Jonathan Decker DO and Glenn Chapman III DO Larkin Community Hospital

1. A Case of Back Pain with Resistant Hypertension Resulting From
an Anomalous Accessory Renal Artery
Jonathan Decker DO and Glenn Chapman III DO
Larkin Community Hospital
Introduction
The presence of an accessory renal artery can be a
potential alternate diagnosis for a patient with
hypertension that is refractory to treatment for what is
seemingly benign renal hypertension. The accessory renal
artery usually branches directly from the aorta and usually
serves a small portion of the kidney. Due to the presence
of accessory artery which causes an alteration in the fluid
dynamics that effect the respective kidney, it develops
kidney ischemia, thereby it causes an increase in renin
secretions and this leads to a reno-vascular, renin-
dependent hypertension, and a chronic kidney disease
condition.
Imaging
The treating physician pursued imaging of the patient’s
renal arteries by way of magnetic resonance arteriography.
On imaging, it was found that the patient had an accessory
renal artery. Other imaging modality options include not
only magnetic resonance arteriogram, but also CT
angiogram and ultrasound of the renal arteries for
screening purposes.
Conclusion
Accessory renal arteries can be potential causes
of resistant hypertension. Abnormalities of renal
structures may be present in up to 20-30% of
adults. Ultrasound serves as an ideal screening
modality for renal artery stenosis and accessory
renal arteries due to its being non-invasive, free of
radiation, low cost, and lack of contraindications
because of renal failure and contrast allergy. After
the establishment of a hemodynamically significant
stenosis that results in hypertension there exist
multiple treatment options. The treatment options
which are to be considered for a hemodynamically
significant stenosis of an accessory renal artery are
embolization, balloon angioplasty, stenting and
even partial nephrectomy.
References
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Case Presentation
A 60 year old male patient arrived with chronic low back
pain and concomitant hypertension found on review of
vital signs. After several follow-up visits the patient was
noted to have consistently elevated blood pressure that
was resistant to medical intervention. After having started
the patient on a fourth medication for the patient’s blood
pressure, the patient was diagnosed with resistant
hypertension.
Figure One
Figure one demonstrates the origin of an accessory
left renal artery from the aorta inferior to the left
renal artery and left kidney.
Figure Two
Figure two demonstrates the path of the tortuous
left accessory renal artery with insertion to the
lower pole of the patient’s left kidney.