Abnormal renal echogenicity Sonographic renal salt and pepper pattern Heterogeneous, increased parenchymal echogenicity. This imaging appearance is caused by multiple tiny cysts smaller than or just approaching the size necessary for detection, which disrupt the echo pattern without being clearly distinguishable, and appear as white grains on renal ultrasound, mainly in a subcapsular location. See Figure 2 of PMID:22034641 and Figure 11 of PMID:30599104.