Presence Of Multiple Renal Arteries Research Articles

Results and Significance of Angiography in Potential Kidney Donors

Multiple renal arteries originating from the aortoiliac vessels were identified angiographically in 44% of 444 prospective renal donors. Bilateral multiple renal arteries were identified in 12%. With good immunological donor-recipient matching, 17 kidneys with multiple renal arteries were transplanted with excellent results; therefore, presence of multiple renal arteries should not be considered a contraindication to kidney transplantation. A high proportion (17%) of the prospective donors, acceptable by all other means of evaluation, had abnormmal angiographic findings that led to reconsideration of their acceptance. In addition to multiple renal arteries, neither renovascular atherosclerosis nor fibromuscular dysplasia proved to be an absolute contraindication to transplantation.

Incidence of Anatomical Variants in Renal Vasculature in the Presence of Normal Renal Function

This report defines the incidence of variations in the renal vascular pedicle in a group of patients with normal renal function as determined by standard laboratory criteria. The study group consisted of 166 patients undergoing renal arteriography as potential renal allograft donors. Ninety-seven patients were male and 69 were female. Ages ranged from 18-54 years, median age being 37 years. All patients underwent preliminary screening tests including blood chemistries, creatinine clearance, urinalysis, culture and excretory urography. If these studies were normal, renal arteriography was performed utilizing flush aortogram and, in 20% of cases, selective renal arteriography. The most common anomaly was the presence of multiple renal arteries supplying the same kidney, occurring in 32% of cases. Prehilar segmental branching was the second most common variation, occurring in 17% of patients. Other variations included fetal lobulation (4%), significant stenosis at origin of the renal artery (2%), fibromuscular dysplasia (2%), microaneurysms (0.5%), true aneurysms (1%) and dromedary hump (0.5%). Less than one-half of the patients demonstrated the simplest vascular pedicle, namely, single artery and vein bilaterally. The incidence of anatomical variations in the renal vascular pedicle is greater than attributed to normal subjects in previous reports. Anomalies determine the choice of kidney in renal allografting and may disqualify a potential donor, even in the face of ostensibly normal renal function. Routine arteriography should be considered a standard prerequisite in the evaluation of potential living related renal donors.

Urologic Complications in Renal Transplantation

The current overall reported incidence of major urologic complications following renal transplantation is 5 per cent. The presence of such a complication increases the likelihood of patient mortality by a factor of three. Standard utilization of postoperative radionuclide scanning is very useful in early diagnosis. Vesical fistulas generally result from improper bladder closure. The incidence of bladder complications increases with secondary and tertiary grafts. Ureteral complications result when the blood supply of the ureter is impaired. These include fistula formation, necrosis, and obstruction. Immediate surgical correction is indicated in almost all serious urologic complications following transplantation; otherwise there is marked increase in morbidity and mortality. Complications appearing early in the postoperative period carry a poor prognosis for both graft and recipient survival. The presence of urinary tract infection early in the postoperative period also correlates negatively with graft survival. The presence of multiple renal arteries in the donor has been associated with an increased rate of urologic complications. Ureteral fistulas can be avoided by meticulous dissection of the donor at the time or organ harvesting. Great care must be taken to preserve the arterial and venous blood supply to the ureter by avoiding any dissection into the renal hilum. Aberrant renal arteries must be preserved or repaired if damaged. Ureteroneocystostomy is the preferred method for re-establishing urinary tract continuity following transplantation. The immediate surgical correction of urologic complications is mandatory, and the techniques involved are highly specialized and must be individualized with each patient.