR can not be held responsible for views, opinions and written statements of researchers published in this journal

Contact

148, IMSR Building, Ayurvedic Layout,
        Near NIT Complex, Sakkardara,
        Nagpur-24, Maharashtra State, India

editor@ijcrr.com

editor.ijcrr@gmail.com


Copyright © 2020 IJCRR. Specialized online journals by ubijournal .Website by Ubitech solutions