Pediatric obesity is a growing global health concern, associated with metabolic, cardiovascular, and kidney complications. Early identification and intervention are crucial to preventing long-term morbidity. This review examines the epidemiology, pathophysiology, and clinical implications of childhood obesity, focusing on its impact on kidney health. We discuss non-invasive diagnostic tools, including kidney ultrasound, and evidence-based management strategies. Obesity in children is linked to hypertension, insulin resistance, and early signs of kidney dysfunction, including increased kidney echogenicity and hyperfiltration. Ultrasound findings may serve as early markers of kidney involvement, potentially guiding risk stratification and intervention. Addressing pediatric obesity requires a multidisciplinary approach, incorporating lifestyle modifications, medical management, and early detection of organ damage. The aim of this narrative review is to summarize the pathophysiology of pediatric obesity-related kidney damage, current evidence on ultrasound-based screening, and possible diagnostic techniques. Further research is needed to validate ultrasound as a routine screening tool for obesity-related kidney disease in children.