A 42-year-old woman with a past medical history of left hemi- spheric stroke presents to hospital with signs and symptoms of renal failure. She has been seen by her GP for hypertension and abdominal pain with outpatient investigations pending

c. A renal tract ultrasound should be considered a first-line imaging investigation in renal disease as a lot of information can be reliably gained easily and quickly. The history is consistent with that of autosomal dominant polycystic kidney disease (ADPKD) suggested by the previous stroke and renal failure in such a young woman. Renal ultrasonography has a high sensitivity and specificity for diagnosing polycystic kidney disease in addition to picking up other renal masses, size of kidneys, obstruction to outflow, collections and bladder volumes. Other rare causes of ‘enlarged’ kidney include renal tumours, benign cysts, single kidney hypertrophy, amyloidosis and renal contusion and trauma. The association of polycystic kidney disease with subarachnoid haemorrhage due to rupture of a berry aneurysm should be noted as well as the association with cardiac valvular lesions (especially mitral valve prolapse) and diverticulitis.