Unilateral Quadrifurcation of Renal Artery: a Rare Variation and Its Clinical Implications

Introduction: Renal transplantation has become the treatment of choice for most patients with end-stage renal disease. This involves recovering the kidney along with adequate vessel length from the donor and implanting it into the recipient anastomosing all vessels diligently. Usually “single renal artery kidneys” are preferred. However with the ever increasing waiting list of patients needing kidney transplants, kidneys with multiple arteries supplying it, are also used for transplant purposes. Case study: During routine dissection of an adult male cadaver by medical students, the aorta and right renal artery showed variations. Result: The right renal artery was observed to be quadrifurcating into inferior phrenic, inferior suprarenal and two duplicate renal arteries. There was no middle suprarenal artery and the branches of renal artery or their branches were the sole arterial supply to the suprarenal gland. No variations were observed in the branching pattern of the left renal artery. Discussion: Precise knowledge of renal arterial supply and associated variations is critical for success of renal surgeries as well as to avoid complications. Present article discusses the details of the rare hitherto unreported variation of “quadrifurcation of renal artery”, its possible embryological explanation and its clinical implications from point of view of renal surgeries.