Objective To determine the prognostic value of sonographically detected fetal hyperechogenic kidneys with normal amniotic fluid volume. Methods Seven cases of hyperechogenic fetal kidneys were identified by sonography over a 7‐year period (1996–2002). Increased renal echogenicity was diagnosed when the renal parenchyma was of greater echogenicity than adjacent liver tissue. Amniotic fluid volume was measured by the semiquantitative sonographic technique known as the amniotic fluid index (AFI). Results Three of the live‐born infants had autosomal dominant polycystic kidney disease and one had autosomal recessive polycystic kidney. In the remainder, autopsy study revealed multifocal renal dysplasia in two cases and normal kidneys in one. Conclusions Increased renal echogenicity with normal amniotic fluid volume in a fetus without other anomalies is a difficult diagnostic dilemma. Although it is usually indicative of renal parenchymal disease with possible renal failure after birth or in early childhood, in some cases, it represents a normal variant. Copyright © 2005 John Wiley & Sons, Ltd.