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Table of Contents
ORIGINAL ARTICLE
Year : 2021  |  Volume : 70  |  Issue : 4  |  Page : 233-238

Comparison of human renal arteries in cadavers and in computed tomography scans – A morphometric study


Department of Anatomy, Seth GSMC and KEMH, Mumbai, Maharashtra, India

Date of Submission23-Sep-2020
Date of Acceptance14-Oct-2021
Date of Web Publication21-Dec-2021

Correspondence Address:
Dr. Parvez Abutaher Chowki
Department of Anatomy, Second Floor, College Building, Seth GSMC and KEMH, A D Marg, Parel, Mumbai - 400 012
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/jasi.jasi_193_20

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  Abstract 


Introduction: The right and left kidneys receive their blood supply from the lateral branches of the abdominal aorta that is, respectively, from the right and the left renal arteries. The study of renal arteries is thus very important, but the literature shows a scarcity of data for the Indian population. This study was, therefore, planned to compare the morphometry of human renal arteries in cadavers and in computed tomography scans. Material and Methods: The study was conducted on 36 formalin-fixed cadavers and on 36 computed tomographic scans of renal arteries. The various parameters measured included the length of renal arteries, internal diameter of renal arteries at its origin, the vertical distance between the renal arteries at its origin and the point of bifurcation of the aorta, and vertical distance between the origins of the right and left renal arteries. Results: The length of the right renal artery was more than the left renal artery, there was no difference in the internal diameter of both the vessels at their origin and no difference in the vertical distance between the site of origin of renal arteries and bifurcation of Aorta. Discussion and Conclusion: The information of the right renal artery being longer than the left kidney confirms with the data available in the literature. The vertical distance between the origins of the renal artery and bifurcation of the aorta is important as it aids the radiologists for performing angiography. Furthermore, the data from this study would aid and supplement the preexisting data for the surgeons during renal transplantations.

Keywords: Aorta, cadavers, computed tomography scans, kidney, renal artery


How to cite this article:
Patil RA, Chowki PA. Comparison of human renal arteries in cadavers and in computed tomography scans – A morphometric study. J Anat Soc India 2021;70:233-8

How to cite this URL:
Patil RA, Chowki PA. Comparison of human renal arteries in cadavers and in computed tomography scans – A morphometric study. J Anat Soc India [serial online] 2021 [cited 2022 Aug 17];70:233-8. Available from: https://www.jasi.org.in/text.asp?2021/70/4/233/333187




  Introduction Top


The renal arteries are known to exhibit morphological and morphometric variations. These variations are extensive and attributed to the complex embryonic development of the kidneys.[1] With the advent of the era of renal transplantation, the morphometric study of renal arteries has become a topic of interest for anatomists, clinicians, and surgeons. Furthermore, since the dawn of laparoscopic nephrectomy as the technique of choice for organ procurement in living kidney donors, computed tomography (CT) scan has emerged in a key role. It aids in as a noninvasive preoperative planning method for anatomic evaluation.[2] Several studies have been conducted over the last few years correlating the CT angiography, MR angiography, and conventional angiographic anatomy with the surgical findings, the cadaveric studies have shown the vivid type of pattern.[3] Unfortunately, there is the dearth of comparative studies on this topic in the Indian population, Thus the present study aims to add on the existing data of comparative studies. This data will help the clinicians to understand the cause of the increasing renal diseases and the surgeons to advent more conservative methods in renal surgeries.


  Material and Methods Top


The study was conducted on 36 formalin-fixed cadavers and on 36 computed tomographic scans of renal arteries. Thus, data of 71 formalin-fixed kidneys (36 right and 35 left sides as in one cadaver left kidney were absent) and 72 renal arteries on computed tomographic scans (36 right and 36 left sides) was studied. Cadavers were studied in the Department of Anatomy of a teaching institute and CT scans data were obtained from the Department of Radiology of a tertiary care hospital.

The data (reports) of computed tomographic scans were taken retrospectively from the medical records on DVD. The various parameters were measured using digital imaging and communications in medicine (DICOM) viewer software.

