 Good day everybody. Dr. Sanjay Sanyal, Professor Department chair. This is a supine cadaver. I'm standing on the right side. The camera person is also on the right side. We have removed every structure from the abdomen and we are seeing the pustary abdominal wall. These are the locations where the kidneys are located. So let's take the left side. I've lifted up thin membrane structure here and I've reflected here and I've reflected here. This is the posterior parietal peritoneum and after that we can see a thick fatty layer. This is the retropadoneal fat. Once we cut open the retropadoneal fat which we have done here, we notice that the retropadoneal fat which is a variable thickness which varies from person to person, there's a distinct plane of cleavage and we can see yet another layer here. This is the continuation of the fascia transversalis which here in this region becomes known as the anterior layer of the renal fascia or the gerotas fascia and under that we can see yet one more layer of fat. This is the perinephric fat and once we remove this then we can see the kidney here. Fascia transversalis as it moves medially on the posterior abdominal wall, it splits to form the renal fascia or the gerotas fascia and it forms an anterior layer of renal fascia and there's a posterior layer of renal fascia and inside that layer we have this fat which is the perinephric fat and further posteriorly behind the posterior layer of renal fascia there'll be yet one more layer of fat and that is known as the perineal fat body. So these are all the fatty structures and the fascia structures around the kidney. We have shown it on the left side, we can show the similar thing on the right side also though there's a slight variation. I'm lifting up the posterior peritoneum here and we can see the retropadoneal fat. We have separated it out here and we can see the beginning of the renal fascia or the gerotas fascia with the perinephric fat here. That's all we can see on this side because of certain pathology the findings are not so clear as on the left side. This extra peritoneal fat is a well documented area for retropadoneal lipoma, retropadoneal liposarcoma and as an adverse effect to certain medications patient can also develop what is known as retropadoneal fibrosis and obstruction of the ureter. We have completely removed everything. I'm standing on the right side, camera person is on the left side. This is going to be a demonstration of the kidney and the ureter and the vascular structures. Let's start with the peritoneum here on the left side. This is the parietal peritoneum, this shiny thing that you see here. When this parietal peritoneum comes in front of the kidney we can see that the kidney is retropadoneal. So we have reflected the parietal peritoneum. Under that there is a layer of fat which is called retropadoneal fat. After we have removed the retropadoneal fat we have two other layers of fat and we can see one of the layers of fat here. We have retained a little bit of that on the left side. This is the perinephric fat which completely encircles the kidney. This perinephric fat is situated under the renal fascia or the gerotas fascia. The gerotas fascia is derived from the extension of the fascia transversalis which splits anteriorly and posterior to enclose. Further posteriorly we see this layer of fat which is behind the posterior layer of gerotas fascia and this is referred to as the pararenal fat body. So we have removed all of this and once we remove this fat anteriorly we notice that this particular kidney had a very thick and a white renal capsule which was completely separate from the kidney. Normally the renal capsule cannot be separated so easily and we can see it here and inside the kidney is quite shrunken and atrophic. So this is what we see on the left side and if you were to look on the posterior aspect we can see multiple honeycombed appearances of the kidney. So this looks like an end stage renal disease. If we were to look on the right side we see the same thing to an even more extreme degree. Here we have completely removed all the fat and fascia and we can see that the kidney is completely atrophic. And we can see this is the renal capsule I was talking about. It is thick, it is white and it is easily separable from the kidney and we have separated it out from here. And we can see the kidney has got multiple honeycombed appearance. So this is the first abnormality that we noticed about both the side kidneys. Now let's take a look at the blood vessels of the kidney. This is the inferior vena cava and this is the aorta. So we can see this vein coming out. This is the renal vein and as we know the left renal vein is longer than the right renal vein. The left renal vein is opening into the hyalum of the kidney and it is receiving this vein here. This is the left supra renal vein. This is the left supra renal gland and it is also receiving these veins here. These are the left testicular or the gunadal vein. Accompanied this, we have this vessel here. This is the left renal artery. We can see that in this particular cadaver there are not one but two