Kidney auto-transplantation in a 7-year-old with complex renal artery anatomy and multi-drug-resistant hypertension: a case report

Abstract

Introduction

There are numerous surgical techniques used for revascularization in the setting of renal artery stenosis in children, although formal guidelines do not exist and “standard of care” is dictated by center experience.

Case presentation

We present a case of a 7-year-old male with multi-drug-resistant hypertension in the setting of complex renal artery anatomy. His genetic testing was unrevealing for congenital aortopathies, and his clinical history was not suggestive of vasculitis or other inflammatory conditions. Computerized tomography angiogram (CTA) demonstrated two main renal arteries on the right, both with high grade, proximal stenosis, and on the left his main renal artery was occluded, with robust collateral filling. Nuclear function testing of the left kidney demonstrated <10 % function. The patient initially underwent an aorto-renal bypass using hypogastric artery; however, the bypass became occluded on post operative day four. To salvage the kidney, the patient underwent an auto-transplantation into the pelvis using a syndactylization technique to salvage both right renal arteries. He recovered well and is slowly weaning his anti-hypertensives at his last visit, 9 months post-operative.

Conclusion

Auto-transplantation can be a useful method to surgically manage complex renal artery stenosis, and salvage failed prior repairs.