Assessment of chronic kidney disease is very difficult and is usually detected using renal biopsy which is an invasive procedure and may results in complications. A new image technique Short Wave Elastography (SWE) is now under development to measure kidney elasticity, and to assess the capability of detecting kidney diseases at earlier stages. Contemporary investigations have delineated Human Epididymis Protein 4 (HE4) as a progressive oncological biomarker instrumental in monitoring ovarian cancer recurrence among women. Concomitantly, enhanced expression of the HE4 gene has been observed in myofibroblasts implicated in fibrotic processes, indicating its prospective significance as a diagnostic marker for renal fibrosis. The aim of our study is assessment of (SWE) for measuring the degree of fibrosis in the kidney as noninvasive method for diagnosis of fibrosis in patients with chronic kidney disease (CKD) whether dialysis or pre-dialysis patients and measurement HE4 protein level in CKD patients and assessment of using it as a biomarker of renal fibrosis and correlation between HE4 level and degree of fibrosis in CKD patients. Methods: In this investigation, a cohort of ninety-three individuals was scrutinized, comprising sixty-two patients diagnosed with CKD. This patient cohort was stratified into two groups: thirty individuals receiving conservative pre-dialysis care and thirty-two undergoing hemodialysis. A control group consisting of thirty-one subjects, matched for age and sex with the patient cohort, was also included. Renal stiffness was assessed utilizing SWE imaging techniques, and levels of HE4 were quantitatively measured in the sera of all participants employing ELISA methodologies. Results: SWE exhibits proficiency in detecting renal fibrosis in CKD patients, although it fails to discern distinct CKD stages classified by GFR. Conversely, HE4 holds potential as a diagnostic biomarker for the assessment of fibrotic progression in CKD cohorts