Сонографічні патерни патології нирок у рутинній клінічній практиці: діагностичні труднощі, типові помилки та диференційна діагностика

Ultrasound examination of the kidneys remains one of the leading first-line imaging methods in nephrology, urology, and general clinical practice because of its availability, non-invasiveness, and suitability for repeated dynamic assessment. At the same time, interpretation of sonographic patterns of renal pathology is often associated with diagnostic difficulties, especially in cases of dilatation of the pelvicalyceal system, cystic lesions, hyperechoic inclusions, diffuse parenchymal abnormalities, and equivocal focal processes. The aim of the study was to perform a visual-analytical assessment of sonographic patterns of renal pathology in routine clinical practice and to identify the main diagnostic difficulties of interpretation, common pitfalls, and the most important approaches to differential diagnosis. Materials and methods. The study had a retrospective visual-analytical design. A total of 447 sonographic images from 107 patients obtained at VETA-PLUS LLC from October 2025 to February 2026 were analyzed. Ultrasound examinations were performed using a Toshiba Aplio 300 system. All examinations were carried out by one experienced ultrasound physician. Thirty-three patients whose archived sonographic material demonstrated renal findings relevant to the predefined analytical categories were included in the final visual-analytical cohort. Results. Among the 33 included patients, dilatation changes of the pelvicalyceal system were identified most frequently, in 12 patients (36.4%), simple cysts in 7 (21.2%), diffuse parenchymal changes in 5 (15.2%), calculi or hyperechoic foci in 4 (12.1%), indeterminate renal changes in 3 (9.1%), and focal lesions or pseudotumorous patterns in 2 patients (6.1%). Altogether, dilatation changes, cystic lesions, and diffuse parenchymal abnormalities accounted for 72.7% of all included observations. The most diagnostically challenging patterns requiring particularly cautious interpretation and/or additional assessment were present in at least 27.3% of patients. Conclusions. Routine renal sonography is a highly accessible and practically valuable first-line imaging method; however, in complex cases its informativeness depends substantially on correct recognition of typical patterns, knowledge of diagnostic pitfalls, and proper differential assessment. The greatest difficulties in everyday practice are associated with dilatation changes of the pelvicalyceal system, cystic lesions, diffuse parenchymal abnormalities, and equivocal focal processes.