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Does Increased Echogenicity of Renal Cortex Indicate Underlying Pathology?

January 4, 2008
Written by: , Filed in: Abdominal Imaging, Pediatric Radiology
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The objective of a recent study was to determine the frequency of hyperechogenicity of the renal cortex in children with acute abdominal illness, and to assess the transient feature of this finding.

The Results show that increased echogenicity of renal parenchyma in acutely ill children does not necessarily indicate renal disease.

Participants
Over a 1-year period, patients who were referred by an emergency pediatrician or pediatric surgeon for an abdominal sonographic examination were enrolled.

Exclusion criteria included any history of renal disease, neoplasms, kidney transplantation, or other renal anomalies.

Patients with concurrent use of diuretics were excluded, and patients <2 years of age were not included. Final diagnoses were recorded on the basis of follow-up sonography, additional imaging, or pathologic evaluation. Methodology
After 1 year, records of patients with increased echogenicity of the renal parenchyma were evaluated for renal disease.

Renal cortex echogenicity was classified into 3 groups:

  • group 1, in which renal cortex echogenicity was less than liver echogenicity;

  • group 2, in which renal cortex echogenicity equaled that of liver parenchyma;
  • group 3, in which renal cortex echogenicity was greater than that of liver echogenicity.

Almost all patients in group 2 or 3 were re-examined after 2 weeks.

Results
189 patients were included in the study. The mean age of the patients was 10 years; 10% of patients were classified into group 3, 8% in group 2, and 82% into group 1. No concurrent renal disease or urinary tract infection was diagnosed in the study population, although final diagnoses ranged from normal abdomen to appendicitis and mesenteric adenitis. Serum creatinine and urine sediment were normal in all patients in groups 2 and 3. None of the patients with increased renal cortex echogenicity had a renal disorder after 1 year of clinical follow-up.

Conclusions
Findings suggest that increased echogenicity in the kidneys compared with liver echogenicity is not a prognostic indicator of renal pathology. The sample size is adequate for statistically significant Conclusions. Prior studies sought to show that echogenicity of the renal parenchyma is not increased in normal subjects.

Alternatively, this study sought to determine that increased renal echogenicity is a nonspecific finding, which may be an indicator of disease other than renal disease.

Reviewer’s Comments
A variable to keep in mind when absorbing the study Results is that comparison was always made to the liver parenchyma, which was assumed to be normal.

It is conceivable that the echogenicity of the renal parenchyma may have been elevated, but not as elevated as the liver in conditions such as hepatic steatosis.

The practical lesson from the article should be that hyperechogenicity of the renal cortex in children with acute abdominal illness should alert the radiologist to search the abdomen more thoroughly for a cause of the acute abdominal illness.

Author: : Basil Hubbi, MD

Reference:
Wiersma F, Toorenvliet BR, et al. Increased Echogenicity of Renal Cortex: A Transient Feature in Acutely Ill Children.
AJR; 2008; 190 (January): 240-243

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