By using a microbubble contrast agent and contrast-specific imaging software, the contrast-enhanced ultrasound (CEUS) is able to depict the micro and macrocirculation of the target organ. A review of the peer reviewed literature was done regarding the current role of ultrasound CEUS imaging in the evaluation of renal pathology with reference to the diagnosis of renal ischaemia, in the characterization of complex cystic lesions and in those with equivocal enhancement at CT. CEUS provides information on tissue perfusion and may play a role in kidney mass characterization similar to the role of contrast-enhanced CT and MRI. In this context, the characterization of cystic lesions is probably the most consolidated field of application of contrast agents on kidney ultrasound imaging. Finally, CEUS provides a good alternative to CT, especially in patients with contraindications to iodinated contrast agents. The usefulness of CEUS in these applications is confirmed by extensive literature production and this article focuses on the potential clinical applications of recent advances in CEUS technology in urology.