Hello Thanks for writing to HCM According to reports,grade II echogenic(bright) kidneys with loss of corticomedullary differentiation indicates renal parenchymal disease. You need proper clinical examination and investigations. Investigations include routine hemogram,RBS,LFT,RFT(includes urea,creatinine,GFR,BUN,Serum sodium,potassium,phosphorus,bicarbonate,chloride). Further investigations can be done if needed. There is also mild ascitis with bilateral pleural effusion.It may be related to renal problem. Prostate is mildly enlarged in size with thickened urinary bladder wall. Hope i have answered your query. Take Care Dr.Indu Bhushan