title: Correlation of renal histopathology with sonographic findings.
abstract: BACKGROUND
  Judgments about irreversible renal disease are frequently based on the sonographic appearance of the kidneys. However, the sensitivity and specificity of sonography in identifying chronic, irreversible disease have never been determined, and the specific pathologic changes that increase renal cortical echogenicity have not been defined.
  
  
  METHODS
  We retrospectively compared sonographic parameters (length, quantitative echogenicity, cortical thickness, and parenchymal thickness) to biopsy findings of glomerular sclerosis, tubular atrophy, interstitial fibrosis, and interstitial inflammation in 207 patients.
  
  
  RESULTS
  Echogenicity showed the strongest correlation with all 4 histologic parameters (r= 0.28-0.35). Renal size was significantly correlated with glomerular sclerosis (r=-0.26) and tubular atrophy (r= 0.20). Parenchymal thickness, but not cortical thickness, correlated with tubular atrophy (r=-0.23). By multivariate analysis, tubular atrophy and interstitial inflammation, but not interstitial fibrosis, were significant determinants of cortical echogenicity. Severe chronic disease (>50% sclerosed glomeruli or a score of 3 out of 5 or greater for tubular atrophy or interstitial fibrosis) was present in 69% and 47% of patients with combined renal length <20 cm and >20 cm, respectively (P= <0.05). For cortical echogenicity >1.0 (>liver echogenicity) and </=1.0, the proportions of severe disease were 66% and 30%, respectively (P < 0.001). Severe disease was present in 86% of patients with combined renal length <20 cm and cortical echogenicity >1.0.
  
  
  CONCLUSIONS
  Cortical echogenicity is the sonographic parameter that correlates best with renal histopathology. Although size or echogenicity alone are poor predictors of chronic irreversible disease, the likelihood of treatable disease in small kidneys with increased cortical echogenicity is very low.
authors.affiliation: Renal Division, Emory University, Atlanta, Georgia 30322, USA.
authors.forename: Sammy
authors.initials: S
authors.lastname: Moghazi
authors.forename: Edria
authors.initials: E
authors.lastname: Jones
authors.forename: Jill
authors.initials: J
authors.lastname: Schroepple
authors.forename: Kraisith
authors.initials: K
authors.lastname: Arya
authors.forename: William
authors.initials: W
authors.lastname: McClellan
authors.forename: Randolph A
authors.initials: RA
authors.lastname: Hennigar
authors.forename: W Charles
authors.initials: WC
authors.lastname: O'Neill
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001706:Biopsy; D005260:Female; D006801:Humans; D007668:Kidney / Q000033:anatomy & histology / Q000000981:diagnostic imaging* / Q000473:pathology*; D007674:Kidney Diseases / Q000000981:diagnostic imaging* / Q000473:pathology*; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D014463:Ultrasonography