The renal arteries are among the most challenging of the major aortic branches to image with spiral CT. Optimization of CT acquisition parameters is critical to creating diagnostic renal CT angiograms. When careful attention is paid to prescribing these examinations, renal CT angiography can be a very useful, noninvasive alternative to conventional angiography for the assessment of renal artery stenosis, screening of potential renal donors, planning repair of ureteropelvic junction stenoses, and identification of relevant renal artery relationships to abdominal aortic lesions. This review outlines important technical considerations for performing renal CT angiography and examines currently published data on the utility of spiral CT in a variety of clinical conditions.