Echogenic Kidneys
Paula J. Woodward, MD
DIFFERENTIAL DIAGNOSIS
Common
Autosomal Recessive Polycystic Kidney Disease (ARPKD)
Obstructive Cystic Dysplasia
Less Common
Trisomy 13
Meckel-Gruber Syndrome
ESSENTIAL INFORMATION
Key Differential Diagnosis Issues
Are there other anomalies?
Trisomy 13 and Meckel-Gruber syndrome have anomalies in addition to the kidneys
Helpful Clues for Common Diagnoses
Autosomal Recessive Polycystic Kidney Disease (ARPKD)
Echogenic, large kidneys
Normal hypoechoic cortex may be present
Look for thin, hypoechoic rim around echogenic medulla
Diffusely hyperechoic in severe disease
May see small, scattered macroscopic cysts
Oligohydramnios variable depending on severity of renal involvement
Early onset oligohydramnios → poor prognosis
Obstructive Cystic Dysplasia
Chronic obstruction disrupts normal nephron tubular induction
Cortical echogenicity often increased from microscopic cysts
Macroscopic cortical cysts usually present, but occasionally, kidneys will be appear small and echogenic
Helpful Clues for Less Common Diagnoses
Trisomy 13
Cystic dysplasia seen in 50%
Kidneys usually echogenic and enlarged; cysts may be visible
Multiple major anomalies in > 90%
Brain/face: Holoprosencephaly, cyclopia, proboscis, hypotelorism, midline or bilateral cleft lip
Body: Postaxial polydactyly, cardiac defects, intrauterine growth restriction
Meckel-Gruber Syndrome
Triad of findings (2 findings required for diagnosis)
Renal cystic dysplasia most consistent finding, present in 95-100%
Encephalocele in 60-80%
Postaxial polydactyly in 55-75%
Renal involvement has variable appearance, but often severe
Grossly enlarged, echogenic kidneys most common
May have macroscopic cysts
Oligohydramnios common and often severe
Appearance may be identical ARPKD so important to look for associated findings
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