Anatomic variations of renal arteries in patients with essential hypertension: A retrospective study

Abstract

BackgroundAberrant renovascular anatomy has been reported to occur in up to 80% of patients with Essential Hypertension (EH). In more than 20% of subjects, at least one kidney is found to be supplied by more than one artery arising from the aorta (1).MethodsWe analysed reports of renal Angiographic CT (ACT) scans at our Institution between 2015 and 2017 and searched for anatomic variations of renal arteries, excluding stenosis. Other cardiometabolic variables, such has dyslipidaemia, diabetes mellitus (DM), ischemic heart disease and previous history of stroke and myocardial infarction were also collected.ResultsWe identified 235 ACT reports and 24.7% (n = 58) had no significant abnormalities, 55.7% (n = 131) were excluded because of stenotic lesions and 19.6% (n = 46) presented anatomic variations of renal arteries: 6.5% arterial trifurcation; 15.2% arterial duplication; 32.6% superior polar artery; 15.2% inferior polar artery; 13% accessory artery and 15.2% early bifurcation. The right renal artery was the most affected vessel (73.9%). We performed a retrospective analysis of these 46 patients: the mean age was 42.5 years, 52.1% males and 47.9% females. EH was found in 80.4% of them, 23.9% had DM and 28.2% had dyslipidaemia. There was previous history of stroke in 13% of patients. There was no history of ischemic heart disease or myocardial infarction.ConclusionThere has been some debate regarding the role of atypical renal vascularization in hypertension pathogenesis. One of the hypotheses defends renin-dependent mechanisms due to impaired renal perfusion through accessory vessels. (1) However, future studies are needed to support these explanations.