A physician-validated, board-style question from the Active Transport QBank. Try it, then check the reasoning for every option.
A 40-year-old man presents with flank pain and hematuria. He has a history of hypertension but no prior surgeries. A CT scan reveals multiple accessory renal arteries supplying the lower pole of the right kidney. Which complication is this anatomical variation most likely to cause?
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A
Bladder outlet obstruction due to urethral strictureIncorrect. Urethral stricture is not caused by accessory renal arteries and is anatomically unrelated.
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B
Chronic pyelonephritis from vesicoureteral refluxIncorrect. Vesicoureteral reflux arises from defective ureterovesical junction, not aberrant renal arteries.
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C
Polycystic kidney disease causing renal enlargementIncorrect. Polycystic kidney disease is genetic (PKD1/PKD2), unrelated to accessory artery anatomy.
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D
Renal artery stenosis resulting in hypertensionIncorrect. Renal artery stenosis with hypertension involves the main renal artery, not crossing accessory vessels.
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E
Ureteropelvic junction obstruction leading to hydronephrosisCorrect. Lower-pole accessory renal arteries can cross and compress the UPJ, producing obstruction and hydronephrosis.
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Answer: E. The presence of multiple accessory renal arteries can lead to compression at the ureteropelvic junction, causing obstruction and subsequent hydronephrosis. The key detail is the location and number of accessory arteries, which are known to impinge on the ureter at the junction, unlike renal artery stenosis or polycystic kidney disease, which would present differently.