NBME 22 Anomalous origins of multiple renal arteries to each kidney (NBME Answers)

Retired NBME 22 Answers

nbme22/Block 4/Question#19 (reveal difficulty score)
A 76-year-old man with a 1-month history of a ...
Anomalous origins of multiple renal arteries to each kidney 🔍 / 📺 / 🌳 / 📖
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+11 upvote downvote
submitted by ∗almondbreeze(110)

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a good pic showing anomalous arteries in horseshoe kidney

https://www.researchgate.net/figure/A-case-of-horseshoe-kidney-with-accessory-renal-arteries-Posterior-aspect-of-the_fig1_313729399

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+6 upvote downvote
submitted by ∗aesalmon(95)

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Those arteries go wherever they want - off the Aorta, common iliacs, wherever. Only 2 ureters tho

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+1 upvote downvote
submitted by ∗niboonsh(409)

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https://www.ncbi.nlm.nih.gov/pubmed/15599631 The horseshoe kidney was detected before surgery in 12 patients (80%) by ultrasonography, angiography, computed tomography (CT) or excretory urography. Angiography revealed multiple or anomalous renal arteries in 8 of 12 patients studied preoperatively

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+1 upvote downvote
submitted by ∗j000(17)

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AAA is usually below renal arteries and above bifurcation (pathoma)

the kidneys are stuck at IMA level (IMA is normally below renal arteries and above bifurcation)

so when repairing AAA in a patient with horseshoe kidney, it is complicated by the fact that renal arteries are lower than normal... in the area where AAA usually occurs

anomalous origins of renal arteries = instead of being higher up, it is stuck at IMA level

hope that helps

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+0 upvote downvote
submitted by ∗nwinkelmann(366)

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Can someone explain how to rule out the other answer choicers?

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warbyparker1 you can r/o SMA because as kidneys ascend they get stuck low in the INFERIOR MA (L3 level). So I guess there should be no problem w SMA +3

hello I think friability of vascular tissue would indicate in inflammatory process (the one I can think of is strawberry cervix) -- so i think that's why you can rule out choice C. +2

avocadotoast You can rule out multiple ureters with abnormal courses because the ureteral development relies on the ureteric bud. There will multiple ureters if the ureteric bud divides before it comes in contact with the metanephric blastema. Horseshoe kidneys are simply due to fusion of the lower poles and don't involve the embryonic tissues, so those two processes are not likely related. +1

chaosawaits FA2019, p567: horseshoe kidneys function normally and rarely cause cancer +

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