A 9-year-old girl with a single dysplastic kidney and chronic kidney disease presented to the hospital to undergo transplantation of a kidney from a deceased donor. During preparation of the kidney for transplantation, the donor kidney was found to have five renal arteries.
During fetal development, multiple mesonephric arteries supply blood to the kidney. Typically, one mesonephric artery persists to become the renal artery; the persistence of multiple mesonephric arteries can lead to multiple renal arteries. Although two renal arteries is a common anatomical variant, three or more arteries in a single kidney is less common. Kidneys with multiple arteries are more technically challenging to transplant and are associated with an increased risk of vascular complications. The risks of such complications may be greater in children, who have smaller blood vessels. For these reasons, transplantation was deferred in the young patient, and the donor kidney was transplanted into a 35-year-old man. At 3 years after transplantation, the adult recipient of the kidney was clinically well, with a serum creatinine level of 1.0 mg per deciliter (88 μmol per liter; reference range, 0.7 to 1.2 mg per deciliter [59 to 104 μmol per liter]). The child underwent live-donor kidney transplantation 18 months after the originally scheduled date. At the 2-year follow-up, she was also clinically well, with a serum creatinine level of 0.9 mg per deciliter (76 μmol per liter; pediatric reference range for age, 0.4 to 0.8 mg per deciliter [36 to 67 μmol per liter]).