Abstract
Increased echogenicity of the kidney in the newborn has many causes, some of which reflect serious renal disease. The major abnormal imaging pattern is the large, diffusely hyperechoic kidney with abnormal architecture. Its differential diagnosis includes recessive and dominant polycystic kidney disease (PKD), glomerulocystic kidney disease, and diffuse cystic dysplasia. The family history and ultrasonic screening of the parents and siblings are essential in the evaluation. The identification of associated nonrenal abnormalities is important to the recognition of syndromal cystic disease. Glomerulocystic kidney disease, which comprises sporadic and syndromal forms, appears similar to dominant PKD. While renal biopsy almost always differentiates recessive from dominant PKD, renal biopsy cannot differentiate among the forms of glomerulocystic kidney disease, except in the case of tuberous sclerosis, which has unique histopathological characteristics. Other causes of the enlarged hyperechoic kidneys with abnormal architecture include renal vein thrombosis and congenital nephrotic syndrome. A second pattern is the hyperechoic small kidney with abnormal architecture. Many of these kidneys are dysplastic and associated with urinary tract obstruction. The combination of hyperechoic parenchyma and pyelocaliceal dilatation suggests obstructive cystic dysplasia. Cortical and medullary necrosis in the newborn also causes hyperechogenicity in small kidneys. A third pattern contains those kidneys with medullary hyperechogenicity, the most common cause of which in the newborn is nephrocalcinosis associated with furosemide therapy. A systematic approach to the differential diagnosis of the hyperechoic kidney will enable the nephrologist to choose additional imaging studies and to limit the use of invasive procedures.
Similar content being viewed by others
References
Hricak H, Slovis TL, Callen CW, Callen PW, Romanski RN (1983) Neonatal kidneys: sonographic anatomic correlation. Radiology 147:699–702
Slovis TL, Sty JR, Haller JO (1989) Imaging of the pediatric urinary tract. Saunders, Philadelphia
Chiara A, Chirico G, Comelli L, De Vecchi E, Rondini (1990) Increased renal echogenicity in the neonate. Early Hum Dev 22:29–37
Eggert P, Debus F, Kreller-Laugwitz G, Oppermann HC (1991) Densitometric measurement of renal echogenicity in infants and naked eye evaluation: a comparison. Pediatr Radiol 21:111–113
Kraus RA, Gaisie G, Young LW (1990) Increased renal parenchymal echogenicity: causes in pediatric patients. Radiographics 10:1009–1018
Haller JO, Berdon WE, Friedman AP (1982) Increased renal cortical echogenicity: a normal finding in neonates and infants. Radiology 142:173–174
Einstein DM, Singer AA, Paushter DM, Nasif A Jr, Nally JV (1992) Hypoechoic renal pyramids: sonographic visualization in older children and young adults. Urol Radiol 13:162–165
Bernstein J, Slovis TL (1992) Polycystic diseases of the kidney. In: Edelmann CM Jr (ed) Pediatric kidney disease, vol 2, 2nd edn. Little Brown, Boston, pp 1139–1157
Kaplan BS, Kaplan P, Rosenberg HK, Lamothe E, Rosenblatt DS (1989) Polycystic kidney disease in childhood. J Pediatr 115:867–879
McDonald RA, Avner ED (1991) Inherited polycystic kidney disease in children. Semin Nephrol 11:632–642
Currarino G, Stannard MW, Rutledge JC (1989) The sonolucent cortical rim in infantile polycystic kidneys. J Ultrasound Med 8:571–574
Argubright KF, Wicks JD (1987) Third trimester ultrasonic presentation of infantile polycystic kidney disease. Am J Perinatol 4:1–4
Melson GL, Shackelford GD, Cole BR, McClennan BL (1985) The spectrum of sonographic findings in infantile polycystic kidney disease with urographic and clinical correlations. J Clin Ultrasound 13:113–119
Wernecke K, Heckemann R, Bachmann H, Peters PE (1985) Sonography of infantile polycystic kidney disease. Urol Radiol 7:138–145
Metreweli C, Garel L (1980) The echographic diagnosis of infantile renal polycystic disease. Ann Radiol (Paris) 23:103–107
Herman TE, Siegel MJ (1991) Pyramidal hyperechogenicity in autosomal recessive polycystic kidney disease resembling medullary nephrocalcinosis. Pediatr Radiol 21:270–271
Journel H, Guyott C, Barc RM, Belbeoch P, Quemener A, Jouan H (1989) Unexpected ultrasonographic prenatal diagnosis of autosomal dominant polycystic kidney disease. Prenat Diagn 9:663–671
