Left renal artery !

The left renal artery carries blood from the aorta to the left kidney; the left renal vein crosses in front of it.

Official name: Renal artery

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What it is

Leaves the side of the aorta at L1-L2 and runs a short way to the left kidney, dividing into segmental branches.

What it does

Brings the left kidney its share of about a fifth of all the blood the heart pumps.

Key facts

Origin: Left side of the aorta at about L1–L2, just below the SMA; shorter than the right, behind the left renal vein
Branches: Anterior and posterior divisions giving 5 segmental arteries; inferior suprarenal and ureteric branches
Supplies: Left kidney, part of the left adrenal, upper ureter (varies: accessory renal arteries in about 25–30%)

Relations

Course: Runs laterally from the abdominal aorta across the left crus of the diaphragm and psoas major to the hilum, dividing into anterior and posterior divisions close to it
In front: Left renal vein, body of the pancreas and the splenic vein
Behind: Left crus of the diaphragm and psoas major

How to find it

Not palpable. From the front it lies behind the left renal vein, which crosses the aorta just below the superior mesenteric artery; the vein is lifted to expose the artery. At the hilum, as on the right, the vein is in front and the renal pelvis behind.

Examination

Auscultation over the epigastrium or flank: a bruit, especially one that continues into diastole, suggests renal artery stenosis

On imaging

Duplex Doppler shows a high peak velocity at a narrowing; CT or MR angiography maps stenosis and accessory arteries. In fibromuscular dysplasia angiography shows a string of beads.

Common problems

Renal artery stenosis: a narrowing that can cause high blood pressure.

Clinical notes

A narrowed renal artery lowers kidney perfusion, triggering renin release and renovascular hypertension (Goldblatt mechanism)
In bilateral stenosis, or stenosis to a single kidney, blocking the renin–angiotensin system can cause a sharp fall in kidney function
Most abdominal aortic aneurysms start below the renal arteries; the length of normal aorta below them decides how the aneurysm is repaired
In donor nephrectomy the left kidney is usually preferred for its longer vein, despite its shorter artery

Anatomical variants

Accessory renal arteries in at least about 30%, often to the lower pole
Early (prehilar) division of the main artery, which shortens the trunk available for clamping or grafting

Development

The kidney starts low in the pelvis and climbs to the lumbar region, picking up new arteries from the aorta as it rises while the lower ones normally fade; the ones that persist become accessory or polar renal arteries.

Test yourself

Think of the answer, then tap the question to see it.

How does the left renal artery relate to the left renal vein near the aorta?

The left renal vein crosses in front of it, so in surgery the vein is met first and the artery lies behind it.

How does the renal artery divide near the hilum?

Into anterior and posterior divisions giving 5 segmental arteries; it also gives inferior suprarenal and ureteric branches.

How common are accessory renal arteries, and where do they usually go?

In about 25–30% of people or more, often to the lower pole; they shape plans for living donor nephrectomy and aortic surgery.

What can happen when the renin–angiotensin system is blocked in bilateral renal artery stenosis?

A sharp fall in kidney function, also seen with stenosis to a single kidney.

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Educational information, not medical advice. For any symptom, see a health professional.

Its names

Official Latin (TA2): arteria renalis TA2 4269
Official Spanish (DeCS): Arteria renal DeCS D012077
English (TA2): Renal artery

Sources: Terminologia Anatomica (TA2); DeCS; Anatomy, Abdomen and Pelvis, Renal Artery; Anatomy of the Human Body (20th ed.): The Abdominal Aorta (Lea & Febiger (Gray's Anatomy, 1918), 1918) · adapted, Public domain.

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