Background: Chronic kidney disease (CKD) is a major health concern globally, often leading to kidney failure, with diabetes and hypertension as significant risk factors. Early detection and effective management are crucial for mitigating its progression. Ultrasound imaging provides a non-invasive means to assess structural changes in the kidneys of both diabetic and non-diabetic individuals. Objective: The objective of this study is to analyze renal changes in diabetic versus non-diabetic adults using ultrasound imaging to measure kidney dimensions, cortical thickness, and echogenicity grades, and to correlate these measurements with obesity, hypertension, and diabetes. Methods: A cross-sectional study was conducted at Mahaban Medical and Research Hospital in Swabi, KP, Pakistan, including 65 adults aged 18-65. Kidney dimensions (length, width) and cortical thickness were measured using a Toshiba prime ultrasound machine with convex transducers ranging from 3.0—5.0 MHz to 7.0—14.0 MHz. Participants were categorized as diabetic or non-diabetic based on their medical records. Information on obesity, hypertension, and diabetes was collected through medical records and self-reporting. Echogenicity grades were assigned based on ultrasound findings, and data were analyzed using descriptive statistics and cross-tabulation of echogenicity grades. Results: The study included 65 participants with a mean age of 42 years. The average dimensions for right kidneys were 9.14 cm in length, 3.98 cm in width, and cortical thickness of 0.80 cm; left kidneys measured 8.84 cm in length, 4.05 cm in width, and cortical thickness of 0.77 cm. Of the participants, 40% were obese, 63.1% had hypertension, and 44.6% were diagnosed with diabetes. The most common echogenicity grade observed was Grade 3, particularly in bilateral cases. Conclusion: This study highlights the complex nature of kidney health, revealing significant impacts of obesity, hypertension, and diabetes on renal structure and function. The findings underscore the necessity for comprehensive clinical assessments and targeted interventions to prevent and manage CKD effectively.