During anatomic study of the abdominal cavity, additional renal branches from the aortic axis were revealed in a 97-year-old male Caucasian cadaveric donor. Continued dissection outlined notable anatomic variations in the arterial, venous, and ureteric patterns. No urologic or cardiovascular issues were reported by the donor or family at the time of enrolment in the Deeded Body Program. For this type of study, Institutional Review Board approval is not required for research conducted with cadaveric specimens.\nBoth kidneys were retroperitoneal and similar in size with measurements of 12.3 cm (l) and 12.7 cm (r) in the craniocaudal direction. Despite the fact that the lengths were similar, there were marked differences in the relative positioning of the superior and inferior poles. The superior pole of the right kidney was situated more superiorly. The inferior pole of the left kidney was positioned near the superior border of the left common iliac artery. Although each kidney occupied an extended volume, neither kidney had a pelvic component. Hilar structures entered/exited the organs anteriorly, not with the typical medially projected hilum ().\nA total of five major arteries (3l and 2r) emerged from the aortic and common iliac axes (Figures and ). The superior left renal artery originated from the abdominal aorta and supplied the superior pole. This artery (5.2 mm diameter) branched into two vessels of similar caliber to supply the upper third of the organ. Supply to the left gonad originated from the more inferior of these two branches (Figures and ). The middle left renal artery (6.1 mm diameter) originated from the iliac junction, just anterior to the median sacral artery (Figures and ). The inferior left renal artery (5.4 mm diameter) originated from the common iliac artery, and coursed posteriorly to the kidney before entering the hilum anteriorly (from the lateral aspect of the organ), to supply the inferior pole (Figures , , and ). On the contralateral side, the vasculature to the right kidney consisted of only two renal arteries, both originating from the abdominal aorta. The superior renal artery (6.2 mm diameter) branched laterally from the aorta (at the same level as the left superior renal) and supplied the superior pole. As with the contralateral side, this artery also branched into two vessels of similar caliber, but supplied the superior half of the organ (Figures and ). In contrast to the contralateral side, the right gonadal artery branched directly from the aorta at its generally observed position, just inferior to the (superior) renal artery. Arterial supply to the inferior pole (6.5 mm diameter) originated on the lateral aorta, at a level inferior to the inferior mesenteric artery, and branched into two arteries (Figures , , and ).\nMultiple contributing veins, of different caliber, coalesced into four major renal veins (2l and 2r) that returned blood from the kidneys to the IVC (). The relative positioning of the superior renal veins followed the conventional pattern, entering the IVC through single vessels at a level just inferior to the superior mesenteric artery as it emerged from the aorta. On the right side, three major veins merged into a short segment (3 mm in length) to drain the superior 2/3 of the organ. The inferior 1/3 of the organ was drained through two primary contributors that merged into a single vein that ultimately drained into the IVC at the level of the previously described right inferior renal artery. A visible and substantive anastomotic connection was evident between the superior and inferior venous pathways (). On the left side, the superior renal vein received contributions from the suprarenal gland and the superior half of the kidney. Venous return from the left gonad ultimately merged into the most inferior branch of the three primary contributors to the superior renal vein (Figures and ). The inferior renal vein drained directly into the anterior aspect of the IVC at the junction of the common iliac veins, posterior to the bifurcation of the aorta. The most inferior of the three primary contributors to the inferior renal vein emerged from the posterior lateral aspect of kidney and spanned the hilum to ultimately converge into the inferior renal vein. The middle contributor emerged from the parenchyma, but was unremarkable. As on the contralateral side, a visible and substantive venous anastomotic connection was evident between the superior and inferior aspects of the kidney ().\nUnilateral duplication of the kidney with concomitant ureters was evident for the right side (). Aligned with the arterial pattern of this organ, the superior ureter demonstrated a discreet collecting system with well-formed minor and major calyces draining into a defined renal pelvis. The majority of the superior renal pelvis was positioned posterior to the vasculature (Figures and ). At the inferior portion of the kidney, the hilum was more anteriorly directed with the calyces and renal pelvis more evident given their anterior position relative to the vasculature. Both ureters continued inferiorly and independently to enter the bladder (). Histological investigation of the ureterovesical junctions was not completed; however a distinct orifice near the bladder trigone was evident for each ureter. On the contralateral side, the single ureter emerged from a widened and anteriorly projected hilum (). Major calyces from the peripheral parenchyma were evident and these calyces contributed to an elongated renal pelvis. The remaining course of the left ureter was unremarkable.
Routine undergraduate dissection for medical students in our department revealed a unilateral non-rotated kidney on the left side in a 97-year-old male cadaver. The body was donated to our department for teaching and research purposes. The cause of death was cardiopulmonary arrest.\nThe right kidney was found to be normal in its location, shape, size, and ureter formation. Varied vasculature was observed in the form of branches of the renal artery and formation of the renal vein. The left kidney was found to be at a lower position than usual, at the level of the second, third, and fourth lumbar vertebrae. The inferior pole was at the level of the L4-L5 intervertebral disc. The kidney was broader near its middle third and inferior pole. The cratered hilum of the left kidney, instead of being at its medial border, occupied a large part of the anterior surface and was situated nearer to the lateral than the medial border. The renal vein and ureter were the two structures traversing through the hilum, but the renal artery was entering the renal parenchyma through the medial border.\nThe structures emerging from the hilum of the kidney mainly comprised the renal vein and the tubular ureter. The renal vein had two major tributaries, superior and inferior. The inferior tributary was formed by joining two tributaries emerging from the inferior region of the renal parenchyma and proceeded obliquely upward and medially to join with the superior renal vein. The left gonadal vein drained into this inferior tributary. The main trunk of the renal vein traversed its usual course between the abdominal aorta and superior mesenteric artery to drain into the inferior vena cava. There was no well-defined renal pelvis; instead the tubular ureter had four divisions entering into the renal parenchyma at the hilum of the kidney (labeled a, b, c, and d in ). The course of the ureter was then downward and medial to the urinary bladder.\nThe abdominal aorta was tortuous all along its course in the abdomen. The Main Renal Artery (MRA) is described as a single vessel, at a more or less constant position opposite the renal hilus, from the abdominal aorta, and which continues undivided (except for several small branches- the inferior suprarenal, the perirenal and the ureteral arteries) in its straight course to the renal hilus. The MRA was thin and originated from the abdominal aorta at a level just inferior to the origin of the superior mesenteric artery, entering the kidney through its medial border after giving off 3 branches (represented by red asterisks in and ) to the left suprarenal gland. The accessory renal artery (AcRA) arose from the aorta just lateral and inferior to the origin of the inferior mesenteric artery, entering the renal parenchyma through the medial border of the kidney. The AcRA divided into two segmental arteries before piercing the lower part of the medial border of the kidney ().\nThe case was observed in a body donated to our department for educational and research purposes. Body is accepted only after taking consent of the deceased/next of kin which is in accordance to Anatomy act of India.