These kidney ultrasound images were obtained from a patient with end-stage kidney disease likely secondary to diabetic nephropathy and hypertensive nephrosclerosis. The patient also had cirrhosis and you can see some ascites in between the liver and right kidney.

Normally, renal vasculature is not visible (except for the anechoic main renal vein occasionally) without the color Doppler. Here you can see the hyperechoic vascular pattern with some shadowing suggestive of diffuse vascular calcification. CT scan without contrast confirmed the findings (obtained for some other reason).

Vascular calcification is highly prevalent in patients with advanced chronic kidney disease, particularly those on dialysis. Interestingly, it is observed even in young dialysis patients, who lack the typical cardiovascular risk factors of hypertension, dyslipidemia, and smoking. Unfortunately, there is no specific therapy to prevent progression or revert vascular calcification, other than careful attention to calcium and phosphate balance.