Most diffuse medical renal conditions have non-specific appearances on ultrasound, the kidneys often appearing normal in the early stages of disease. Renal failure may be acute or chronic and its causes are numerous. If acute, an increase in overall renal size may be observed and there may be a diffuse alteration in the renal echogenicity, however this can be either hypo-or hyperechoic compared with normal. Either increased or decreased corticomedullary differentiation may also be observed (Fig. ultrasound images below).
ultrasound images of Acute renal failure demonstrating an enlarged, diffusely hyperechoic kidney with loss of corticomedullary differentiation.
Ultrasound images of Acute renal failure in paracetamol overdose. The kidney is large (16 cm) and hyperechoic with increased corticomedullary differentiation. Although ultrasound is successful in detecting renal parenchymal disease, the acoustic changes are not specific and the cause must usually be diagnosed histologically, ultrasound being invaluable in directing the biopsy procedure. In chronic renal failure the kidneys shrink and the cortex thins. The end-stage kidney can be quite tiny and hyperechoic and may be difficult to differentiate from the surrounding tissues (Fig.Ultrasound images below).
Depending on the cause, either one but generally both of the kidneys are affected.
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