Hyperechogenic kidneys Echogenic kidneys Normal renal parenchyma is similar (isoechoic) or slightly darker (hypoechoic) compared with liver and includes the cortex and medulla. The thickness of the renal cortex is measured from the outer border of the medullary pyramids (yellow line) or from the arcuate arteries to the renal capsule. The medullary pyramids (white arrow) contain fluid in parallel tubules, which is anechoic (black) and appear as regularly spaced dark pools at the inner margin of the parenchyma (arrow). Because fat is echogenic, the central renal sinus appears bright. An increase in amplitude of waves returned in ultrasonography of the kidney, which is generally displayed as increased brightness of the signal. HP:0004719 Increased echogenicity of the renal parenchyma UMLS:C3275899 Abnormal renal echogenicity