Objective To investigate the ultrasonographic characteristics of acute Stanford type A aortic dissection (ATAAD) involving renal artery and its relationship with renal function. Methods The patients with ATAAD admitted to our hospital from February 2013 to May 2023 were selected. According to whether dissection involved renal artery, the patients were divided into a renal artery involved group and a renal artery uninvolved group. The general data and ultrasonic characteristics of the two groups were compared, and the relationship between ultrasonic characteristics and renal artery involvement in ATAAD patients was analyzed by logistic regression analysis and correction model. Receiver operating characteristics (ROC) curve was used to evaluate the predictive value of ultrasonic characteristics for renal artery involvement in ATAAD patients. In addition, according to blood urea nitrogen (BUN) and Serumcreatinine (Scr), patients with renal artery involvement were divided into a normal renal function group and an abnormal renal function group. The general data of the two groups were compared, and the risk effect of ultrasonic characteristics involving renal artery in renal function was analyzed by Log-binomial model. Pearson correlation analysis was used to analyze the correlation between ultrasonic features involving renal artery and renal function indexes. Results Finally 163 patients were collected, including 154 males and 89 females, aged 20 to 85 (50.06±10.46) years. There were significant differences in gender, Scr and BUN between the renal artery involved group and the non-involved group (P<0.05). Compared with the non-involved group, the ascending aorta diameter, the proportion of patients with left ventricular wall thickening and renal perfusion difference in the involved group were greater (P<0.05). Logistic regression analysis showed that after adjusting for confounder, the ultrasonic characteristics and OR values of renal artery involvement in ATAAD patients were 1.916, 2.578 and 1.969, respectively. Ascending aortal diameter, left ventricular wall thickening and poor renal perfusion were independent influencing factors of renal artery involvement (P<0.05). The ultrasonic features were effective in predicting renal artery involvement in ATAAD patients. The combined prediction of the three factors involved renal artery, and the prediction efficiency was higher. Compared with normal renal function group, BUN, Scr, ascending aorta diameter, proportion of ascending aorta widening patients and renal perfusion difference in abnormal renal function group were greater (P<0.05). Log-binomial model analysis showed that the risk ratio of increasing ascending aorta diameter, widening ascending aorta and increasing renal perfusion difference had statistical significance before and after significant adjustment (P<0.05). The results of Pearson correlation analysis showed that ascending aorta diameter, ascending aorta widening and renal perfusion difference were closely related to renal function indexes (P<0.05). ConclusionThe ultrasonic features of ATAAD involving renal artery can affect renal function and have a certain correlation, and the increase of ascending aorta diameter, widening of ascending aorta and renal perfusion difference are independent risk factors for renal function abnormalities.