Echogenic Kidneys

Fetal echogenic kidneys are kidneys that appear bright on ultrasound imaging, a finding that indicates a possible kidney condition.

Further investigation and testing is needed. However, because echogenic kidneys are associated with a wide range of kidney disorders and outcomes, it is often not possible before birth to diagnose the specific cause or determine the baby’s prognosis.

Echogenic kidneys can be bilateral (both kidneys are bright on imaging) or unilateral (only one kidney appears bright).

Ultrasound Imaging and Echogenicity

Prenatal grayscale ultrasounds capture images using shades of gray (commonly referred to as black and white images). How bright or dark something appears is its “echogenicity.” The brighter (whiter) it appears, the more echogenic it is.

During the ultrasound scan, as the sound waves reflect off the fetal body structures or tissue, the returning echoes appear on imaging as dots. The stronger the reflected echo, the brighter the dot.

Normally, the brightness or echogenicity of the fetal kidney is equal to that of the liver. If the kidneys appear brighter than the liver, they are considered to be echogenic or hyperechogenic.

How do echogenic kidneys affect my baby?

Echogenic kidneys is considered a “nonspecific finding” because it doesn’t indicate a specific condition or diagnosis, but rather the possibility of a kidney abnormality.

The most frequent causes of fetal echogenic kidneys include:

• Polycystic kidney disease (autosomal dominant and autosomal recessive)
• Multicystic dysplastic kidney
• Chromosomal abnormalities
• Overgrowth syndromes
• Cytomegalovirus (CMV) infection
• Urinary tract obstruction

In some cases, echogenic kidneys may be a normal “variant” for that child (not the result of an underlying condition), or it may be what’s known as a “transient” or temporary finding.

Diagnosis

Echogenic kidneys may be diagnosed during a routine prenatal ultrasound.

If echogenic kidneys are detected, a closer examination will be performed to look for other abnormalities, including enlargement of the fetal kidneys, structural abnormalities of the fetal kidneys or urinary tract, a lack of amniotic fluid (the fluid that surrounds the fetus in the womb), and other congenital malformations, which may indicate a chromosomal condition. Genetic testing may be recommended.

If fetal echogenic kidneys is an isolated finding, meaning there are no other abnormalities detected, the underlying cause and the baby’s prognosis are often uncertain.

In severe cases, where the fetal kidneys are also enlarged and the amniotic fluid level is low (known as oligohydramnios), kidney (renal) failure is likely and the prognosis is poor. Without kidney function, the fetus is unable to produce urine, a primary component of amniotic fluid. Amniotic fluid is vital to the baby’s health and development. Too little fluid can lead to underdeveloped lungs (pulmonary hypoplasia) and breathing difficulties at birth, deformities of the limbs and face (known as Potter sequence) caused by compression in the womb, stillbirth and neonatal death.

Specialized Evaluation and Prenatal Care

If echogenic kidneys are diagnosed during pregnancy, you may be referred to a fetal center for further evaluation and additional testing.

At Texas Children’s Fetal Center, we arrange for you to visit as quickly as possible for a comprehensive assessment by a team of specialists experienced in evaluating echogenic kidneys and diagnosing and treating congenital kidney conditions. Team members include maternal-fetal medicine physicians (OB/GYNs specializing in high-risk pregnancies), fetal imaging experts, pediatric nephrologists and urologists, geneticists and genetic counselors, and neonatologists. 

Additional testing may include:

• High-resolution anatomy ultrasound to confirm the diagnosis and look for other abnormalities
• Ultra-fast MRI for a more detailed view of fetal anatomy
• Fetal echocardiogram to evaluate your baby’s heart
• Amniocentesis and chromosomal analysis to identify any chromosomal anomalies
• Fetal bladder tap (vesicocentesis) to obtain a urine sample and evaluate your baby’s kidney function

Following this thorough evaluation, our specialists will meet with you about the results and answer any questions your family has, to help you make the most informed decisions regarding your baby’s care and treatment.

A diagnosis of echogenic kidneys during pregnancy enables your family and your healthcare team to plan ahead for the specialized treatment and expertise your baby may need at birth, optimizing outcomes.

Pregnancy and Delivery

Mother and baby will be closely monitored throughout pregnancy with more frequent ultrasounds to assess fetal growth and watch for signs of complications.

We recommend delivery at a hospital with the expertise and resources to treat congenital kidney conditions and any associated defects, including the highest level neonatal intensive care unit (NICU). Delivery and postnatal care should be carefully planned and coordinated across a team of maternal-fetal medicine, neonatal and pediatric specialists.

Our Fetal Center team works closely with experts from Texas Children’s Renal Service, one of the largest programs in the world for the treatment of children with congenital kidney diseases, providing seamless access to the critical care services and specialists your child may need at birth. Here, the pediatric specialists treating your newborn have been an integral part of their care team since before birth.

Treatment After Birth

After birth, your baby will undergo a thorough physical exam and testing to evaluate the kidneys, assess function kidney, and look for any associated defects or other abnormalities.

Treatment needs will depend on each child’s unique condition and symptoms.

Children born with a kidney condition require ongoing monitoring by a pediatric nephrologist experienced in these congenital defects, with regular ultrasounds, blood pressure checks, and urine and blood testing to evaluate kidney function.

Postnatal Care Team

Depending on your child’s condition, his or her postnatal care team may include:

• Neonatologist
• Pediatric nephrologist, a specialist in disorders of the kidney
• Pediatric urologist, a specialist in the treatment of the urinary tract
• Genetic counselor

Why Texas Children’s Fetal Center?

• A single location for expert maternal, fetal and pediatric care. At Texas Children’s Hospital, mother and baby receive the specialized care required for fetal echogenic kidneys and congenital kidney conditions all in one location, including the highest level NICU, if needed.
• A skilled, experienced team with proven outcomes. We have a dedicated team of maternal-fetal medicine (MFM) specialists, fetal imaging experts, genetic counselors, neonatologists, and pediatric nephrologists and urologists who work in concert to care for you and your baby every step of the way, using proven protocols we’ve developed over the years. With their combined expertise and unified approach, this team offers the best possible care for pregnancies involving echogenic kidneys.
• We care for your child’s needs at every stage of life. Our comprehensive approach starts with your first prenatal visit and continues through delivery, postnatal care, and childhood, thanks to one of the nation’s leading teams of fetal and pediatric specialists.

Videos

• Texas Children’s Fetal Center: Our care began before he/she was born

Additional Resources

• 6 things to consider when choosing a fetal center