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Case 2 – Discussion

The kidneys are small and echogenic (R: 8.4 cm, L: 8.7 cm). Due to the echogenicity the renal calyces appear prominent. There is also a large pleural effusion that is well visible on the figure showing the longitudinal renal scan.

Small and Echogenic Kidneys

Echogenicity results from increased reflection of ultrasound. Normally, renal echogenicity is less than the echogenicity of (normal) liver and spleen. Increased renal echogenicity in CRF usually correlates with renal fibrosis (small kidneys such as in the present case). Normal sized or even large hyperechogenic kidneys are seen in a number of conditions such as advanced diabetic nephropathy, diffuse renal lymphomas, HIV-nephropathy and others. In ARF increased echogenicity is sometimes seen in ATN (perhaps due to renal edema) as well as in AIN. In the present case the ultrasonographically small and echogenic kidneys are compatible with several clinical diagnoses such as chronic glomerulonephritis or hypertensive nephrosclerosis.

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