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The kidneys are bilateral retroperitoneal organs located just below the diaphragm, exhibiting the highest degree of innervation after the adrenal glands.[1][2][3] The superior margin of the left kidney is usually near the T12 vertebra at approximately the level of the 11th rib, extending to L3, whereas the right kidney lies slightly lower, between the 12th rib and L3. The lower position of the right kidney reflects its placement beneath the liver. Renal innervation comprises both afferent and efferent fibers forming the renal plexus (see Image. Renal and Adrenal Nerve Pathways).[4] Afferent fibers mediate nociception, enabling detection of renal pain and other sensory signals. Efferent fibers are predominantly sympathetic and play a central role in regulating renal blood flow, renin release, and systemic blood pressure.[5][6][7][8][9][10] The renal plexus receives input from multiple contributing plexuses that accompany the renal artery and vein before entering the hilum of the kidney.[11] The clinical relevance of renal nervous system anatomy in blood pressure regulation has increased substantially with the development and U.S. Food and Drug Administration approval of catheter-based renal denervation devices for treating patients with drug-resistant hypertension.[12][13][14] The critical role of renal innervation in regulating blood pressure and kidney function underscores its significance in managing cardiovascular and renal disorders. Advances in catheter-based renal arterial denervation therapies have highlighted the functional impact of the sympathetic perivascular nerve supply of the kidneys in patients with drug-resistant hypertension.[15][16] A comprehensive understanding of renal nerve anatomy and physiology enables clinicians to guide procedural strategy, optimize patient selection, and anticipate therapeutic outcomes (see Image. Kidney Anatomy).