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.
A 36-year-old woman was admitted to our hospital with intermittent right flank pain for 4 years. The pain-free interval had been shortened when she sought medical attention. The pain was dull and confined to the right upper quadrant anteriorly and posteriorly. The pain was most often experienced during the later hours of the day, especially after ingestion of large quantities of fluid. She had been treated at a local clinic in the past for urinary tract infection with right flank pain and weakness. Physical examination revealed blood pressure of 110/80 mmHg and the presence of costovertebral-angle tenderness. Urinalysis were within normal limits (WBC 0-1/HPF, RBC 0-1/HPF). Biochemical analysis revealed blood urea nitrogen level of 11.0 mg/dL and serum creatinine level of 0.8 mg/dL.\nKidney ultrasonogram showed a marked dilatation of the right pelvocalyceal system and right proximal ureter. However, the left kidney showed normal appearance. Excretory urogram revealed a marked right hydronephrosis with dilated calyces due to ureteropelvic junction obstruction (). Computed tomography angiogram (CTA) clearly displayed the aberrant renal artery which originated from the aorta below the normal right renal artery (). A source image of magnetic resonance angiogram (MRA) also showed a severe hydronephrosis of the right kidney and smooth obstruction of the right ureteropelvic junction due to extrinsic compression by an aberrant renal artery which originated from the aorta, crossing anteriorly to the ureteropelvic junction (). Retrograde pyelogram demonstrated linear indentation of the proximal ureter (). Tc-99m DTPA renal scan revealed a markedly delayed excretion of the right kidney. After furosemide infusion, the delayed right kidney excretion was somewhat improved ().\nThe patient underwent surgical exploration via an anterior approach which revealed a slightly ptotic, mobile, right kidney which was normal in size, with a marked hydronephrotic pelvis froman aberrant renal artery and vein crossing the ureteropelvic junction, proceeding to the lower pole and compressing the ureteropelvic junction against the lower pole of the kidney. A dismembered pyeloplasty was performed, with the pelvis anastomosed to the ureter in front of the aberrant renal artery.