Renal artery

Renal artery
Renal arteries branching left and right from the aorta (in red)
Details
SourceAbdominal aorta
BranchesInferior suprarenal artery, segmental arteries
VeinRenal vein
SuppliesKidneys
Identifiers
LatinArteria renalis
MeSHD012077
TA98A12.2.12.075
TA24269
FMA14751
Anatomical terminology

The renal arteries are paired arteries that supply the kidneys with blood. Each is directed across the crus of the diaphragm, so as to form nearly a right angle.

The renal arteries carry a large portion of total blood flow to the kidneys. Up to a third of total cardiac output can pass through the renal arteries to be filtered by the kidneys.

Structure

The renal arteries normally arise at a 90° angle off of the left interior side of the abdominal aorta, immediately below the superior mesenteric artery.[1] They have a radius of approximately 0.25 cm,[2] 0.26 cm at the root.[3] The measured mean diameter can differ depending on the imaging method used. For example, the diameter was found to be 5.04 ± 0.74 mm using ultrasound but 5.68 ± 1.19 mm using angiography.[4][5]

Due to the anatomical position of the aorta, the inferior vena cava, and the kidneys, the right renal artery is normally longer than the left renal artery.[1][6]

Branches

Before reaching the hilus of the kidney, each artery divides into four or five branches. The anterior branches (the upper, middle, lower and apical segmental arteries) lie between the renal vein and ureter, the vein being in front, the ureter behind. The posterior branches, which are fewer in number and include the posterior segmental artery, are usually situated behind the ureter.[7]

Each vessel gives off some small inferior suprarenal branches to the suprarenal gland, the ureter, and the surrounding cellular tissue and muscles.

One or two accessory renal arteries are frequently found, especially on the left side since they usually arise from the aorta, and may come off above (more common) or below the main artery. Instead of entering the kidney at the hilus, they usually pierce the upper or lower part of the organ.

Variation

The arterial supply of the kidneys is variable and there may be one or more renal arteries supplying each kidney.[1] It is located above the renal vein. Supernumerary renal arteries (two or more arteries to a single kidney) are the most common renovascular anomaly, occurrence ranging from 25% to 40% of kidneys.[8] Aberrant renal arteries may be present, and may complicate surgical procedures.[9]

Clinical significance

Stenosis

Renal artery stenosis, or narrowing of one or both renal arteries will lead to hypertension as the affected kidneys release renin to increase blood pressure to preserve perfusion to the kidneys. RAS is typically diagnosed with duplex ultrasonography of the renal arteries. It is treated with the use of balloon angioplasty and stents, if necessary.

Atherosclerosis

Atherosclerosis can also affect the renal arteries and can lead to poor perfusion of the kidneys leading to reduced kidney function and, possibly, renal failure.

Trauma

A renal artery is damaged in 4% of blunt traumas and 7% of penetrating traumas to the abdomen.[10]

Additional images

References

  1. 1 2 3 Listmann, Mishan; Tubbs, R. Shane (2020-01-01), Tubbs, R. Shane; Iwanaga, Joe; Oskouian, Rod J.; Moisi, Marc (eds.), "Chapter 19 - The Abdominal Aorta", Surgical Anatomy of the Lateral Transpsoas Approach to the Lumbar Spine, St. Louis: Elsevier, pp. 185–188, ISBN 978-0-323-67376-1, retrieved 2021-01-13
  2. ↑ Kem, D. C.; Lyons, D. F.; Wenzl, J.; Halverstadt, D.; Yu, X. (2005). "Renin-Dependent Hypertension Caused by Nonfocal Stenotic Aberrant Renal Arteries: Proof of a New Syndrome". Hypertension. 46 (2): 380–5. doi:10.1161/01.HYP.0000171185.25749.5b. PMID 15967872.
  3. ↑ Ottesen, Johnny T.; Danielsen, Michael, eds. (2000). Mathematical Modelling in Medicine. IOS Press. ISBN 978-4-274-90318-2.
  4. ↑ Renal Artery Aneurysm at eMedicine
  5. ↑ Aytac, Suat K.; Yigit, Hasan; Sancak, Tanzer; Ozcan, Hasan (2003). "Correlation between the diameter of the main renal artery and the presence of an accessory renal artery: sonographic and angiographic evaluation". Journal of Ultrasound in Medicine. 22 (5): 433–9, quiz 440–2. doi:10.7863/jum.2003.22.5.433. PMID 12751854. S2CID 24188140.
  6. ↑ Saldarriaga, Bladimir; Pinto, Sergio A; Ballesteros, Luis E (2008). "Morphological Expression of the Renal Artery: A Direct Anatomical Study in a Colombian Half-caste Population". International Journal of Morphology. 26 (1): 31–8. doi:10.4067/S0717-95022008000100005.
  7. ↑ Leslie, Stephen W.; Sajjad, Hussain (11 Aug 2021). "Anatomy, Abdomen and Pelvis, Renal Artery". National Center for Biotechnology Information. PMID 29083626. Retrieved 15 Nov 2021.{{cite journal}}: CS1 maint: url-status (link)
  8. ↑ Coello-Torà, Iris; Segura-Sampedro, Juan José; Pérez-Celada, Judit; Jiménez-Morillas, Patricia; Morales-Soriano, Rafael (January 2020). "[Accessory renal artery arising from infrarenal aorta, exposed during linphadenectomy due to cytoreductive surgery and HIPEC.]". Archivos Espanoles de Urologia. 73 (1): 76–77. ISSN 0004-0614. PMID 31950928.
  9. ↑ Cerny, Joseph C.; Karsch, Daniel (1973-12-01). "Aberrant renal arteries". Urology. 2 (6): 623–626. doi:10.1016/0090-4295(73)90322-1. hdl:2027.42/33981. ISSN 0090-4295. PMID 4766019.
  10. ↑ Kaufman, John A. (2004-01-01), Kaufman, JOHN A.; Lee, MICHAEL J. (eds.), "CHAPTER 12 - Renal Arteries", Vascular and Interventional Radiology, The Requisites, Philadelphia: W.B. Saunders, pp. 323–349, ISBN 978-0-8151-4369-7, retrieved 2021-01-13
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