There is a wide range of congenital renal anomalies that can present in adulthood. These include unilateral agenesis, ectopia, as well as malrotation and fusion anomalies. These may have clinically relevant associated anomalies. Alternatively, these may present due to related sequela of urinary stasis or malposition. We will discuss the imaging findings of a spectrum of congenital renal anomalies presenting in adults.