Where are the renal arteries located?

Anatomical Location of Renal Arteries

The renal arteries typically originate from the abdominal aorta between the upper margin of L1 and lower margin of L2 vertebra, with the most common location being at the L1-L2 intervertebral disc level. 1

Normal Anatomical Position

• The renal arteries are a pair of lateral branches arising from the abdominal aorta, just below the origin of the superior mesenteric artery at the L2 vertebral level 2
• The right renal artery is typically longer than the left due to the position of the aorta on the left side of the vertebral column 2
• The left renal artery often originates slightly higher than the right renal artery 3
• In 98% of patients, the main renal arteries originate from the aorta between the upper margin of L1 and lower margin of L2 vertebra 1

Relationship to Other Vascular Structures

• The renal arteries arise from the lateral aspect of the abdominal aorta, below the origin of the superior mesenteric artery 2
• The renal veins are located anterior to the renal arteries, with the left renal vein being approximately three times longer than the right 2
• The left renal vein passes in front of the abdominal aorta to join the inferior vena cava 2
• The renal arteries are positioned above the renal veins in the vascular pedicle of the kidney 2

Common Variations

• A single renal artery supplying each kidney is present in approximately 76% of individuals 1
• Multiple renal arteries (variations from the typical single artery per kidney) occur in about 24% of cases 1
• Bilateral multiple renal arteries are found in approximately 5% of individuals 1
• Additional renal arteries are more common on the right side (16%) compared to the left side (13%) 1
• Extra renal arteries can be classified as either accessory (entering through the hilum) or aberrant (entering directly into the kidney parenchyma outside the hilum) 2, 1

Clinical Significance

• Understanding the precise location and variations of renal arteries is crucial for:

  • Renal transplantation and kidney retrieval surgeries 2
  • Evaluation and management of renovascular hypertension 1
  • Diagnosis and treatment of renal artery stenosis 4
  • Surgical planning for abdominal aortic aneurysm repair 4
  • Interpretation of imaging studies such as CT angiography and MR angiography 4

• Awareness of potential variations is particularly important when:

  • Performing non-invasive diagnostic evaluation for renal artery stenosis 1
  • Planning surgical procedures involving the renal arteries 1
  • Evaluating potential kidney donors for transplantation 2
  • Interpreting vascular imaging studies of the abdomen 4

Imaging Considerations

• CT angiography and MR angiography are excellent modalities for visualizing renal artery anatomy 4
• When evaluating renal arteries with imaging, practitioners should be knowledgeable about:
  • Normal anatomy and common variations such as accessory renal branches 4
  • Various etiologies of renal artery disease including atherosclerosis, fibromuscular dysplasia, aneurysms, and thrombosis 4
  • Relationship between renal arteries and surrounding structures 4