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Case Report
Bilateral accessory (aberrant) renal arteries associated with uncontrolled hypertension—Role of renin-angiotensin-aldosterone antagonist drugs for treatment goal: A case report
1 Department of Internal Medicine, University of Toledo College of Medicine and Life Sciences, Toledo, OH, USA
2 Department of Biological Sciences, Bowling Green State University, Bowling Green, OH, USA
3 Department of Radiology, University of Toledo College of Medicine and Life Sciences, Toledo, OH, USA
Address correspondence to:
Basil Akpunonu
MD, Department of Internal Medicine, University of Toledo College of Medicine and Life Sciences, 3000 Arlington Avenue, Mail Stop 1186, Toledo, OH 43614,
USA
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Article ID: 101289Z01BA2022
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Akpunonu B, Hummell J, Akpunonu J, Mbaso C, Tasma B, Elsamaloty H. Bilateral accessory (aberrant) renal arteries associated with uncontrolled hypertension—Role of renin-angiotensin-aldosterone antagonist drugs for treatment goal: A case report. Int J Case Rep Images 2022;13:101289Z01BA2022.ABSTRACT
Introduction: Accessory (aberrant) renal arteries (ARAs) are extra vessels that supply the kidneys in addition to the usual single arteries. They typically arise from the abdominal aorta but can also originate from other abdominal/pelvic arterial systems. They are not uncommon and can be seen in up to 30% of adults. Accessory renal arteries can complicate various urological, abdominal surgery, interventional radiological, and transplantation procedures. The prevalence of ARA has been noted in patients with uncontrolled blood pressure, but the causative relationship has been a subject of interest and discussion. We present a case of a patient with resistant hypertension who was noted on investigation to have elevated serum plasma renin activity and bilateral aberrant renal arteries without stenosis. Blood pressure was easily controlled to goal with the addition of Spironolactone and Losartan. Accessory renal arteries should not be ignored in some cases of hypertension management.
Case Report: A 49-year-old woman had developed elevated blood pressure during her previous pregnancies, and hypertension persisted after pregnancy. Angiotensin-converting enzyme (ACE) inhibitors and angiotensin receptor blockers (ARB) could not be used at the time because of teratogenic considerations. Antihypertensive drugs as calcium channel antagonists, beta-blockers, direct vasodilators, and thiazide-based diuretics did not control the blood pressure to goal. Renal Doppler studies showed a slight increase in peak velocity on the right renal artery. A computed tomographic angiography (CTA) and magnetic resonance angiography (MRA) showed accessory renal arteries in both the right and left kidneys. Laboratory tests were unremarkable except for persistent hypokalemia and plasma renin activity was significantly elevated. The addition of Losartan 100 mg daily and Spironolactone 50 mg daily was needed to get blood pressure to goal.
Conclusion: Accessory renal arteries could lead to perfusion abnormalities, contribute to or exacerbate maintenance and control of blood pressure. Drugs affecting the renin-angiotensin-aldosterone pathway are important in the treatment of patients with accessory (aberrant) renal arteries if hypertension is renin mediated.
Keywords: Hypertension, Mineralocorticoid receptor antagonists, Renal artery, Therapeutics
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Acknowledgments
Thank you to Brenda Joyce for her administrative support and assistance with the submission of this case report.
Author ContributionsBasil Akpunonu - Substantial contributions to conception and design, Acquisition of data, Analysis of data, Interpretation of data, Drafting the article, Revising it critically for important intellectual content, Final approval of the version to be published
Jeannine Hummell - Substantial contributions to conception and design, Acquisition of data, Analysis of data, Interpretation of data, Drafting the article, Revising it critically for important intellectual content, Final approval of the version to be published
Joseph Akpunonu - Substantial contributions to conception and design, Acquisition of data, Analysis of data, Interpretation of data, Drafting the article, Revising it critically for important intellectual content, Final approval of the version to be published
Chiamaka Mbaso - Substantial contributions to conception and design, Acquisition of data, Analysis of data, Interpretation of data, Drafting the article, Revising it critically for important intellectual content, Final approval of the version to be published
Brian Tasma - Substantial contributions to conception and design, Acquisition of data, Analysis of data, Interpretation of data, Drafting the article, Revising it critically for important intellectual content, Final approval of the version to be published
Haitham Elsamaloty - Substantial contributions to conception and design, Acquisition of data, Analysis of data, Interpretation of data, Drafting the article, Revising it critically for important intellectual content, Final approval of the version to be published
Guarantor of SubmissionThe corresponding author is the guarantor of submission.
Source of SupportNone
Consent StatementWritten informed consent was obtained from the patient for publication of this article.
Data AvailabilityAll relevant data are within the paper and its Supporting Information files.
Conflict of InterestAuthors declare no conflict of interest.
Copyright© 2022 Basil Akpunonu et al. This article is distributed under the terms of Creative Commons Attribution License which permits unrestricted use, distribution and reproduction in any medium provided the original author(s) and original publisher are properly credited. Please see the copyright policy on the journal website for more information.
