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At the time the article was created Omar Bashir had no recorded disclosures.View Omar Bashir's current disclosures
At the time the article was last revised Craig Hacking had the following disclosures:
- Philips Australia, Paid speaker at Philips Spectral CT events (ongoing)
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The renal arteries originate from the abdominal aorta and enter the renal hila to supply the kidneys. Any variant in arterial supply is important to clinicians undertaking surgery or other interventional renal procedures.
They arise from the lateral surface of the abdominal aorta at the L1-2 vertebral body level, inferior to the origin of the superior mesenteric artery.
The right renal artery courses inferior and obliquely, passing posterior to the IVC and the right renal vein to reach the renal hilum. The left renal artery is much shorter and arises slightly more superior to the right main renal artery. The left renal artery courses more horizontally, posterior to the left renal vein to enter the renal hilum. Renal arteries are between 4-6 cm in length and usually 5-6 mm in diameter.
Each renal artery gives off small branches in its proximal course, prior to dividing into dorsal and ventral rami. These branches are very small and often not visible on imaging studies:
The dorsal and ventral rami divide into segmental branches within the renal hilum before entering the parenchyma: apical, anterior superior, anterior inferior (middle), inferior and posterior segmental renal arteries. These then divide into lobar branches which successively branch into interlobar, arcuate, and interlobular arteries. The afferent arterioles, which supply the glomeruli, originate from the interlobular arteries.
can be technically difficult and only completed in 60% of patients
normal peak systolic velocity is 150-180 cm/s and elevation beyond this may indicate renal artery stenosis of >60% 4
normal renal arterial resistive index (RI) is ≈ 0.60
common; occur in ~30% of the population, bilateral in ~10%
enter the renal hilum
may arise from the aorta below (more commonly) or above the renal artery
termed aberrant renal arteries when they enter renal capsule in the upper or lower pole rather than the hilum
early-branching (or prehilar branching): occurs in ~10% of the population
occurs within 1.5-2.0 cm of origin in the left renal artery or in the retrocaval segment of the right renal artery
important to recognize in renal transplant for successful anastomoses
precaval course (see case 6)