In cadavers, after manual dissection, the length of the renal artery was measured from the level of origin to the hilum. However in cases, where the renal artery branched before the hilum, measurement was taken up to the first branch. These measurements were taken using divider and scale [Figure 1]. The internal diameter of the renal artery was measured at its origin. To measure this circumference of the vessel was taken by cutting it open [Figure 2] and using the formula (circumference = π × Diameter) the internal diameter was recorded. The vertical distance between the right renal artery at its origin and the point of bifurcation of the aorta was measured with the help of thread, divider, and scale. Similarly, the distance between the left renal artery at its origin and the point of bifurcation of the aorta was also measured [Figure 3]. The vertical distance between the site of origin of the right renal artery and the left renal artery was measured with the help of a thread, divider, and scale [Figure 4]. Similar parameters were measured in computed tomographic scans using tools in the DICOM viewer software [Figure 5], [Figure 6], [Figure 7], [Figure 8]. Furthermore, observation for accessory renal arteries was done in both cadaveric and CT studies, but since this parameter was not an objective of the present study the details of the same are excluded.
Figure 1: Illustration showing measurement of length of renal artery in cadaver

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Figure 2: Illustration showing measurement of internal circumference (diameter) of renal artery (placed on a graph paper) at its origin in cadaver

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Figure 3: Illustration showing measurement of vertical distance between site of origin of left renal artery and bifurcation of aorta in cadaver

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Figure 4: Illustration showing measurement of vertical distance between site of origin of right renal artery and left renal artery in cadaver

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Figure 5: Illustration showing measurement of length of renal artery in CT study

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Figure 6: Illustration showing measurement of internal diameter of renal artery at its origin in CT study

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Figure 7: Illustration showing measurement of vertical distance between site of origin of right renal artery and bifurcation of aorta in CT study

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Figure 8: Illustration showing measurement of vertical distance between site of origin of right renal artery and left renal artery in CT study

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Statistical analysis of the data was carried out to find out the mean and standard deviation in Microsoft excel.

Student's t-test (unpaired t-test) was used to determine the significance of the difference in the values between left and right renal arteries. The same test was applied to determine the significance of the difference between the values obtained in cadavers and CT study independently. (The value of “P” <0.05 was considered significant and >0.05 was considered not significant).


  Results Top


The following results were obtained:

Length of renal artery [Table 1]
Table 1: Length of renal artery

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On comparing the length of the renal arteries in cadavers with same in CT study, “P” value was 0.0017 (<0.05) for the right renal arteries. Similarly, on the left side, the “P” value was 0.00016 (<0.05).

Internal diameter of renal artery at its origin [Table 2]
Table 2: Internal diameter of renal artery at its origin

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On comparing the internal diameter of renal artery at its origin in cadavers with same in CT study, “P” value was 0.0011 (<0.05) for the right side. While on the left side, the “P” value was 0.0024 (<0.05) hence significant.

Vertical distance between the site of origin of the renal artery and bifurcation of the aorta [Table 3]
Table 3: Vertical distance between renal artery at origin and point of bifurcation of the aorta

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On comparing the values of the cadaveric study and CT study, the “P” value was 0.0003 for the right side and 0.0007 for the left side.

Vertical distance between the site of origin of the right renal artery and left renal artery [Table 4]
Table 4: Vertical distance between right and left renal artery

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On comparing the vertical distance between the site of origin of the right renal artery and left renal artery in cadavers and CT the “P” value was 0.012.

The accessory renal arteries were observed in 16 cadavers and 5 CT scans.


  Discussion Top


The various morphometric measurements of the renal artery are important for stenting and transplantation. These information are not only useful for planning but also for performing of endovascular and laparoscopic urological procedures, vascular operation for renal artery stenosis, uroradiological procedures and also for medical device development. These data can be useful in the development of new devices or techniques which may significantly increase the number of candidates for those promising therapeutic options in interpreting managing surgical approaches and diagnosing functional alterations.[4]

Length of renal artery

In cadaveric study, on comparison of the length of renal arteries of the right and left sides, the results of our study were found to be comparable with other similar studies in the literature [Table 5]a.[7],[8]


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In CT angiography, when the length of renal arteries of both sides was compared with other studies, the mean length of the renal artery in CT Angiogram was more than our study [Table 5]b.[4],[9],[10],[11] This difference could be due to the difference in the software used for measuring the vessels.

