Advances in Noninvasive Imaging for Hypertensive Kidney Disease: Ultrasound and Elastography Insights

Hypertensive kidney disease (HKD) represents a significant contributor to chronic kidney disease and end-stage renal failure, yet its early detection remains challenging due to nonspecific clinical and imaging findings. The lack of a noninvasive diagnostic tool, preventing the use of biopsy and diagnosis by exclusion, suggests the underdiagnosis of patients and overestimation of HKD as the cause of renal replacement therapy. Ultrasonography, including Doppler assessment and renal resistive index measurements, provides a widely accessible, noninvasive approach to evaluate renal structure and hemodynamics, aiding in the identification of early renal impairment or renal artery stenosis. Shear-wave elastography (SWE) has emerged as a promising modality for noninvasive assessment of renal stiffness, potentially detecting structural changes prior to functional deterioration. Current evidence demonstrates SWE’s diagnostic potential in chronic kidney disease and early hypertensive renal disease; however, limitations such as inter-device variability, heterogeneous patient populations, and short follow-up periods constrain its clinical applicability. Neither ultrasonography nor SWE can yet serve as standalone diagnostic tools for HKD, emphasizing the need for standardization, further validation, and longitudinal studies to clarify their role in patient management and prediction.