INTRODUCTION

Anomaly is a congenital disorder, that has been present since birth. But the word congenital neither applies nor excludes genetic disorders. Congenital anomalies occurring due to environmental factors are called Teratogens. Infections, deficiency in the diet and toxins are environmental causes ¹ . Congenital anomalies are present since birth with structural deformity found immediately after birth and their presence may be detected by signs and symptoms later on ² . Congenital Anomalies are seen in 2% of the population as a major abnormality. Abnormalities are of two types namely malformations where growth disturbances occur during embryogenesis and the other is deformation. It is a late change that appears in a structure which was normal earlier ³ .

Congenital disorders of the kidneys and urinary tract are the major contributors to morbidity and mortality. It accounts for 50% of all congenital anomalies and has a frequency of between 3.3 and 11.1% in the general population ⁴ . Congenital anomalies of the kidney are usually found associated with the urinary tract. This comprises a broad spectrum of renal and urinary malformations which can range from complete renal agenesis to hypodysplasia, multicystic kidney dysplasia, duplex, ureteropelvic junction obstruction, megaureter etc ^{5, 6} . About 20 to 30 percent of all anomalies found in the prenatal period are congenital defects of the kidney and urinary tract ⁷ .

The kidneys are a pair of bean-shaped organs that are situated in the abdomen, between the third lumbar and the 12th thoracic vertebrae. Each kidney measures approximately 4 to 5 inches in length ^{5 .} In the process of filtering blood, the kidneys produce urine, which builds up in the pelvis of the kidneys and drains through the ureters into the urinary bladder. The renal pelvis is funnel-shaped, and the ureters are each around 25 to 30 cm long, 3 mm in diameter, and thick-walled. To enter the lateral angle of the urinary bladder, the ureter descends. The ureter runs obliquely through the bladder wall for about 1.9 cm before opening into the urinary bladder ⁸ .

To know the various types of congenital anomalies of the renal system the study was conducted in the different Districts of Maharashtra.

MATERIALS and METHOD

This study was done on cadavers in the Department of Anatomy at VMGMC Solapur, GMC Jalgaon and GMC Baramati. The congenital renal anomalies were studied by dissection methods. These were incidental findings during routine dissection of cadavers by the students as well as faculties in the above colleges. The observation was made on dissected specimens for the presence of any variations in the morphology of kidneys and ureters. All the unwanted fasciae and fat were removed and the specimens were cleaned to note the anomalies. Following variations were studied:

• Morphological variations like agenesis of the kidney, nodular kidney, constricted (small) kidneys and bilateral polycystic kidney.

• Variations in location like ectopic kidney.

• Variations in the morphology of ureters like the presence of double ureters on the right side were noted.

All the above anomalies were said to present since birth. A thorough checkup was done for the presence of any other associated anomalies.

OBSERVATION:

Nodular kidney: A nodular kidney on the right side was detected in a cadaver in the Department of Anatomy at GMC, Solapur. The other left kidney was ectopic in the pelvis. The anterior surface of a nodulated kidney was uneven and found to be enlarged (Table 1 ).

There was another cadaver showing absence of a kidney on the right side while the left side kidney and ureter were intact. Empty Renal Fossa was observed in both cadavers no other anomalies were observed.

Polycystic Kidneys: Polycystic kidneys were seen in a 51 year's old donated male body in the Department of Anatomy at GMC Jalgaon, Maharashtra (Table 1 ). We also noted multiple pancreatic cysts.

Small kidneys: On performing dissection in elderly female cadavers aged around 70-75 years were observed with bilateral, smaller than normal size kidneys (Table 1 ) at Government Medical College, Baramati, Maharashtra. But ureters and bladder were normal. The right kidney measured 7.1cm and the left kidney measured 6.2cm. The parenchymal thickness of the right kidney was 0.8 cm, and that of the left kidney was 0.8cm.

