Grading Of Renal Parenchymal Disease Using Gray Scale Ultrasound PAKISTAN JOURNAL OF Health Sciences

The shape of the normal adult kidney is like a bean, retroperitoneally present between twelve thoracic and third lumbar vertebra. Ultrasound can identify increased cortical echogenicity and reduced cortical parenchymal thickness, as well as reduced renal size in CKD. Objective: To diagnose renal parenchymal disease and its grading using gray scale sonography. Methods: It was cross-sectional research undertaken at Tertiary Hospital in Lahore, Pakistan radiology department. This research took place over ve months, from January 2022 to May 2022. A convenient sampling approach using previously published articles was used to obtain a sample size of 78 patients. After informed consent, patients who were assessed for renal ultrasonography at the study region, during the study period, were included. Data was entered and analyzed on SPSS version 22.0. Results: The mean age was 46.47±12.0. The frequency for males was 47(60.3%), and for females was 31(39.7%). Blood urea (mg/dl) had a mean value of 92.16±46.88, and Serum creatinine (mg/dl) in male patients had a mean value of 6.86±6.18 while in female patients had 5.50±5.36. The blood urea nitrogen of patients had a mean value of 50.16±33.70 and a glomerular ltration rate with a mean value of 81.34±23.12. The frequencies of sonographic grading of renal cortical echogenicity show patients of Grade 1 had 32(41.0%), Grade 2 28(35.9%), Grade 3 12(15.4%), and Grade 4 6(7.7%). Conclusion: Renal parenchymal disease is the most prevalent disease in elder males. Grade 1 of renal parenchymal disease is most common in patients, followed by Grade 2, Grade 3, and Grade 4.

considered to have higher echogenicity when the liver or spleen is less echogenic than the right or left kidney respectively [7]. Chronic kidney disease (CKD) has a detrimental effect on long-term health outcomes because it increases the risk of cardiovascular disease and accelerates the onset of renal failure [8]. Patients with kidney illness frequently experience cognitive impairment. The level of serum creatinine is a well-established indication of renal parenchymal disease severity [9,10]. Ultrasonography is a low-cost, non-invasive examination technique that provides enough anatomical information to diagnose kidney abnormalities without patient exposure to radiations, and it has so effectively supplanted traditional radiography in the United States and internationally [11]. These details help determine the severity of renal parenchymal damage, its reversibility, and whether or not a

M E T H O D S
patients who were assessed for renal ultrasonography, increased Urea, Serum creatinine, Blood urea Nitrogen, and Glomerular Filtration Rate at the study region during the study period were included. Known subjects with a history of acute kidney injury, kidney transplant patients, and obstructive uropathy were excluded. The patient demographic data was collected on a specially designed data collection sheet. Data were entered and analyzed on SPSS version 22.0. renal biopsy is necessary. Cortical echogenicity is used to grade kidney disease, with Grade 1 indicating mild disease, Grade 2 indicating moderate disease, Grade 3 indicating severe disease, and Grade 4 indicating end-stage renal disease [12]. Grade 0:renal parenchyma is less echogenic than the liver [13]. Grade 1:renal parenchyma has the same echogenicity as the liver.Grade 2:renal parenchyma has echogenicity more than that of the liver [10]. Grade 3:renal parenchyma has echogenicity more than that of the liver, and poor corticomedullary distinction [13,14]. Grade 4: renal parenchyma has echogenicity more than that of the liver, and corticomedullary distinction is lost [15]. To evaluate regardless of whether the renal disease is worsening or is normal, serial sonographic tests are conducted. USG can identify increased cor tical echogenicity and reduced cortical parenchymal thickness, as well as reduced renal size [16]. Early detection can aid in the adoption of early treatment [17]. Sonographic measurements such as length of kidney, corticomedullary distinction, and echogenicity of renal cortex do not allow for differentiating various types of renal health illnesses in individuals with renal parenchymal disease [18,19]. Increased cortical echogenicity, on the other hand, is a non-speci c sign of renal parenchymal illness. Sonographic parameters for assessing renal parenchymal disease include the size of the kidney, contour, corticomedullary distinctions, thickness of the cortex, and prominence of the medullary pyramids [20,21]. In a healthy kidney, the renal cortex generates lower-intensity backscattered echoes than that of the liver, spleen, or renal sinus. In contrast, the renal medulla is somewhat hypoechoic [22]. Renal length and parenchymal thickness diminish as CKD progresses, whereas parenchymal echogenicity rises [23]. Permanent damage is indicated by a renal length of less than 10cm and increased echogenicity [24]. Diabetes and hypertension are two of the most prominent chronic non-communicable diseases, both of which are common triggers for end-stage renal failure [25,26]. Ultrasound is the initial imaging modality utilized to explore the kidneys, it is critical in the diagnosis of renal illness. The radiologist will be able to understand the clear criteria and detrimental ndings that are symptomatic of pathology, allowing them to recognize it early and design a treatment strategy to avoid complications.
It was cross-sectional research undertaken at Tertiary Hospital in Lahore, Pakistan radiology department. This research took place over ve months, from January 2022 to May 2022. A convenient sampling strategy using previously published articles was used to obtain a sample size of 78 patients [6,10,19,21,27]. After informed consent,

R E S U L T S
The mean age was 46.47±12.03, with a minimum age of 28.00 and a maximum age of 83.00. Gender distribution shows the frequency of males 47(60.3%), and females 31(39.7%). According to signs and symptoms of patients with renal parenchymal disease shows that 32(9.2%) patients came with nausea, 16(4.6%) patients came with vomiting, 21(6.0%) patients came with the loss of appetite, 61(17.5%) patients came with fatigue and weakness, 21(6.0%) patients came with sleep problems, 45(12.9%) patients came with urinating more or less, 57(16.3%) patients came with muscle cramps, some of them like 19(5.4%) came with shortness of breath, 32(9.2%) came with dry itchy skin, 39(11.2%) patients came with swelling of feet and ankles and 6(1.7%) patients came with others, Table 1.

C O N C L U S I O N
Ultrasound can identify increased echogenicity and reduced cortical parenchymal thickness, as well as reduced renal size.The renal parenchymal disease is most prevalent in elder males. Grade 1 of chronic kidney disease is most common in patients, followed by Grade 2, Grade 3, and Grade 4 is observed in the least number of patients. [3]

R E F E R E N C E S
[4]