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Hypothesis: Accessory renal arteries may be an overlooked cause of renin-dependent hypertension

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Fig. 1: Multidetector CT angiography.
Fig. 2: Multidetector CT angiography.

References

  1. Bundy JD, Mills KT, Chen J, Li C, Greenland P, He J. Estimating the association of the 2017 and 2014 hypertension guidelines with cardiovascular events and deaths in US adults: an analysis of national data. JAMA Cardiol. 2018;3:572–81.

    PubMed  PubMed Central  Article  Google Scholar 

  2. Herrmann SM, Textor SC. Current concepts in the treatment of renovascular hypertension. Am J Hypertension. 2018;31:139–49.

    CAS  Article  Google Scholar 

  3. Derkx F, Schalekamp M. Renal artery stenosis and hypertension. Lancet. 1994;344:237–9.

    CAS  PubMed  Article  Google Scholar 

  4. Boutari C, Georgianou E, Sachinidis A, Katsimardou A, Christou K, Piperidou A, et al. Renovascular hypertension: novel insights. Curr hypertension Rev. 2020;16:24–9.

    Article  Google Scholar 

  5. Hansen KJ, Edwards MS, Craven TE, Cherr GS, Jackson SA, Appel RG, et al. Prevalence of renovascular disease in the elderly: a population-based study. J Vasc Surg. 2002;36:443–51.

    PubMed  Article  Google Scholar 

  6. Textor SC, Lerman L. Renovascular hypertension and ischemic nephropathy. Am J Hypertension. 2010;23:1159–69.

    CAS  Article  Google Scholar 

  7. Marks LS, Maxwell MH. Tigerstedt and the discovery of renin. Historical note Hypertension. 1979;1:384–8.

    CAS  PubMed  Article  Google Scholar 

  8. Goldblatt H, Lynch J, Hanzal RF, Summerville WW. Studies on experimental hypertension I. The production of persistent elevation of systolic blood pressure by means of renal ischemia. J Exp Med. 1934;59:347–79.

    CAS  PubMed  PubMed Central  Article  Google Scholar 

  9. Goldblatt H, Kahn JR, Hanzal RF. Studies on experimental hypertension: IX. The effect on blood pressure of constriction of the abdominal aorta above and below the site of origin of both main renal arteries. J Exp Med. 1939;69:649–74.

    CAS  PubMed  PubMed Central  Article  Google Scholar 

  10. Fasciolo JC, Houssay BA, Taquini AC. The blood-pressure raising secretion of the ischaemic kidney. J Physiol. 1938;94:281.

    CAS  PubMed  PubMed Central  Article  Google Scholar 

  11. Braun-Menendez EFJC, Fasciolo JC, Leloir LF, Muñoz JM. The substance causing renal hypertension. J Physiol. 1940;98:283–98.

    CAS  PubMed  PubMed Central  Article  Google Scholar 

  12. Page IH, Helmer OM. A crystalline pressor substance (angiotonin) resulting from the reaction between renin and renin-activator. J Exp Med. 1940;71:29–42.

    CAS  PubMed  PubMed Central  Article  Google Scholar 

  13. Braun-Menendez E, Page IH. Suggested revision of nomenclature—angiotensin. Science. 1958;127:242.

    CAS  PubMed  Article  Google Scholar 

  14. Basso N, Terragno NA. History about the discovery of the renin-angiotensin system. Hypertension. 2001;38:1246–9.

    CAS  PubMed  Article  Google Scholar 

  15. Kem DC, Lyons DF, Wenzl J, Halverstadt D, Yu X. Renin-dependent hypertension caused by nonfocal stenotic aberrant renal arteries: proof of a new syndrome. Hypertension. 2005;46:380–5.

    CAS  PubMed  Article  Google Scholar 

  16. Gulas E, Wysiadecki G, Szymański J, Majos A, Stefańczyk L, Topol M, et al. Morphological and clinical aspects of the occurrence of accessory (multiple) renal arteries. Arch Med Sci: AMS. 2018;14:442.

    PubMed  Article  Google Scholar 

  17. Zorgdrager M, Krikke C, Hofker SH, Leuvenink HG, Pol RA. Multiple renal arteries in kidney transplantation: a systematic review and meta-analysis. Ann Transplant. 2016;21:469–78.

    PubMed  Article  Google Scholar 

  18. Cenal, U, Erturk, T, Karayagiz, AH, Ozdemir, E, Polatkan, SV, Cakir, U et al., 2019, May. Geographic distribution of multiple arteries and veins of 878 kidney donors from a transplant center in Turkey. In Transplantation proceedings (Vol. 51, No. 4, pp. 1086–1088). Elsevier.

  19. Jamkar AA, Khan B, Joshi DS. Anatomical study of renal and accessory renal arteries. Saudi J Kidney Dis Transplant. 2017;28:292.

