It should be emphasized that normal-sized kidneys do not exclude CKD as renal size is initially preserved in diabetic nephropathy or infiltrative disorders. Increase in renal echogenicity is a nonspecific subjective manifestation of renal disease. In a series of 1,007 patients with CKD, abnormalities were detected in 26.8% of patients at initial US evaluation [39]. The most common US findings were increased echogenicity in 10.3%, cortical t hinning in 4 . 3%, renal artery stenosis in 4. 3%, and hydronephrosis in 1.9% of patients [39]. However, these findings contributed to the diagnosis in only 5 . 9% o f patients and affected management in 3.3% of patients [39]. Renal Failure The low impact on management does not support the use of US for routine surveillance of CKD. US may be indicated when there is a prior history of stones or obstruction, renal artery stenosis, frequent urinary tract infections, or family history of autosomal dominant polycystic kidney disease [39]. In patients with CKD and diabetes or hypertension, US has minimal impact on diagnosis and management [6,8]. US Duplex Doppler Kidneys Retroperitoneal A high RI can be a predictor of progression of CKD, but an elevated RI is not specific to renal disease [37], and threshold values vary in the literature. The literature search did not identify any studies regarding the use of RIs US in the initial evaluation of CKD. For renovascular disease, US is a low-yield test unless the patient has a history of renal artery stenosis [39]. Variant 3: Renal failure. Kidney disease of unknown duration. Initial imaging. Some patients will present without prior laboratory results and cannot be definitively categorized into AKI or CKD. In these patients, a detailed history, physical examination, and laboratory analysis of blood (for serum creatinine, blood urea nitrogen, complete blood count, and differential) and urine (microscopy for casts and epithelial cells, chemistry, and biomarkers) will be obtained in addition to imaging.
Renal Failure. It should be emphasized that normal-sized kidneys do not exclude CKD as renal size is initially preserved in diabetic nephropathy or infiltrative disorders. Increase in renal echogenicity is a nonspecific subjective manifestation of renal disease. In a series of 1,007 patients with CKD, abnormalities were detected in 26.8% of patients at initial US evaluation [39]. The most common US findings were increased echogenicity in 10.3%, cortical t hinning in 4 . 3%, renal artery stenosis in 4. 3%, and hydronephrosis in 1.9% of patients [39]. However, these findings contributed to the diagnosis in only 5 . 9% o f patients and affected management in 3.3% of patients [39]. Renal Failure The low impact on management does not support the use of US for routine surveillance of CKD. US may be indicated when there is a prior history of stones or obstruction, renal artery stenosis, frequent urinary tract infections, or family history of autosomal dominant polycystic kidney disease [39]. In patients with CKD and diabetes or hypertension, US has minimal impact on diagnosis and management [6,8]. US Duplex Doppler Kidneys Retroperitoneal A high RI can be a predictor of progression of CKD, but an elevated RI is not specific to renal disease [37], and threshold values vary in the literature. The literature search did not identify any studies regarding the use of RIs US in the initial evaluation of CKD. For renovascular disease, US is a low-yield test unless the patient has a history of renal artery stenosis [39]. Variant 3: Renal failure. Kidney disease of unknown duration. Initial imaging. Some patients will present without prior laboratory results and cannot be definitively categorized into AKI or CKD. In these patients, a detailed history, physical examination, and laboratory analysis of blood (for serum creatinine, blood urea nitrogen, complete blood count, and differential) and urine (microscopy for casts and epithelial cells, chemistry, and biomarkers) will be obtained in addition to imaging.