Renal ectopic blood vessels and accessory blood vessels

　　1. Etiology

　　The renal artery originates from three groups of primary vascular sheaths, which fuse to form a complete vascular system that provides blood for retroperitoneal structures. The cranial group includes two pairs of arteries that transition away from the adrenal glands to form the phrenic artery. The middle group includes three pairs of vessels that enter the renal upper pole region and run laterally to form the adrenal artery. The caudal group consists of four arteries that form the renal artery. During the migration of the kidney, these vascular networks selectively regress, and the remaining vessels gradually form the main trunk. The arteries at the upper and lower poles of the kidney and the polycystic malformations are due to incomplete regression.

　　2. Pathogenesis

　　Multiple, wandering, and accessory blood vessels compressing a small calyx, a large calyx, or the renal pelvis-ureteral junction can cause hydronephrosis, urinary tract infection, and calculus formation, resulting in corresponding pain or hematuria. The entanglement and compression of the inferior renal artery on the renal vein can lead to orthostatic proteinuria. The occurrence of hypertension is no different from that of normal blood supply. There are two views on the mechanism of ureteral obstruction caused by ectopic blood vessels: ① Mayo, Quinby, and others believe that it is caused by the crossing of ectopic blood vessels and ureters; ② Hinman, Legeu, Geraghty, and others believe that it is caused by the ureter crossing over the ectopic blood vessel when the kidney is ptotic, leading to obstruction. Both situations can be seen in clinical practice, and obstruction, hydronephrosis, and ptosis form a vicious cycle.

　　The symptoms of renal vascular malformations mainly come from hydronephrosis, infection, and calculus due to poor urine drainage. The symptoms of ureteral obstruction begin in childhood, but due to insufficient understanding, their significance has not been emphasized until severe complications requiring surgical treatment are discovered. The symptoms of ureteral obstruction are the same as those of hydronephrosis. Therefore, clinically, they can mainly cause urinary tract infections, as well as complications such as urinary tract calculi and septicemia.

　　The symptoms of renal vascular malformations are mainly from hydronephrosis, infection, and calculus caused by poor urine drainage.

　　The symptoms of ureteral obstruction begin in childhood, but due to insufficient understanding, its significance has not been paid attention to until severe complications require surgical treatment and are discovered. The symptoms of ureteral obstruction are the same as those of hydronephrosis. When hydronephrosis occurs, the pressure inside the kidney increases, so back pain is the most common, and occasionally severe colic may occur due to edema or acute obstruction. During acute onset, fever and vomiting may occur, which are easy to be misdiagnosed as appendicitis. Urinary frequency is a reflex symptom. If there is infection, symptoms such as urethral burning, difficulty in urination, hematuria, and other symptoms may occur.

　　Due to obstruction and urine retention, the treatment effect is not good, and it evolves into 'chronic pyelonephritis'. During acute obstruction, infection intensifies, and it is often diagnosed as 'acute pyelonephritis', actually the pathological change is 'acute pyonephrosis'. The cause of hematuria is renal congestion or secondary infection. Infection is often accompanied by low-grade fever and gastrointestinal disorders, such as anorexia, nausea, vomiting, indigestion, chronic gastritis, constipation, diarrhea, weight loss, anemia, and other symptoms, so adult infectious hydronephrosis is often misdiagnosed as peptic ulcer or cholecystitis and other diseases.

　　Due to renal insufficiency, toxins are absorbed, urinary tract infection, systemic symptoms such as headache and gastrointestinal disorders can occur, such as toxicosis, while a healthy kidney can still support, but if there is obstruction on both sides, or if there is obstruction on one side and the contralateral kidney is absent, underdeveloped, or damaged by toxicosis, symptoms of azotemia appear. When the kidney is completely or almost completely destroyed, the patient may become unconscious and unaware.

　　The etiology of this disease is unclear, and it is related to autosomal recessive inheritance, usually associated with marriage between close relatives, and this disease cannot be prevented directly. For patients with a suspected family history of chromosomal abnormalities, genetic screening should be performed to avoid offspring suffering from the disease due to chromosomal inheritance after marriage. At the same time, attention should be paid to strengthening prenatal nutrition, rational diet, and avoiding adverse stimuli that affect embryo development, such as emotional excitement.

　　When the following manifestations are present in intravenous urography, it is suspected that there is renal vascular abnormality:

　　1. Renal pelvis filling defect is consistent with abnormal blood vessel conditions

　　2. Renal hydronephrosis with sharp termination of the upper renal calyx indentation

　　3. Obstruction at the junction of the renal pelvis and ureter

　　4. There are differences in the time of contrast medium concentration in the renal segment or the whole kidney (especially when there is hypertension), and ectopic renal arteries refer to renal arteries that do not originate from the abdominal aorta, often accompanied by renal position abnormalities and renal fusion, such as ectopic kidneys and horseshoe kidneys, originating from the nearby major artery trunk, selective renal artery angiography can show multiple vascular malformations.

　　1. What kind of food is good for the body for patients with ectopic renal arteries and accessory arteries

　　Eat light, easy-to-digest foods, fresh vegetables, and moderate amounts of fruit, drink appropriate amounts of water. Pay attention to the balance of dietary nutrition.

　　2. Foods to avoid for renal ectopic arteries and accessory arteries

　　Avoid overeating and eating unclean food. Avoid seafood, beef, mutton, spicy刺激性 food, alcohol, and all kinds of things that cause heat: five-spice powder, coffee, coriander, etc. Avoid all tonics, tonics, and easily overheating foods such as chili, ganmao, chocolate, etc.

　　(The above information is for reference only, please consult a doctor for details.)

　　1. Treatment

　　The treatment of ectopic vessel obstruction of the ureter is mainly surgical. Methods such as medication, corset, ureteral dilation, and pelvicalyceal lavage cannot be effective. As to which kind of surgery to adopt, it needs to be decided based on the findings of exploration. During surgery, it is required to expose the kidney's blood supply clearly, and reveal the causes of obstruction such as ureteral stricture, perirenal fibrosis, ureteral entanglement, and stones. If most of the renal parenchyma is healthy, even with mild inflammation, conservative surgery should be adopted as much as possible. If the contralateral kidney is absent or severely damaged, the kidney should be preserved, and nephrostomy should be performed. In emergency surgery, when the renal function of the contralateral kidney is unknown, nephrostomy is also an appropriate measure. After the renal stent is drained for several days or weeks, renal function improves, infection decreases, and it is possible to perform necessary and possible surgery.

　　If the ectopic vessel is a vein, it can be cut to relieve obstruction, as the kidney has a rich collateral circulation, so it will not cause damage. If the ectopic vessel is an artery, compress this artery during surgery and observe the range of change in renal cortex color. If the range of color change is small, this artery can be cut. If the color change affects more than 1/4 of the renal parenchyma, cutting the artery after surgery may lead to renal atrophy and necrosis, and it is best to adopt other surgical methods that avoid this artery (such as ureteropelvic ostomy, pelvioplasty, renal high fixation, ureteroplasty, etc.). If X-ray examination suggests the presence of stones, polyps, or valves, then the pelvis needs to be incised and explored for necessary treatment. After the cause of obstruction is removed, there should be no urinary retention.

　　2. Prognosis

　　Renal vascular malformations do not increase the susceptibility of the kidneys to diseases, and hydronephrosis secondary to vascular abnormalities is actually very rare. Multiple vascular abnormalities will not induce hypertension.