    Article  Google Scholar 

  20. Lauder L, Ewen S, Tzafriri AR, Edelman ER, Lüscher TF, Bergmann M, et al. Renal artery anatomy assessed by quantitative analysis of selective renal angiography in 1000 patients with hypertension. EuroIntervention: J EuroPCR Collaboration Working Group Interventional Cardiol Eur Soc Cardiol. 2018;14:121.

    Article  Google Scholar 

  21. Özkan U, Oguzkurt L, Tercan F, Kizilkilic O, Koç Z, Koca N. Renal artery origins and variations: angiographic evaluation of 855 consecutive patients. Diagnostic interventional Radiol. 2006;12:183.

    Google Scholar 

  22. Khamanarong K, Prachaney P, Utraravichien A, Tong‐Un T, Sripaoraya K. Anatomy of renal arterial supply. Clin Anat: Off J Am Assoc Clin Anatomists Br Assoc Clin Anatomists. 2004;17:334–36.

    CAS  Article  Google Scholar 

  23. Marshall AG. Aberrant renal arteries and hypertension. Lancet. 1951;258:701–5.

    Article  Google Scholar 

  24. Robertson P, Hull D, Klidjian A, Hilton D, Dyson ML. The assessment and treatment of hypertension: New views on essential hypertension. Lancet. 1962;280:567–72.

    Article  Google Scholar 

  25. Robertson PW, Hull DH, Klidjian A, Dyson ML. Renal artery anomalies and hypertension: A study of 340 patients. Am Heart J. 1967;73:296–307.

    CAS  PubMed  Article  Google Scholar 

  26. Ooi BS, Chen BT, Toh CC, Khoo OT. Causes of hypertension in the young. Br Med J. 1970;3:744–6.

    CAS  PubMed  PubMed Central  Article  Google Scholar 

  27. Ooi BS, Yu SF, Chen BT, Khoo OT. The accessory artery in essential hypertension. Postgrad Med J. 1971;47:197–8.

    CAS  PubMed  PubMed Central  Article  Google Scholar 

  28. Davies ER, Sutton D. Hypertension and multiple renal arteries. Lancet. 1965;285:341–4.

    Article  Google Scholar 

  29. Nomura G, Kurosaki M, Kondo T, Takeuchi J. Essential hypertension and multiple renal arteries. Am Heart J. 1971;81:274–80.

    CAS  PubMed  Article  Google Scholar 

  30. Carey RM, Whelton PK. The 2017 American College of Cardiology/American Heart Association Hypertension Guideline: A Resource for Practicing Clinicians. Ann Intern Med. 2018;168:359–60.

  31. Whelton, PK, Carey, RM and Aronow, WS 2017. Detection, evaluation, and management of high blood pressure in adults a report of the American college of cardiology/American heart association task force on clinical Practice guidelines. Hypertension, 71.

  32. Whelton PK, Carey RM, Aronow WS, Casey DE, Collins KJ, Dennison Himmelfarb C, et al. ACC/AHA/AAPA/ABC/ACPM/AGS/APhA/ASH/ASPC/NMA/PCNA guideline for the prevention, detection, evaluation, and management of high blood pressure in adults: a report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines. J Am Coll Cardiol. 2017;71:e127–e248. 2018

    PubMed  Article  Google Scholar 

  33. Glodny B, Cromme S, Reimer P, Lennarz M, Winde G, Vetter H. Hypertension associated with multiple renal arteries may be renin-dependent. J Hypertension. 2000;18:1437–44.

    CAS  Article  Google Scholar 

  34. Ostadfar, A (2016). Chapter 1 - fluid mechanics and biofluids principles. In A. Ostadfar (Ed.), Biofluid mechanics (pp. 1–60) Academic Press.

  35. Goupil R, Cowley D, Wolley M, Ahmed AH, Gordon RD, Stowasser M. The utility of renal venous renin studies in selection of patients with renal artery stenosis for angioplasty: a retrospective study. J Hypertension. 2015;33:1931–8.

    CAS  Article  Google Scholar 

  36. Halpern EJ, Nazarian N, Wechsler RJ, Mitchell DG, Outwater EK, Levin DC, et al. US, CT, and MR evaluation of accessory renal arteries and proximal renal arterial branches. Academic Radiol. 1999;6:299–304.

    CAS  Article  Google Scholar 

  37. Bakker J, Beek FJ, Beutler JJ, Hene RJ, De Kort GA, de Lange EE, et al. Renal artery stenosis and accessory renal arteries: accuracy of detection and visualization with gadolinium-enhanced breath-hold MR angiography. Radiology. 1998;207:497–504.

    CAS  PubMed  Article  Google Scholar 

  38. Lee SM, Drach GW. Renovascular hypertension from segmental renal artery stenosis: importance of segmental renal vein renin sampling. J Urol. 1980;124:704–6.