Furthermore, the comparison between the length of right and left renal arteries in cadavers and right and left renal arteries in CT studies, respectively showed a significant P value [Table 1]. This indicates that the mean length of the right renal artery was found to be significantly longer than the mean length of the left renal artery. This is probably due to the location of the abdominal aorta to the left of the median plane in the abdomen and the long path of the renal artery on the right side. Thus, the information regarding the variations between the right and left arterial length would help the surgeons in preventing undue accidents while operating in this region.

Internal diameter of renal artery at its origin

In cadaveric study, our findings of internal diameter are comparable with Vaghela et al.[7] and Saldarriaga et al.,[8] because they have measured the “diameter” of renal artery at its origin, whereas the findings of Shalini et al.,[6] did not match with our study, This could be because that in their cadaveric study the “width” of the artery was measured and there is no detailing given for the measurement [Table 6]a.[6],[7],[8]


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In the CT study, our findings did not match with any of the previous studies in the literature. This could be because of less sample size in our study or could be because of the software variability along with inter-observer difference [Table 6]b.[4],[9],[10],[11]

Even though our cadaveric study did not show any difference in the right and left diameter of the renal arteries, there was a difference of 0.04 cm in the diameter measured on CT [Table 2]. This is comparable with a similar study done by Sankaran et al.[4] and Turba et al.[12] This revealed that the left kidney can be more preferable for transplantation than the right.

Vertical distance between the site of origin of the renal artery and bifurcation of the aorta

In cadaveric study, the vertical distance between the site of origin of the renal artery and bifurcation of the aorta on the right side and the left side was compared with similar studies [Table 7].[13],[14] In both cadaveric and CT studies, the difference between the average vertical distance between the site of origin of the renal artery and bifurcation of the aorta on the right side and left side was statically not significant [Table 3].
Table 7: Comparison of the vertical distance between the site of origin of the renal artery and bifurcation of the aorta

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In the majority of the other similar studies (cadaveric and CT) this parameter is not considered, instead, most of them have measured the distance between the origin of the superior mesenteric artery and renal arteries. In his study, the distance of the renal artery from the bifurcation of the aorta was measured as it would help the radiologists with the data for easy access for catheterization during angiographic studies.

Vertical distance between the site of origin of the right renal artery and left renal artery

Although in most people right kidney sits in a lower position in the retroperitoneum than the left, data indicate that the right renal artery has a higher point of origin from the aorta than the left.[1]

However, in our study, we found that renal arteries of both sides originating at the same level in 16.6% of cases in cadavers and 33.3% of cases in CT study [Table 4]. This was similar to the dissection study done by Merklin and Michels on 185 autopsy kidneys. They have reported renal arteries of both sides originating at the same level in 30% of cases.[15] Furthermore, our results match with R. Shalini et al. who had done their study on 30 pairs of kidneys and reported that both-sided renal arteries originating at the same level in 46.6%.[6]


  Conclusion Top


The present study provides comprehensive data about the morphometry of renal arteries. It shows and supports the fact that renal arteries show diverse variations. The study provides cadaveric and CT values of renal artery morphometry for reference purposes in the Indian population. The significant difference seen after comparing the values obtained by the two groups (cadaver and CT) could be attributed to the software used which failed to give realistic values in addition to the subjective errors in calculating them. Probably, an increased study population would yield an actual comparable value.

