In Our set up may be condition is different as many old people land in ED and v cum to know that they never had any lab tests or ultrasound ever in life.

So our ED radiology is always over burden many pts referred to us with provisional DX of hepatic enceph but after scan liver is almost fine in many cases but B/L echogenic shrunken kidneys in many known HTN pts and some time even no previous medical history so when we give the Dx of progressive renal failure usually SR from medical wards resend pt for hepatic evaluation untill lab evidence prove they seems to be unsatisfied.