Multiple renal arteries

Last revised by Arlene Campos on 10 Feb 2025

Multiple renal arteries, also known as additional or accessory renal arteries, are a common variant of the renal arteries.

Various terms have been proposed to describe supernumerary renal arteries, although there is no consensus 6,8,9:

  • multiple renal arteries

    • may be preferred as these are end-arteries, equivalent to a segmental branch of a single artery, and thus are the sole supply of a renal segment

    • most commonly used term in the literature 8

  • additional renal artery

    • arises from the abdominal aorta and enters the kidney

    • second most commonly used term in the literature

  • multiple renal artery

    • enter the kidney via the renal hilum

      • main renal artery: largest hilar artery

      • hilar supplemental artery: smaller hilar artery

    • third most commonly used term in the literature 8

  • supplementary renal artery

  • aberrant/extrahilar/perforated renal artery: enter kidney elsewhere, but at the renal hilum 8

    • superior/inferior polar artery: enters at the superior/inferior renal pole

      • solitary

      • pedicular: accompanied by polar vein and nerve plexus

      • false supernumerary: replaces a segmental artery

      • true supernumerary: does not replace a segmental artery

Multiple renal arteries are present in ~25% (range 20-30%) of the population 1,8,9 although has considerable regional variation being reported to be more common in White and African populations, and less common in Indian and Chinese populations 8. There appears to be no gender predilection 8.

Multiple renal arteries can occur unilaterally with no clear side predilection 8 and they occur bilaterally in 10-15% of cases 1.

A single supernumerary renal artery is most prevalent (~15%; range 9-22%) although two supernumerary renal arteries are also common (~5%; range 3-7%) with 3 or more uncommon (<1-2%) 8,9.

Supernumerary arteries most commonly arise from the abdominal aorta and rarely from a wide number of other arteries 8.

Supernumerary renal arteries most common enter the kidney at the hilum (~60%) followed by the inferior pole (~30%) then superior pole (~10%) 8.

The first recorded case of multiple renal arteries was described by Eustachius in the sixteenth century 7,8.

Accurate identification is of utmost importance for surgical planning prior to live donor transplantation 2,3 and renal artery embolization for various reasons 4,5.

Cases and figures

  • Figure 1: illustration
  • Case 1: MRA
  • Case 2: causing PUJ obstruciton
  • Case 3: bilateral accessory
  • Case 4: with aortic aneurysm
  • Case 5
  • Case 6: bilateral
  • Case 7: bilateral variants
  • Case 8: triple right renal arteries
  • Case 9: bilateral
  • Case 10: precaval accessory right renal artery
  • Case 11: aberrant extra renal artery and vein arising from common iliac vessels
:

Updating… Please wait.

 Unable to process the form. Check for errors and try again.

 Thank you for updating your details.