The University of Toledo Translation Journal of Medical Sciences 
Internal Medicine Abstract, Department of Medicine Research Symposium UTJMS 2023 May 05; 11(1):e1-e1 

Bilateral Accessory (Aberrant) Renal 
Arteries Associated With Uncontrolled 
Hypertension—Role of Renin-Angiotensin-
Aldosterone Antagonist Drugs for 
Treatment Goal: A Case Report 

Basil Akpunonu1*, J. Hummell1, J. Akpunonu1, C. Mbaso1, B. Tasma1, H. Elsamaloty2 

1Division of Internal Medicine, Department of Medicine, The University of Toledo, 
Toledo, OH 43614 
2Department of Radiology, The University of Toledo, Toledo, OH 43614 

*Corresponding author: Basil.Akpunonu@utoledo.edu

Published: 05 May 2023 

Introduction: Accessory (aberrant) renal arteries (ARAs) are extra vessels that supply the kidneys in 
addition to the usual single arteries. They typically arise from the abdominal aorta but can also originate 
from other abdominal/pelvic arterial systems. They can be seen in up to 30% of adults, can complicate 
various urological, abdominal surgery, interventional radiological, and transplantation procedures.   

Case Report: A 49-year-old woman had developed elevated blood pressure during her previous 
pregnancies, and hypertension persisted after pregnancy. Angiotensin- converting enzyme (ACE) 
inhibitors and angiotensin receptor blockers (ARB) could not be used at the time because of teratogenic 
considerations. Antihypertensive drugs as calcium channel antagonists, beta-blockers, direct 
vasodilators, and thiazide-based diuretics did not control the blood pressure to goal. Renal Doppler 
studies showed a slight increase in peak velocity on the right renal artery. A computed tomographic 
angiography (CTA) and magnetic resonance angiography (MRA) showed accessory renal arteries in 
both the right and left kidneys. Laboratory tests showed persistent hypokalemia and plasma renin 
activity was significantly elevated. The addition of Losartan 100 mg daily and Spironolactone 50 mg 
daily was needed to get blood pressure to goal.  

Conclusion: Accessory renal arteries could lead to perfusion abnormalities, contribute to or exacerbate 
maintenance and control of blood pressure. Drugs affecting the renin-angiotensin-aldosterone pathway 
are important in the treatment of patients with accessory (aberrant) renal arteries if hypertension is renin 
mediated. 

https://dx.doi.org/10.46570/utjms.vol11-2023-669 

https://dx.doi.org/10.46570/utjms.vol11-2023-669
mailto:Basil.Akpunonu@utoledo.edu