Introduction: Autopsy studies aid to the knowledge of pathology by unveiling some of rare lesions which are a source of learning from a pathologist’s perspective. Perinatal autopsies form an integral part in providing a clue to ascertain the cause of perinatal deaths and to study the congenital anomalies. Kidneys being important organs in maintaining the homeostasis, are affected by a variety of lesions like congenital anomalies, neoplasms and infections apart from being secondarily involved by diabetes, poisoning and other systemic diseases. Aims and objectives: 1. To determine the spectrum of histopathological findings of kidney in medicolegal autopsies. 2. To study the congenital anomalies and other lesions of kidney in perinatal autopsies. Materials and Methods: A retrospective study of medicolegal cases (269) and perinatal autopsies (100) for six years were included. The gross and microscopic findings of the specimens were taken into consideration. Results: Acute tubular necrosis (ATN) (51.16%) was the commonest histopathologic finding with the next common being changes secondary to diabetic nephropathy (16.27%). Others include hydronephrosis (13.9%), pyelonephritis (9.3%), multilocular cystic renal cell carcinoma (MCRCC), adult polycystic kidney disease (ADPKD), a case of coexisting pulmonary tuberculosis with liver cirrhosis and renal cell carcinoma (RCC) and a case of tumor to tumor metastasis. Perinatal autopsies showed cystic renal dysplasia, renal agenesis, autosomal recessive polycystic kidney disease (ARPKD) and a hybrid lesion. Conclusion: This study highlights the various incidental findings in medicolegal autopsies, which are imperative in academic and research purposes. Despite the growing complexity and dependence on newer diagnostic methodologies, the traditional role of histopathology in autopsy remains the gold standard.

Keywords: Autopsy; Cystic renal dysplasia; Hybrid lesion; Renal cell carcinoma; Tumor to tumor metastasis.