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Increased Echogenicity of Renal Cortex: A Transient Feature in Acutely Ill Children

¹ Department of Radiology, Haga Teaching Hospital, Location Leyweg, Leyweg 275, 2545 CH, The Hague, The Netherlands.
² Department of Radiology, Leiden University Medical Centre, Leiden, The Netherlands.
³ Department of Surgery, Haga Teaching Hospital, Location Leyweg, The Hague, The Netherlands.
⁴ Present address: Department of Surgery, Leiden University Medical Centre, Leiden, The Netherlands.
⁵ Department of Pediatrics, Haga Teaching Hospital, Location Juliana Children's Hospital, The Hague, The Netherlands.
⁶ Department of Radiology, Haga Teaching Hospital. Location Juliana Children's Hospital, The Hague, The Netherlands.

OBJECTIVE. The purpose of our study was to determine the frequency of hyperechogenicity of renal parenchyma in children with acute abdominal illness and to evaluate the assumed transient feature of this hyperechogenicity.

MATERIALS AND METHODS. Between January 2005 and February 2006, 189 consecutive patients (112 boys and 77 girls; mean age, 10 years) presenting with acute abdominal pain were examined with sonography. Patients with a known history of renal disease and those with acute urinary tract infection were excluded from the study. Echogenicity of the renal cortex in comparison with adjacent liver was recorded. Renal cortex echogenicity was divided into three groups; group 1, renal cortex echogenicity less than liver parenchyma echogenicity; group 2, renal cortex echogenicity similar to that of liver parenchyma; and group 3, renal cortex echogenicity greater than that of liver parenchyma. Patients with hyperechogenicity were reexamined with sonography after 2 weeks or more. The final sonographic diagnosis and clinical outcome were noted.

RESULTS. Renal cortex echogenicity was equal to or greater than that of the liver parenchyma in 18% (n = 34) of 189 patients. Increased echogenicity of the renal cortex returned to normal in 2 or more weeks in all patients. Three patients had no follow-up. Clinical diagnoses were idiopathic acute abdominal pain (n = 74), appendicitis (n = 83), mesenteric lymphadenitis (n = 15), ileocecitis (n = 7), gastroenteritis (n = 7), Crohn's disease (n = 1), intussusception (n = 1), and pneumonia (n = 1). No concurrent renal disease was diagnosed.

CONCLUSION. Increased echogenicity of renal parenchyma in children with acute illness is a transient feature and does not necessarily indicate renal disease.

Keywords: abdomen • children • kidney • pediatric imaging • renal echogenicity • sonography

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