Renal ectopic blood vessels and accessory blood vessels
Introduction
Introduction of renal ectopic blood vessels and accessory blood vessels 85% of the kidneys have a renal artery. According to the distribution of blood supply, the renal parenchyma is divided into 5 segments: the top segment, the upper segment, the middle segment, the lower segment and the posterior segment. Each segment is supplied by a single blood vessel originating from the main renal artery. The main artery of the renal artery is initially divided into two groups, the front branch is supplied to the upper, middle and lower segments, and the posterior branch is supplied to the posterior segment. basic knowledge The proportion of illness: 0.001% Susceptible people: no special people Mode of infection: non-infectious Complications: urinary tract obstruction
Cause
Renal ectopic vascular and accessory vascular causes
(1) Causes of the disease
The renal artery originates from three groups of primitive vascular sheaths, which fuse to form intact blood vessels to provide blood for the retroperitoneal structure. The cephalic group consists of two pairs of arterial dorsal adrenal glands that form the radial artery, and the middle group includes three pairs of blood vessels that enter the suprarenal region. Lateral movements form the adrenal artery, and the four arteries in the caudal group form the renal artery. These vascular networks are selectively degraded during the migration of the kidney, and the remaining blood vessels gradually form the trunk, and the upper and lower arteries and polyarterial malformations of the kidney It is due to incomplete degradation.
(two) pathogenesis
Multiple, vagus and additional blood vessels compress a small fistula, a large fistula or pelvic ureteral junction causes hydronephrosis, urinary tract infections and stone formation, resulting in corresponding pain or hematuria, lower extremity renal artery entanglement and compression There may be erectile proteinuria in the renal vein. There is no difference between the occurrence of hypertension and the normal blood supply. There are two views on the principle of ectopic vascular obstruction caused by ectopic blood vessels: 1 Mayo, Quinby, etc. are considered to be caused by the intersection of ectopic blood vessels and ureters; 2Hinman, Legeu, Geraghty, etc. believe that the ureteral straddles over the ectopic blood vessels and causes obstruction when the kidney is drooping. Both cases are clinically seen, obstruction, hydronephrosis and renal ptosis form a vicious circle.
Prevention
Renal ectopic vascular and accessory vascular prevention
There is no effective preventive measure for this disease. Early detection and early diagnosis are the key to the prevention and treatment of this disease.
Complication
Renal ectopic vascular and accessory vascular complications Complications, urinary tract obstruction
The main complications of renal ectopic blood vessels include urinary tract obstruction, infection and stones.
Symptom
Renal vascular and paravascular symptoms Common symptoms Urinary tract infection ureteral obstruction Diarrhea nausea urinary edema Renal vascular malformation coma
The symptoms of renal vascular malformation are mainly caused by hydronephrosis, infection, and stones caused by poor drainage of urine.
Symptoms of ureteral obstruction begin at an early age, but because of insufficient knowledge, its significance has not been taken seriously, until severe complications require surgical treatment, the symptoms of ureteral obstruction are symptoms of hydronephrosis, when hydronephrosis, Increased intra-renal pressure, so the waist is the most common, occasional edema or acute obstruction and severe cramps, acute exacerbation with fever and vomiting, easily misdiagnosed as appendicitis, frequent urination is a reflex symptom, if there is infection Urethral burning, dysuria, hematuria and other symptoms.
Due to obstruction and urinary retention, the treatment effect is not good, but evolved into "chronic pyelonephritis", the infection is aggravated in acute obstruction, often diagnosed as "acute pyelonephritis", in fact the pathological change is "acute renal empyema", hematuria The cause is renal congestion or secondary infection, often with low fever and gastrointestinal disorders, such as anorexia, nausea, vomiting, indigestion, chronic gastritis, constipation, diarrhea, weight loss, anemia, etc. Adult infectious hydronephrosis is often misdiagnosed as ulcer disease or cholecystitis.
Due to renal insufficiency, toxins are absorbed, urinary tract infections can produce systemic symptoms of toxemia such as headache, gastrointestinal disorders, etc., a healthy kidney can still support, but if there are obstructions on both sides, or if there is obstruction on one side, If the lateral kidney is absent, dysplasia or toxemia damage, there are symptoms of azotemia. When the kidney is completely destroyed or almost completely destroyed, the patient is unconscious and unconscious.
Examine
Renal ectopic blood vessels and accessory blood vessels
Intravenous urography has suspicious renal vascular abnormalities in the following manifestations:
1. The renal pelvic filling defect is consistent with the abnormal vascular condition.
2. Hydronephrosis with sharply terminated superior infundibulum.
3. Obstruction of the pelvis and ureter junction.
4. There is a difference between the time of development of a kidney segment or whole kidney and the concentration of contrast agent (especially when there is hypertension). The ectopic vascular refers to the renal artery does not start in the abdominal aorta, and is often accompanied by abnormal renal position and kidney. Fusion, such as ectopic kidney and horseshoe kidney, originates from the nearby aorta, and selective renal angiography can show multiple vascular malformations.
Diagnosis
Diagnostic identification of renal ectopic blood vessels and accessory blood vessels
Renal ectopic blood vessels have no typical symptoms, and their clinical symptoms come from combined urinary tract obstruction, infection or calculus. The diagnosis should be based on imaging examination.
Differential diagnosis
1. The inferior vena cava ureter can also cause upper ureteral obstruction and ureter and hydronephrosis, but the obstruction is caused by vena cava compression of the ureter, not the ureter itself, IVU examination shows renal pelvis and upper ureter dilatation, ureter "S" shape, and shift to the midline, if the IVU results are not satisfactory, retrograde angiography can help to confirm the diagnosis.
2. Ureteral calculi can also cause ureteral obstruction and stagnant water. It needs to be differentiated from renal vascular ectopic phase. There are many cases of paroxysmal cramps and hematuria in ureteral stones. X-ray plain films can be seen on the ureteral stroke with opaque shadows, IVU and Retrograde angiography showed ureter and hydronephrosis above the stone obstruction. The obstruction site was cup-shaped. The negative stones had filling defects in the obstruction site. CT examination was helpful for the diagnosis of negative stones.
3. Ureteral tuberculosis ureter tuberculosis can cause ureteral stricture due to ureteral tuberculosis, but ureteral tuberculosis is rarely primary, secondary to renal tuberculosis, early systemic symptoms of tuberculosis, such as loss of appetite, weight loss, night sweats, low fever Etc., and urinary frequency, urgency, dysuria and other bladder irritation symptoms, B-ultrasound, IVU or retrograde urography in addition to showing renal ureteral hydrops, but also pelvic and renal pelvis destruction and void, ureter is bead-like stenosis changes The tube wall is stiff and the surface is not smooth.
4. Ureteral tumor ureteral tumor can cause ureteral obstruction, causing ureteral dilatation above the tumor, hydronephrosis, but clinically with intermittent painless gross hematuria as the main performance, tumor cells in urine positive, IVU and retrograde urography The ureteral lumen is narrow, with a filling defect inside, and the expansion below is a cup-shaped change.