left renal arteries. This is the one which I have picked up here. It is coming from the aorta. We can see one here and we can see yet one more left renal artery and it is coming from here. This is the other renal artery which is coming from the aorta. So therefore there are two distinct renal arteries coming from the aorta. Now we will shift our focus to the right side. We can see that this is the right renal vein coming from the inferior vena keva. It is coming from one origin and it is becoming two and here also we can see two right renal arteries. One of them is this one coming from the aorta here and we can see yet another one coming from the aorta here. Further posteriorly we can see on the left side we can see the renal pelvis. This is the renal pelvis and this is the ureter and on the right side this is the renal pelvis and this is the ureter. The rule of thumb to be remembered is when these structures are descending down there will be three structures going to the pelvis, to the actual pelvis. One is the ureter accompanied by the testicular or the gonadal vein and the testicular artery. So we can see these three structures are entering towards the pelvis on the left side. Now let's shift our focus to the right side. Again we can see this is the ureter. We can see this is the right testicular vein opening into the inferior vena keva and this is the right testicular artery coming from the aorta. So these three structures are going towards the pelvis. The next structure which I would like to draw your attention to are the supra renal glands. This is the left supra renal gland. This is the supra renal gland here. It is completely separate from the kidney and there's a special septum here. So therefore even if the kidney is separate the supra renal gland remains in its place. It is attached to the under surface of the diaphragm by means of the same facial septum. This side also if you want to take a close look we see this is the right supra renal gland which is completely distinct from the kidney in this particular location. And the right supra renal gland is closely associated with inferior vena keva. The next point I would like to draw your attention to is this structure here which I have lifted up. This is the superior miscentric artery. And just to bring up to speed just above this this is the celiac truck. This superior miscentric artery crosses in front of the left renal vein. So therefore the left renal vein is juxtaposed between the superior miscentric artery and the aorta. And in certain situations the left renal vein can get compressed and that condition is known as nutcracker syndrome. Particularly in a male if the left renal vein gets compressed it can also second really compress the testicular vein on the left side. And that can lead to testicular varicoseal on the left side. If you were to take a look at the position of the kidney this depression on either side of the vertebral column this is referred to as the paravertebral gutter. This paravertebral gutter is the depression produced by the prominence of the vertebral column in front in the middle and the curvature of the posterior abdominal wall on either side. And the kidneys are resting in the paravertebral gutter so therefore the lateral border of the kidney is strictly not lateral but it is posterior lateral. And the medial border of the kidney is strictly not medial but it is anterior medial and that is the orientation of the kidney. This has a particular clinical significance. If a particular patient is recombinant for a long duration of time and if there is infection of the kidney then there is stasis of urine inside the renal pelvis. And that plus the infection leads to what is known as staghorn calculus which fills up the renal pelvic chelicea system in the shape of the horn of a stag. And that is referred to as staghorn calculus that is predisposed by the orientation of the kidney. And as I mentioned that in this particular cadaver both the kidneys seem to be atrophic and the renal capsule is very thick dense and easily separable from the kidney as we can see here. The assistants have done a wonderful job of slicing open both the kidneys. This is the sliced open left kidney and this is the sliced open right kidney. Straight away we can see that both the kidneys are highly atrophic. We cannot make out any difference between the cortex and the medulla. Neither can we make out the medullary pyramids or the renal papillae or the pelvic chelicea system on either side. Initially we also noticed this multiple honeycombed appearances of the kidney parenchyma. And on this side in the pelvic chelicea system we can see some discolored collections which are maybe sludge which will eventually form stones. So therefore the tentative diagnosis is that both of these kidneys are in the stage of end stage renal disease. So that's all I wanted to demonstrate to you in this particular dissection. Thank you very much for watching. Dr. Sanjay Sanyal signing out. Mr. Kendall Cumberbatch is the camera person. If you have any questions or comments please put them in the comment section below. Have a nice day.