    CAS  PubMed  Article  Google Scholar 

  39. Derrick JR, Tyson KR. The surgical significance of aberrant renal arteries in relation to systemic hypertension. Circulation. 1961;24:1192–6.

    CAS  PubMed  Article  Google Scholar 

  40. Id D, Kaltenbach B, Bertog SC, Hornung M, Hofmann I, Vaskelyte L, et al. Does the presence of accessory renal arteries affect the efficacy of renal denervation? JACC: Cardiovascular Interventions. 2013;6:1085–91.

    PubMed  Google Scholar 

  41. VonAchen P, Hamann J, Houghland T, Lesser JR, Wang Y, Caye D, et al. Accessory renal arteries: Prevalence in resistant hypertension and an important role in nonresponse to radiofrequency renal denervation. Cardiovascular Revascularization. Medicine. 2016;17:470–3.

    Google Scholar 

  42. Türkvatan A, Özdemir M, Cumhur T, Ölçer T. Multidetector CT angiography of renal vasculature: normal anatomy and variants. Eur Radiol. 2009;19:236–44.

    PubMed  Article  Google Scholar 

  43. Lloyd LW. The renal artery in whites and American Negroes. Am J Phys Anthropol. 1935;20:153–63.

    Article  Google Scholar 

  44. Geyer JR, Poutasse EF. Incidence of multiple renal arteries on aortography: report of a series of 400 patients, 381 of whom had arterial hypertension. JAMA. 1962;182:120–5.

    CAS  PubMed  Article  Google Scholar 

  45. Sampaio FJB, Passos MARF. Renal arteries: anatomic study for surgical and radiological practice. Surgical Radiologic Anat. 1992;14:113–7.

    CAS  Article  Google Scholar 

  46. Choi SS, Kim SC, Han DJ. Clinical outcome of microsurgical multiple renal artery reconstruction in renal transplantation. J Korean Soc Transplant. 1997;11:81–94.

    Google Scholar 

  47. Satyapal KS, Haffejee AA, Singh B, Ramsaroop L, Robbs JV, Kalideen JM. Additional renal arteries incidence and morphometry. Surgical Radiologic Anat. 2001;23:33–38.

    CAS  Article  Google Scholar 

  48. Costa, HC, Moreira, RJ, Fukunaga, P, Fernandes, RC, Boni, RC and Matos, AC, 2011, January. Anatomic variations in vascular and collecting systems of kidneys from deceased donors. In Transplantation proceedings (Vol. 43, No. 1, pp. 61–63). Elsevier.

  49. Gümüş H, Bükte Y, Özdemir E, Çetinçakmak MG, Tekbaş G, Ekici F, et al. Variations of renal artery in 820 patients using 64-detector CT-angiography. Ren Fail. 2012;34:286–90.

    PubMed  Article  Google Scholar 

  50. Johnson PB, Cawich SO, Shah SD, Aiken W, McGregor RG, Brown H, et al. Accessory renal arteries in a Caribbean population: a computed tomography based study. Springerplus. 2013;2:1–5.

    Article  Google Scholar 

  51. Harraz, AM, Shokeir, AA, Soliman, SA, El-Hefnawy, AS, Kamal, MM, Shalaby, I, et al., 2013, April. Fate of accessory renal arteries in grafts with multiple renal arteries during live-donor renal allo-transplantation. In Transplantation proceedings (Vol. 45, No. 3, pp. 1232–1236). Elsevier.

  52. Lauder L, Ewen S, Tzafriri AR, Edelman ER, Lüscher TF, Bergmann M, et al. Renal artery anatomy assessed by quantitative analysis of selective renal angiography in 1000 patients with hypertension. EuroIntervention: J EuroPCR collaboration Working Group Interventional Cardiol Eur Soc Cardiol. 2018;14:121.

    Article  Google Scholar 

  53. Çınar C, Türkvatan A. Prevalence of renal vascular variations: Evaluation with MDCT angiography. Diagnostic interventional imaging. 2016;97:891–7.

    PubMed  Article  Google Scholar 

  54. Mansur DI, Karki S, Mehta DK, Shrestha A, Dhungana A. A Study on Variations of Branching Pattern of Renal Artery with Its Clinical Significance. Kathmandu Univ Med J. 2019;66:136–40.

    Google Scholar 

  55. Maleki H, Shahriar R, Kazemi R, Khodadadi F. Frequencies of accessory renal arteries in 129 Iranian patients. Am J Clin Exp Urol. 2020;8:38.

    PubMed  PubMed Central  Google Scholar 

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MFH drafted the paper. VB and RI contributed equally in an oversight, supervisory role.

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Funes Hernandez, M., Bhalla, V. & Isom, R.T. Hypothesis: Accessory renal arteries may be an overlooked cause of renin-dependent hypertension. J Hum Hypertens 36, 493–497 (2022). https://doi.org/10.1038/s41371-021-00632-2

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