Abnormalities of the renal vessels

Congenital anomalies of the renal arteries are divided into anomalies in the number, location, shape and structure of the arterial trunks and are most often detected among all malformations of the kidneys and VMP.

[1], [2], [3], [4],

Symptoms of the abnormalities of kidney vessels

Symptoms are associated with a violation of urodynamics of both intra- and extrarenal urinary tracts, manifested by their expansion, pyelonephritis and stone formation. Additional renal arteries in 3.66% of cases are located in the zone of stenosis of LMS and significantly increase the risk of obstruction of the urinary tract. At the junction of the vessel and ureter, irreversible sclerotic changes occur in the wall of the latter, leading to the development of hydronephrosis, pyelonephritis, and the formation of stones. Violation of urodynamics is more pronounced if the additional vessel is located anterior to the urinary tract.

[5], [6], [7], [8]

Forms

[9], [10]

Additional renal artery

An additional renal artery is the most common type of renal vascular anomaly (84.6% of all detected kidney and vestibular malformations). What is called an "additional renal artery"? In the early works of the. Lopatkin wrote: "In order to avoid confusion, each vessel that extends from the aorta in addition to the main renal artery, it is advisable to call additional, and the term" multiple arteries "to use when referring to all the supply of kidneys in such cases." In later publications, the term "supplementary artery" is not used at all, but the term "supplementary artery" is used.

Such arteries "have a smaller caliber than the main one, they go to the upper or lower segment of the kidneys from both the abdominal aorta and the main trunk of the renal, adrenal, celiac, diaphragmatic or common iliac artery." There is no clear difference in the interpretation of these concepts. A In Ayvazyan and AM Voino-Yasenetsky strictly delineated the concepts of "multiple trunk", "additional" and "perforating" the arteries of the kidney. "Multiple main arteries" originate from the aorta and flow into the renal cavity. The source of "additional arteries" is the general and external. Celiac, middle adrenal, lumbar arteries. But they all flow through the kidney recess. "The perforating vessels" - penetrating into the kidney outside its gate. Another interpretation of the anomalies of the number of renal arteries was found in the manual "Campbell's urology" (2002). In it, SB Bauer, referring to a large number of works, describes "multiple renal arteries" - that is, more than one backbone, "abnormal or aberrant" - departing from any arterial vessel other than the aorta and the main renal artery, "additional" - two or more arterial trunk feeding one renal segment.

In this way. We did not find a single terminological approach to the renal vascular anomalies of the quantity, and therefore, the vessels feeding the kidney, in addition to the main artery and receding from the aorta or any vessel, with the exception of the main artery, were considered an "additional or additional vessel". "Aberrant arteries" we referred to as vessels extending from the renal artery and penetrating into the kidney outside the renal sinus. The additional renal artery may depart from the aorta, renal, diaphragmatic, adrenal, celiac, iliac vessels and be directed to the upper or lower segment of the kidney. There are no differences in the location of the extra arteries.

[11], [12], [13], [14]

Double and multiple renal arteries

Double and multiple renal arteries are a type of renal vascular anomaly in which the kidney receives blood supply from two or more equivalent trunks in caliber.

Additional or multiple arteries in the overwhelming number of observations occur in normal kidney and do not lead to pathology, but are often combined with other kidney anomalies (dysplastic, doubled, dystopic, horseshoe-shaped, polycystic, etc.).

[15], [16], [17]

Solitary renal artery

The solitary renal artery, which feeds both kidneys, is an extremely rare type of renal vascular anomaly.

Dystopia of the site of the renal artery

Anomalies of location - abnormality of renal vessels, the main criterion in determining the type of kidney dystopia:

• lumbar - with a low incidence of the renal artery from the aorta;
• iliac - when departing from the common iliac artery;
• Pelvic - when departing from the internal iliac artery.

[18], [19], [20], [21],

Aneurysm of the renal artery

An aneurysm of the renal artery is the dilatation of the vessel due to the absence of muscular fibers in the vessel wall and the presence of only elastic fibers. This anomaly of the renal vessels is very rare (0.11%). It is usually one-sided. The aneurysm can be located both extrarenally and intracranially. Clinically manifested by arterial hypertension, diagnosed for the first time in adolescence. Can lead to thromboembolism of the renal arteries with the development of a kidney infarction.

[22], [23], [24], [25],

Fibromuscular stenosis

Fibromuscular stenosis is a rare vascular anomaly of the renal vessels (0.025%). It represents several alternating narrowings in the form of a "string of beads" in the middle or distal third of the renal vessel, resulting from the excessive development of fibrous and muscular tissues in the wall of the renal artery. Can be two-sided. It manifests itself in the form of a hard-to-correct arterial hypertension without a curvilinear course. Treatment operative. The type of operation depends on the prevalence and localization of the defect.

[26]

Congenital arteriovenous fistulae

Congenital arteriovenous fistulas are less common (0.02%). They are more often localized in arched and lobular vessels and can be multiple. There are symptoms of venous hypertension (hematuria, proteinuria, varicocele).

[27], [28], [29], [30], [31], [32]

Congenital change of renal veins

Congenital changes in renal veins can be divided into anomalies of quantity, shape and location, structure.

Anomalies of the right renal vein are mainly associated with doubling or tripling. The left renal vein, in addition to increasing the number, may have an anomaly of shape and position.

Additional renal vein and multiple renal veins, according to some data, occur in 18 and 22% of observations, respectively. Usually, additional renal veins do not combine with additional vessels. Additional veins, as well as arteries, can cross with the ureter, disrupting urodynamics and leading to hydronephrosis transformation. Anomalies of the development of the left renal vein are more common because of the peculiarities of embryogenesis. Right renal vein during the process of embryogenesis practically does not undergo changes. The left renal vein can pass in front, behind and around the aorta, do not flow into the lower vena cava (an extra-caval flow and an inborn absence of the ordering department).

Abnormalities of the structure include stenosis of the renal vein. It can be permanent or orthostatic.

The clinical significance of these vices is that they can develop the development of venous hypertension, and as a consequence - hematuria, varicocele, menstrual cycle disorder. The influence of venous anomalies on the risk of developing a kidney tumor has been proved.

Earlier, angiography was the "gold standard" in diagnosing an abnormality of renal vessels, but recently it became possible to diagnose these defects with less invasive methods - digital subtraction angiography, color echodopplerography, MSCT, MRI. 

[33], [34], [35], [36], [37], [38], [39]

Treatment of the abnormalities of kidney vessels

Treatment of renal abnormalities vessels is aimed at restoring the flow of urine from the kidney and is the intersection of the extension of the vessel and due to occurrence of the ischemia, kidney resection and sclerotic resection of urinary tract-modified zone and uretero-uretero- or ureteropiepielostomii.

If the supplementary vessel feeds most of the kidney and its resection is not possible, then resection of the narrowed part of the urinary tract and antevasal plastic are performed.