The aim of the investigation was to study the possibilities of complex ultrasonography (using shear wave elastography and power Doppler mapping of the intrarenal vessels) for evaluation of the renal parenchyma as a method of early non-invasive diagnosis in children suffering from obesity and metabolic syndrome.Materials and Methods. Kidney ultrasound examination was performed using portable digital ultrasound system ANGIODIN-Sono/PUltra (BIOSS, Russia). Forty-two children were examined using shear wave elastography of the renal parenchyma and power Doppler mapping for evaluation of intrarenal vessels.Results. Children with obesity and metabolic syndrome were found to have high frequency of registering renal blood flow types 2, 3, and 4 which characterize the decline in its intensity. According to shear wave elastography results, statistically significant differences in renal parenchymal stiffness were revealed in children with obesity and metabolic syndrome, children with metabolic syndrome and control group children (with normal body weight). Renal parenchymal stiffness value in children with obesity was likely to be higher (p>0.05) than in control group children. The revealed changes in renal parenchymal stiffness values in children with metabolic syndrome may speak of vasospasm on the capillary level (the glomeruli), which can be followed by remodeling of the glomerular wall, particularly, against the background of systemic arterial hypertension. This increases the risk of vicious cycle formation: ischemia of the renal parenchyma and activation of juxtaglomerular apparatus ↔ persistence and exacerbation of arterial hypertension. In children with obesity and metabolic syndrome, the mode of power Doppler with a standardized evaluation scheme provides the possibility to identify the intensity of renal blood flow due to high reproducibility of the technique.Conclusion. Complex use of modern renal ultrasound techniques (shear wave elastography + power Doppler mapping) gives the possibility to reveal the group of high cardiovascular risk in children with obesity.Key words: renal ultrasound diagnosis; shear wave elastography; power Doppler mapping of the kidneys; renal parenchymal stiffness; metabolic syndrome; kidneys. Obesity and overweight are closely associated with the development of metabolic syndrome whose markers are diabetes mellitus type 2, arterial hypertension (AH), early atherosclerosis, gastrointestinal tract pathology, reproductive disorders, oxidative stress [1−6]. Recent investigations show that obesity is considered to be an independent risk factor for chronic renal diseases. Insulin resistance, hyperinsulinemia and dyslipidemia found in metabolic syndrome promote AH. Hormonal-metabolic disorders and AH, in turn, affect structural-functional state of the kidneys and lead to glomerulopathy development [7, 8].Renal tissue stiffness can be evaluated quantitatively (this value elevation evidences initiation of parenchymal changes) using a new method of ultrasound diagnosis, shear wave elastography [9]....