Chronic kidney disease (CKD) is assuming epidemic proportions and the prognosis is particularly worse in the tropical developing countries due to poor resources and late presentation. Imaging abnormalities are part of the diagnostic criteria and sonography which offers baseline evaluation at presentation for possible diagnosis and follow up of the disease process in conjunction with blood and urine tests. Furthermore, correlation between sonographic features and indices such as glomerular filtration rate (GFR) would make ultrasound even more useful as an early diagnostic tool in CKD since it is readily available. This study therefore sought to determine the relationship between renal ultrasonic measurements and degree of kidney function among adult Nigerians with CKD. Objective This study was aimed at evaluating the spectrum of ultrasonographic features of CKD and assessing its relationship with kidney function. Patients and Methods The study was carried out at the University of Ilorin Teaching Hospital, (UITH) Ilorin. One hundred and sixty one CKD patients consisting of 60 males and 101 females were consecutively recruited into the study from MOPD and Medical wards of UITH, Ilorin, North- Central Nigeria. They were age- and sex- matched with 161 healthy controls recruited from the same hospital community mainly from the pool of patients presenting for medical fitness certification, artisans, patients relatives and hospital staff. The subjects relevant clinical history was obtained and physical examination carried out. Serum creatinine was used to calculate the GFR using Cocroft-Gault equation. They all had renal ultrasound scan that was done by an experienced radiologist. Results The mean age of the patients (45.06 + 13.0 years) was similar to that of the controls (44.5 + 13.7 years). The anthropometric characteristics of patients were significantly higher than that of the controls. Majority of the patients presented in advanced stage of CKD. There were correlation between renal length and volume with the degree of renal function. Also found was a direct relationship between severity of CKD, duration of illness and the degree of renal echogenicity. Male kidneys were larger than females and the left kidney were larger than the right. Conclusion There is strong correlation between renal length and degree of renal function. The renal echogenicity increased with severity and duration of CKD as the renal size decreased. Majority of the patients in their active reproductive age presented with advanced kidney disease.