Horseshoe-shaped kidney: Both kidneys were fused in the lower pole in horseshoe-shaped manner (Table 1 ). Ureters were normal. A similar anomaly was seen in the Department of Anatomy, VMMC, Solapur. Both kidneys were fused in the lower pole. Fusion of both kidneys in the lower pole in the midline anterior to the abdominal aorta was seen in a cadaver. It was also observed that ureters were unequal in length with the left ureter longer than the right ureters along with distortion of renal parenchyma. Major and minor calyces were not differentiated.

DISCUSSION

There are innumerable congenital anomalies involving the kidney and ureter and the authors have attempted to discuss a few of them observed during the study.

Reddy PR ¹¹ found that Out of the 50 cadavers, five of them had congenital renal anomaly accounting for 10% of the deaths because of renal failure in adults. All the sufferers have been between 40–60 years of age. There have been two instances of lobulated kidney, one horseshoe-shaped kidney, and one case of congenital hypoplasia.

In the present study sample size was 100 out of which 43 were normal kidneys, Polycystic kidneys were 17, Atrophic kidneys were 2, Segmented kidneys were 9, pancake kidneys and Kidneys with accessory vasculature were 28. Choudhary U ¹² conducted a study on 32 cadavers out of which 1 cadaver showed bilateral and 2 showed unilateral (2 L) lobulated kidney, 2 cadavers showed unilateral (1 L,1 R) and 1 showed bilateral accessory renal artery. Two cadavers showed unilateral (1 L,1 R) incomplete double ureter. The present study noted kidneys with accessory renal vasculature in 28 out of 100 kidney samples.

Kasat PA ¹³ conducted a study on ninety adult human cadavers and observed hypoplastic kidneys bilaterally in 3.3% cadavers, 3 showed bilateral and 6 showed unilateral lobulated kidneys and 2 cadavers showed unilateral (1 L, 1 R) incomplete double ureter. One showed bilateral and 5 showed unilateral accessory renal artery amongst 90 cadavers. And also ectopic kidney was seen in one cadaver.

Saritha S ¹⁴ examined 25 cadavers i.e., 50 kidneys and their anatomical observations were the presence of numerous renal arteries in three cadavers. The origin of the main renal arteries of the aorta was between L1-L2 Vertebrae in 22 cadavers. A single renal artery was present in both kidneys in 88% of cadavers i.e. in 44 kidneys. The presence of accessory (aberrant) renal arteries was seen only in 3 cadavers. Out of 3 cadavers’ additional renal arteries were seen unilaterally in 1 cadaver. on the left side and on the right-side kidney had a single renal artery. Bilaterally accessory renal arteries were seen in two cadavers i.e., in 4 kidneys. The extra-renal arteries the accessory or aberrant arteries were seen in 3 cadavers (12%), and in 5 kidneys around 20% respectively. Accessory artery= artery arising from abdominal aorta (AA) or renal artery (RA). Aberrant artery= artery arising from other than the aorta or the renal artery. Perforating artery= artery piercing the upper or lower poles not entering through the hilum.

Bulum B ¹⁵ reported in 50% of the families, there was at least one family member with a known renal or urinary tract disease. Das S et al. ¹⁶ stated that situs inversus abnormality of the kidney is not a common entity. Further, Nathan Hilel, Braacsh W, and Olsson D et al. ^{17, 18, 19} put light on situs inversus abnormality of kidney and aberrant renal vessels.

Many research studies conducted by Hollinshead H.W, Asghar M, Gray S.E, and Banner E.A ^{20, 21, 22, 23} observed situs inversus cases of kidney, even we found in the present study 2% cases of ectopic kidney-pelvic position. Ravishankar et al. ²⁴ reported multicystic dysplastic kidney 1 in 4000 cases; its incidence is unilateral in 24 % of cases and bilateral in 76 % of cases.

Conclusion

It is very important for the radiologist, surgeon and nephrologist to identify anatomical variants for surgical and therapeutic procedures. The knowledge of anatomical variations of the kidney and ureter is of utmost importance for surgical and uro-radiological interventions. Hence early detection and proper follow-up may be helpful in better management and increasing survival rate.

Sources of Support

Nil

Conflict of Interest

None Declared