This study is the first attempt to apply shear wave elastography (SWE) technology to the dynamic evaluation of patients with chronic kidney disease (CKD), aiming to fill the evidence gap of this technology in this clinical scenario.This case-control study enrolled 75 biopsy-confirmed CKD patients (observation group) and 20 healthy adults (control group). Renal morphological parameters (length, diameter, parenchymal thickness) were obtained via two-dimensional ultrasonography. Under SWE mode, three consecutive measurements of Young's modulus (Emean, Emax, Emin) were performed at the right renal lower pole cortex, with the mean value used for analysis.Key findings included: Significant reductions in renal length (9.8±1.2 cm vs. 11.5±0.9 cm, p < 0.05) and parenchymal thickness (1.2±0.3 cm vs. 1.8±0.2 cm, p < 0.05) in CKD patients versus controls; Elevated elasticity parameters in CKD group (Emean: 24.7±5.1 kPa vs. 12.3±2.8 kPa; Emax: 38.9±7.2 kPa vs. 16.1±3.5 kPa; Emin: 15.2±3.8 kPa vs. 8.7±1.9 kPa; all p < 0.05); Stage-dependent variations: CKD Stage 3-4 exhibited 32% higher Emean than Stage 1-2 (p < 0.01); Diagnostic performance metrics: Emax showed superior specificity (92.1% vs. 85.6% for Emean, 78.3% for Emin), Emin demonstrated higher sensitivity (89.4% vs. 82.7% for Emax, 79.5% for Emean); Strong correlations between SWE parameters and disease progression (r = 0.82 for Emax vs. eGFR, P<0.001).SWE provides a reliable non-invasive approach for quantifying renal elasticity alterations, demonstrating excellent diagnostic accuracy in CKD staging. The complementary performance of Emax (specificity) and Emin (sensitivity) suggests their combined use could optimize clinical decision-making.© 2025 Wiley Periodicals LLC.