Sonography is the best screening modality to evaluate patients presenting with renal insufficiency. Ultrasound findings can be normal in patients with renal disease, especially in prerenal azotemia and acute parenchymal renal disease. Echogenic kidneys indicate the presence of parenchymal renal disease; the kidneys may be of a normal size or enlarged. Small kidneys suggest advanced stage chronic kidney disease. Uncommonly, cystic disease of the kidney, especially adult type polycystic kidney disease may be the cause of the patient's renal insufficiency with bilaterally enlarged kidneys containing multiple cysts of various sizes. If hydronephrosis is present, the level and cause of the obstruction should be sought. When ultrasound cannot diagnose the level and cause of obstruction, other imaging modalities, including CT and MRI may be useful. When renovascular disease (arterial stenosis or venous thrombosis) is suspected, spectral and color Doppler can be useful in detecting abnormalities.
*Assistant Professor of Radiology, Department of Radiology, The George Washington University Hospital, Washington, DC; †Professor of Radiology, Department of Radiology, The George Washington University Hospital, Washington, DC; and ‡Professor of Medicine, Department of Radiology and Division of Renal Disease and Hypertension, The George Washington University Hospital, Washington, DC.
Received for publication April 27, 2005: revised June 20, 2005; accepted July 27, 2005.
Drs. Khati and Hill have disclosed that they have no interests in or significant relationships with any commercial companies pertaining to this educational activity.
Dr. Kimmel has disclosed that he is/was a consultant/advisor for Ortho Biotech and that he is/was a stock shareholder for GlaxoSmithKline and Johnson & Johnson.
Wolters Kluwer Health as identified and resolved all faculty conflicts of interest regarding this educational activity.
Reprints: Michael C. Hill, Department of Radiology, The George Washington University Hospital, 900 23rd Street, NW, Room 11104, Washington, DC 20037 (e-mail: firstname.lastname@example.org).