A Human Cadaveric Study On Incidence And Morphology Of Anatomical Variations Of Kidney And Ureter With Emphasis On Its Embryological, Genetic And Clinical Significance

Background: Kidneys are amongst the common sites of congenital abnormalities and anatomical variations.Congenital anomalies of kidney and urinary tract (CAKUT) constitute approximately 20 to 30% of all anomaliesidentified in the prenatal period and a leading cause of renal failure in children. The common variationspertaining to kidney are polycystic kidney, unascended kidney, horseshoe kidney with fused upper or lower pole,atrophic kidney, lobulated kidney, malrotated kidney, bifid pelvis or ureter, most common being bifid pelvis andpancake kidney is a very rare variant.Materials and Methods: Fifty human adult cadavers were included in our study; observed and studied over aperiod of three years in the Department of Anatomy, Grant Govt. Medical College, Mumbai, during routinedissection.Results: In our study we found, 01.01% of renal agenesis, 01.01% of fused pelvic or pancake kidney, 01.01% ofmalrotated kidney, 02.02% of unascended kidneys, 05.05% hypoplastic or atrophic kidneys, 07.07% lobulatedkidneys, 05.05% polycystic kidneys, 02.02% of bifid pelvis and 03.03% of triplicate pelvis.Embryological basis: The development of kidney begins at the fourth week of gestation; the failure of properinductive interaction between the ureteric bud and the metanephric blastemal can lead to various congenitalanomalies. Anomalies can result due to abnormal development, ascent, rotation and migration.Genetic basis: CAKUT are either sporadic, familial, syndromic or non-syndromic. Transcription factor ‘WT1’produced by mesenchyme of the metanephric blastemal helps in epithelialization of ureteric bud. Congenitalabnormality occurs when there is mutation of genes that regulates the expression of WT1.Conclusion: Renal anomalies are one of the commonest anomalies which may remain unnoticed till adulthood.The knowledge of anatomical variations of kidney and ureter is of utmost importance for surgical anduroradiological interventions. Hence an early detection and proper follow-up may be helpful in better managementand increased survival rates.