▲ Hyperechoic medulla▲ Hyperechoic medulla▲ Hyperechoic medulla & Renal cyst▲ Hyperechoic medulla▲ Hyperechoic medullaHyperHyperechoic medulla without posterior shadow→ US reflection ↑→ Hyperechoic medullaCause: Collecting duct dilatation(1) Diuretics use(2) Old age (3) Congenital causeMedullary nephrocalcinosis → Hyperechoic medulla + shadow Cause: Deposition of foreign material (calcium, oxalate etc.) (1) Medullary sponge kidney (2) Renal tubular acidosis (3) Hyperparathyroidism (4) Cystinosis (5) Gout