WK 7 RENAL Echogenic End-Stage Kidney. The kidney (between cursors, +) is significantly more echogenic than the adjacent liver parenchyma (l). Differentiation of cortex from medulla, and even from the renal sinus, is lost. The kidney is small, measuring only 7 cm, indicating it is end stage and unlikely to respond to any form of therapy. The patient has chronic renal failure.