Renal Artery Anatomy and Variations

The renal arteries typically arise from the lateral aspects of the abdominal aorta at the level of the first lumbar vertebra, each entering the hilum of its respective kidney. Upon approach to the renal hilum, the main renal artery divides into segmental branches that supply specific renal segments, ensuring a distinct end-arterial pattern without significant collateral flow. Variations in this classical anatomy occur in approximately 30 percent of individuals and encompass multiple renal arteries, early arterial branching, accessory arteries and polar vessels. Multiple renal arteries arise when more than one mesonephric artery persists during development, leading to double or triple arterial supplies. Early branching, often termed “short renal arteries”, refers to an initial bifurcation occurring within 1.5 centimetres of the aortic origin. Accessory renal arteries commonly enter at the hilum or directly into the renal parenchyma and may arise from the aorta, iliac vessels or other adjacent arteries. Polar arteries, either superior or inferior, supply the respective poles of the kidney and may have clinical implications for segmental perfusion. Embryologically, these variations trace to the sequential degeneration and persistence of mesonephric vessels, and their recognition is vital for surgical planning in procedures such as nephrectomy, renal transplantation and endovascular interventions. Preoperative imaging with multidetector computed tomography angiography has improved detection of these variants, reducing intraoperative surprises and improving outcomes. An in-depth understanding of renal arterial anatomy and its myriad variations is therefore essential for urologists, transplant surgeons and interventional radiologists, as well as for anatomists and clinicians engaged in renal pathology and surgery worldwide.

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Renal Artery Anatomy and Variations publication trend

The graph below shows the total number of articles in renal artery anatomy and variations across all publications each year (not limited to Nature Index journals).

Technical terms

Renal artery: Major vessel supplying arterial blood from the aorta to the kidney.

Accessory renal artery: An additional artery arising independently of the main renal artery, supplying the kidney.

Multiple renal arteries: Condition in which two or more arteries supply a single kidney.

Early branching: Division of the main renal artery within 1.5 cm of its aortic origin.

Polar artery: A vessel (superior or inferior) that supplies the upper or lower pole of the kidney.

MDCT angiography: Multidetector computed tomography technique used to visualise vascular structures non-invasively.

References

1. Angio CT assessment of anatomical variants in renal vasculature: its importance in the living donor. Insights into Imaging (2013).
2. Multidetector computed tomography angiography of the renal arteries: normal anatomy and its variations*. Radiologia Brasileira (2016).
3. Prevalence and Relevance of Multiple Renal Arteries: A Radioanatomical Perspective. Cureus (2021).
4. Does the type of renal artery anatomic variant determine the diameter of the main vessel supplying a kidney? A study based on CT data with a particular focus on the presence of multiple renal arteries. Surgical and Radiologic Anatomy (2017).
5. The prevalence of accessory renal arteries in sudanese population in Khartoum State: a cross-sectional CT study from 2017 to 2020. BMC Nephrology (2024).