ESPN 51th Annual Meeting

ESPN 2018


 
Renal CT Angiography findings of bilateral double renal artery: a preliminary pediatric case report
YASAR KANDUR 1 BESRA DAĞOĞLU 2 ALI ARIKAN 3

1- DEPARTMENT OF PEDIATRIC NEPHROLOGY, NECIP FAZIL CITY HOSPITAL, KAHRAMANMARAS, TURKEY
2- DEPARTMENT OF RADIOLOGY, NECIP FAZIL CITY HOSPITAL, KAHRAMANMARAS, TURKEY
3- DEPARTMENT OF CARDIOVASCULAR SURGERY, NECIP FAZIL CITY HOSPITAL, KAHRAMANMARAS, TURKEY
 
Introduction:

Double renal arteries are among the renal vascular variations. Variation regarding thsese renal arteries have been related to embryological development of vessel.The present pediatric case provide information of rare occurrence of bilateral origin of double renal artery.

Material and methods:

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Results:

             Incidental hypertension discovered in a 11 year old boy during pre-anesthesia assessment for genu valgum surgery. He had no hypertension associated complaints and symptoms.  Examination showed pulse rate of 85 per minute, blood pressure was 200/100 mmHg.  There was no radiofemoral delay and peripheral pulses were well palpable. His weight was 45 kg (>75-90p), height 143 cm (50p), BMI 22 kg/m2. The fundus examination showed retinal arteries that indent the retinal veins suggestive of hypertensive retinopathy grade 2. Blood chemistry results were as follows: blood urea 34 mg/dl, creatinine 0.7 mg/dl, triglyceride 154mg/dL, cholesterol 172 mg/dL. Free T4 and TSH were in normal range. Urinary microscopy and stick examination was unremarkable. Doppler did not show features of main renal artery stenosis, however the left kidney was slight smaller (hypoplasia).  Abdomen computed tomography angiography showed normal main renal arteries, with bilateral accessory renal arteries originated from abdominal aorta (Figure). Decreased calibration was detected at the left renal acessory artery feeding the  lower pole of the left kidney. The patient was treated with amlodipine 0.5 mg/kg and Losartan/hydrochlorothiazide 50/12.5 mg.  On follow up after 1week, the patient blood pressure ranged between 138/95 and 145/96 mm Hg.  A beta blocker was added (Metoprolol).  We planned a Digital subtraction angiography (DSA) for the patient, during his follow up period.

Conclusions:

 The present case provide information of rare occurrence of bilateral origin of double renal artery. Knowledge of the origin and branching pattern is essentially enhancing precision and decreasing morbidity related to interventional procedures so iatrogenic injuries can be avoided with the knowledge of anatomical variation.