Case Report: An Unusual Variant in Kidney Arterial Supply with Two Accessory Renal Arteries from Different Origins

Abstract

Knowledge of the arterial supply of the human kidney is of special interest due to its variable nature as well as the clinical implications during renovascular interventions. This case report describes an unusual pattern in the arterial blood supply of the kidneys. The variation was discovered in an elderly Puerto Rican female during the course of a routine dissection on an embalmed cadaver. The left kidney received arterial supply from two accessory renal arteries. An upper accessory renal artery branched directly from the aorta and entered the kidney at the upper pole. A lower accessory renal artery branched from the main renal artery and entered the main part of the kidney at the level of the hilum. Additional branches appear to supply the left suprarenal gland both directly from the aorta and from the upper accessory renal artery. The right kidney was missing due to unknown causes occurring during the life of the individual.This variant is uncommon, and suggests an atypical embryological development. As the kidney ascends, it gathers its blood supply from nearby arteries, and when it reaches its final destination, one artery remains while the rest degenerate. When this process fails, multiple renal arteries are present in the adult, each with an important function that is not supplemental to that of the main renal artery. However, these extra renal arteries may represent the formation of additional blood vessels rather than an embryological vestige. Understanding these types of variations may help avoid clinical complications, especially during radiological examinations and surgical approaches, such as partial nephrectomies. This is especially true of the extra hilar artery occurring at the level of the hilum, which might be confused for a typical renal artery during imaging.