Farrell TP, Boal DK, Wood BP, Dagen JE, Rabinowitz R (1984) Unilateral abdominal mass: an unusual presentation of autosomal dominant polycystic kidney disease in children. Pediatr Radiol 14:349–352
Sheu J-N, Chen C-H, Tsau Y-K, Wu T-T, Chien C-T, Shy S-W (1991) Autosomal dominant polycystic kidney disease: an unusual presentation as unilateral renal mass in the infant. Am J Nephrol 11:252–256
Bernstein J, Landing BH (1989) Glomerulocystic kidney diseases. In: Bartsocas C (ed) Genetics of kidney disorders. Liss, New York, pp 27–43
Kaplan BS, Kaplan P, Ruchelli E (1992) Inherited and congenital malformations of the kidneys in the neonatal period. Clin Perinatol 19:197–211
Cachero S, Montgomery P, Seidel FG, Springate JE, Feld L, Kuhn JP, Fisher F (1990) Glomerulocystic kidney disease: case report. Pediatr Radiol 20:491–493
Fitch SJ, Stapleton FB (1986) Ultrasonographic features of glomerulocystic disease in infancy: similarity to infantile polycystic kidney disease. Pediatr Radiol 16:400–402
Miller ID, Gray ES, Lloyd DL (1989) Unilateral cystic disease of the neonatal kidney: a rare presentation of tuberous sclerosis. Histopathology 14:529–532
Hayden CK, Swischuk LE (1991) Renal cystic disease. Semin Ultrasound 12:361–373
Cumming WA, Ohisson A, Ashraf A (1986) Brief clinical report: campomelia, cervical lymphocele, polycystic dysplasia, short gut, polysplenia. Am J Med Genet 25:783–790
Wapner RJ, Kurtz AB, Ross RD, Jackson IG (1981) Ultrasonographic parameters in the prenatal diagnosis of Meckel syndrome. Obstet Gynecol 57:388–392
Gloeb DJ, Valdes-Dapena M, Salman F, O'Sullivan MJ, Quetel TA (1989) The Goldston syndrome: report of a case. Pediatr Pathol 9:337–343
Zerres K, Völpel, Weib H (1984) Cystic kidneys. Hum Genet 68:104–135
Kaffe S, Rose JS, Godmilow L, Walker BA, Kerenyi T, Beratis N, Reyes P, Hirschhorn K (1977) Prenatal diagnosis of renal anomalies. Am J Med Genet 1:241–251
Ricci MA, Lloyd DA (1990) Renal venous thrombosis in infants and children. Arch Surg 125:1195–1199
Lalman B, Avni EF, Nasr A, Ketelbant P, Struyven J (1990) Perinatal renal vein thrombosis. J Ultrasound Med 9:473–442
Sanders LD, Jequier S (1989) Ultrasound demonstration of prenatal renal vein thrombosis. Pediatr Radiol 19:133–135
Mocan H, Beattie TJ, Murphy AV (1991) Renal venous thrombosis in infancy: long-term follow-up. Pediatr Nephrol 5:45–49
Avner ED, Ellis D, Jaffe R, Bowen AD (1982) Neonatal radio-contrast nephropathy simulating infantile polycystic kidney disease. J Pediatr 100:85–87
Stapleton FB, Hilton S, Wilcox J, Leopold GR (1981) Transient nephromegaly simulating infantile polycystic disease of the kidneys. Pediatrics 67:554–559
Boechat MI, Querfeld U, Dietrich RB, Cohen A, Kangarloo H, Vargas J (1986) Large echogenic kidneys in biliary atresia. Urology 29:660–662
Bruno MA, Spear GS, Dietrich RB, Pugh PA (1992) Bile nephrosis in a neonate: sonographic findings of rapid kidney enlargement and increased echogenicity. AJR 159:628–630
Green W, Saleeb SFN, Thorstad B, Young D (1991) Bilateral fetal nephromegaly. Invest Radiol 26:842–846
Kaplan BS, Gordon I, Pincott J, Barratt TM (1989) Familial hypoplastic glomerulocystic kidney disease: a definite entity with dominant inheritance. Am J Med Genet 34:569–573
Patriquin H, Robitaille P (1986) Renal calcium deposition in children: sonographic demonstration of the Anderson-Carr progression. AJR 146:1253–1256
Short A, Cooke RWI (1991) The incidence of renal calcification in preterm infants. Arch Dis Child 66:412–417
Hernanz-Schulman M (1991) Hyperechoic renal medullary pyramids in infants and children. Radiology 181:9–11
Jequier S, Kaplan BS (1991) Echogenic renal pyramids in children. J Clin Ultrasound 19:85–92
Shultz PK, Strife JL, Strife CF, McDaniel JD (1991) Hyperechoic renal medullary pyramids in infants and children. Radiology 181:163–167
Adams ND, Rowe JC (1992) Nephrocalcinosis. Clin Perimatol 19:179–192
Avni EF, Spehl-Robberecht M, Lebrun D, Gomes H, Garel L (1983) Pathologie tubulaire aiguë transitoire chez le nourrisson: Aspect échographique caractéristique. Ann Radiol (Paris) 26:175–182
Author information
Authors and Affiliations
Additional information
Wayne State University School of Medicine, USA
Rights and permissions
About this article
Cite this article
Slovis, T.L., Bernstein, J. & Gruskin, A. Hyperechoic kidneys in the newborn and young infant. Pediatr Nephrol 7, 294–302 (1993). https://doi.org/10.1007/BF00853228
Received:
Accepted:
Issue Date:
DOI: https://doi.org/10.1007/BF00853228