Acknowledgment

  1. Dr. Pritha S Bhuiyan


  2. Professor and Head, Department of Anatomy, Seth G.SMC, Mumbai.

  3. Dean, Seth GSMC and KEMH, Mumbai


The authors also acknowledge the immense help received from the scholars whose articles are cited and included in references of this manuscript. The authors are also grateful to authors/editors/publishers of all those articles, journals, and books from where the literature for this article has been reviewed and discussed.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Mishall P. Renal arteries. In: Tubbs RS, Shoja MM, Loukas M, editors. Bergman's Comprehensive Encyclopedia of Human Anatomic Variation. United satates of America: John Wiley & Sons; 2016. p. 682-93.  Back to cited text no. 1
    
2.
Arévalo Pérez J, Gragera Torres F, Marín Toribio A, Koren Fernández L, Hayoun C, Daimiel Naranjo I. Angio CT assessment of anatomical variants in renal vasculature: Its importance in the living donor. Insights Imaging 2013;4:199-211.  Back to cited text no. 2
    
3.
Sasikala P, Sulochana S, Rajan T, Mohan J, Rajendran SM. Comparative study of anatomy of renal artery in correlation with the computed tomography angiogram. World J Med Sci 2013;8:300-5.  Back to cited text no. 3
    
4.
Sankaran PK, Karthikeyan G, Kumaresan M. Morphometric study of renal artery and its variations in level of origin. Natl J Clin Anat 2016;5:11.  Back to cited text no. 4
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5.
Ross JA, Samuel E, Millar DR. Variations in the renal vascular pedicle. (An anatomical and radiological study with particular reference to renal transplantation). Br J Urol 1961;33:478-85.  Back to cited text no. 5
    
6.
Shalini R, Manoranjitham R, Arunkumar KR, Ravivarman C. Comparative study of right and left renal arterial patterns in human cadavers. Int J Anat Res 2016;4:2312-5.  Back to cited text no. 6
    
7.
Vaghela BP, Parmar A, Trivedi BD. Study of morphology of renal artery in 50 human cadavers by dissection method in Ahmedabad district. Indian J Appl Res 2013;3:141-3.  Back to cited text no. 7
    
8.
Saldarriaga B, Pinto SA, Ballesteros LE. Morphological expression of the renal artery. A direct anatomical study in a Colombian half-caste population. Int J Morphol 2008;26:31-8.  Back to cited text no. 8
    
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Palmieri BJ, Petroianu A, Silva LC, Andrade LM, Alberti LR. Study of arterial pattern of 200 renal pedicle through angiotomography. Rev Col Bras Cir 2011;38:116-21.  Back to cited text no. 9
    
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Kapoor A, Mahajan G, Singh A, Sarin P. Multispiral computed tomographic angiography of renal arteries of live potential renal donars: A review of 118 case. Transplantation 2004;77:1535-9.  Back to cited text no. 10
    
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Mohiuddin M, Manzoor A, Ali M, Hassan N. Analysis of renal artery morphometery in adults: A study conducted by using multidetector computed tomography angiography. Pak J Med Sci 2017;33:943-7.  Back to cited text no. 11
    
12.
Turba UC, Uflacker R, Bozlar U, Hagspiel KD. Normal renal arterial anatomy assessed by multidetector CT angiography: Are there differences between men and women? Clin Anat 2009;22:236-42.  Back to cited text no. 12
    
13.
Kapildev M, Vimala V. Morphometric analysis of distance of origin of renal artery from bifurcation of abdominal aorta for interventional procedures. IOSR J Dent Med Sci (IOSR-JDMS) 2019;18:66-8.  Back to cited text no. 13
    
14.
Mane UW, Kulkarni YR. Anatomical study of abdominal aorta and its branches for multiple variations. Int J Anat Res 2016;4:2320-7.  Back to cited text no. 14
    
15.
Merklin RJ, Michels NA. The variant renal and suprarenal blood supply with data on the inferior phrenic, ureteral and gonadal arteries: A statistical analysis based on 185 dissections and review of the literature. J Int Coll Surg 1958;29:41-76.  Back to cited text no. 15
    


    Figures

  [Figure 1], [Figure 2], [Figure 3], [Figure 4], [Figure 5], [Figure 6], [Figure 7], [Figure 8]
 
 
    Tables

  [Table 1], [Table 2], [Table 3], [Table 4], [Table 5], [Table 6], [Table 7]



 

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