Comparison of Ultrasound Grading of Renal Parenchymal Disease and Estimated Glomerular Filtration Rate in Chronic Kidney Disease Patients at St. Paul Hospital, Ethiopia

<i>Background</i>: Chronic kidney disease (CKD) is a global health burden, with an estimated prevalence of 8–16%. Ultrasound and estimated glomerular filtration rate (eGFR) are critical tools for assessing renal function, but studies evaluating their correlation in Ethiopian populations remain lacking. Existing international studies often utilize limited sample sizes, potentially affecting their generalizability to local contexts. <i>Objective</i>: To compare ultrasound-based renal parenchymal grading with eGFR in CKD patients at a tertiary care center in Addis Ababa, St. Paul’s Hospital Millennium Medical College. <i>Methods</i>: We conducted an institutional cross-sectional study of 235 CKD patients from August 2022 to May 2023. eGFR was calculated using the MDRD formula from serum creatinine values. Standardized ultrasound evaluation assessed cortical echogenicity (graded 0-3 relative to splenic echogenicity), corticomedullary differentiation, renal length, and parenchymal thickness. Statistical analysis employed descriptive statistics, ANOVA, and Spearman's correlation using SPSS version 27. <i>Results</i>: The cohort demonstrated significant progressive decline in mean eGFR values corresponding to worsening ultrasound grades: 60.7 ± 14.7 mL/min/1.73m<sup>2</sup> (Grade 0), 43.2 ± 11 (Grade 1), 26.8 ± 6.1 (Grade 2), and 12.2 ± 6.4 (Grade 3). Cortical echogenicity and corticomedullary differentiation showed particularly strong negative correlations with eGFR (P < 0.001). Renal length demonstrated a significant positive correlation with eGFR (right: r = 0.470; left: r = 0.454; both P < 0.001), while parenchymal thickness measurements did not demonstrate strong statistically significant associations. <i>Conclusion</i>: Our study confirms significant correlations between ultrasound-based renal grading and eGFR in CKD patients. We recommend adopting this grading system in clinical practice alongside serum creatinine and GFR measurements for comprehensive renal assessment. The results serve as valuable baseline data for future research, particularly regarding cases with Grade 3 parameters but normal renal size, which may need inclusion in the grading system.