Bilateral renal parenchymal disease reported on ultrasound scan. What next?

This is a common situation that I as a nephrologist face. An apparently healthy person who recently underwent an “executive” health check-up and was found to have “bilateral renal parenchymal disease- grade1” on the ultrasound scan. Everything else is perfectly normal. The only problem is that the “apparently” healthy person is now extremely anxious with hundreds of questions whizzing through his/her mind :

  • is it dangerous?
  • is it curable?
  • do I need to be on a specific diet for it?
  • will it worsen to renal parenchymal disease grade 2 and above?
  • how well are my kidneys working?
  • do I need any other tests?

This post attempts to answer these questions in a simple and straightforward manner.


Coming to the most important question first—

What is renal parenchymal disease?

Let us start by breaking down the words into easily understandable parts :

bilateralmeans seen in both the kidneys
renalmeans pertaining to the kidney
parenchymalmeans pertaining to the substance of the kidney
diseaseis self-explanatory
Meaning Of Bilateral Renal Parenchymal Disease

So basically, the kidneys on both sides are showing some changes on the ultrasound.


That is what the report means: the kidneys look abnormal on the ultrasound.

Understanding a report of “bilateral renal parenchymal disease” on ultrasound scanning:

Different ultrasound specialists report the scan in different ways. A few more technical terms that are used to report the scan include :

diffuse renal parenchymal disease :

diffuse means present throughout the kidney.

bilateral renal parenchymal disease grade 1/grade 2 /grade 3/grade 4 :

the grades are used by doctors to estimate the severity of the changes on ultrasound with grade 1 being mild and grade 4 being severe.

bilateral renal parenchymal disease with cysts :

cysts are bubble like structures which can be normal in older people. They can be present along with parenchymal disease.

Now that we understand a few basic facts about it, the next all important question arises :

Is renal parenchymal disease dangerous ?

“Renal parenchymal disease” is a term used to describe the appearance of the kidneys on ultrasound. It doesn’t give the complete information about the functioning of kidneys in a given patient. Hence, as a nephrologist, I need more information from blood and urine tests before deciding whether it is dangerous or not.

What are these extra pieces of information that I need? At a minimum, I need to look at urine examination and blood creatinine levels. These tests give information about functioning of the kidney. If they are normal I will reassure the patient and follow up. If they are abnormal then further investigations/treatment are warranted.

One more fact to be aware of is that ultrasound is inherently a very subjective test. There is a lot of interpretation of the images that is involved. Two very experienced doctors can interpret the images very differently. One may say that there is an abnormality and another may not agree. Hence, more information from blood and urine tests are needed to understand the exact significance of the ultrasound findings.

Even the ultrasound reports almost invariably mention : “Kindly correlate with RFT.”

So, the nephrologist(kidney doctor) needs to take all the available information into consideration. These include results of blood tests, urine tests, patient history, physical examination to decide on further course of action. In-fact, nothing can be said about the kidneys based on the ultrasound report alone.

One of the main blood tests that helps us in understanding about kidney disease is blood creatinine levels. I have written this article on “when to worry about creatinine levels” which many people have found very useful.

Lastly, addressing a few more questions about the topic that patients ask me —

What are the symptoms/treatment/diet for renal parenchymal disease?

Like I said above, renal parenchymal disease refers to how the kidneys “look” on ultrasound scans. Even though it includes the word “disease”, it is not a specific disease of the kidney. The treatment/symptoms/diet all depend on how well the kidneys are “working”. So, they are highly variable from patient to patient and need to be advised on an individual basis.

In summary :

  • “Bilateral renal parenchymal disease” on ultrasound only tells about abnormal appearance of the kidneys
  • We need to do kidney function tests/renal function tests to know more about the functioning of the kidneys
  • Further tests may be needed to pinpoint the exact causes and extent of kidney disease

Hope this blog post was useful in clarifying your doubts about the topic. Take care!

I have recently started writing about kidney-related topics in the Hindi language. It may be of interest. The first post was all about uric acid in Hindi language. It received a very good response and then I wrote about किडनी ख़राब होने के लक्षण और कारण(kidney failure symptoms and causes in Hindi). Please have a look and provide your feedback.

82 thoughts on “Bilateral renal parenchymal disease reported on ultrasound scan. What next?”

    • Every patient is unique. Will be difficult to give exact diet advice without further details. Please consult a nephrologist/dietician near you.

      • 24 years old female diagnosed on ultrasound IMPRESSION: Bilateral renal parenchymal disease, requires further evaluation with renal function tests. Borderline sized spleen. No other gross abnormality identified.

        Creatinine is 6.5 and is on dialysis since two months .
        Please Answer as urine output is three times in a day.
        1. Which imagine test should we go CT scan with or without Contrast or MRI MRA ?
        2. Is this disease curable and can Kidneys function be recovered or not ?

  1. Thanks doc for enlightenment about the result of my ultrasound..
    The statement is normal sized bilateral kidneys with diffuse parenchymal disease.. I hope you will enlighten me more. Coz im only 27 years old.. ????

  2. Thank you doctor. Very well explained. My husband is 64yrs and this is what was mentioned on his us scan of KUB. Creatinine is at3.17 and egfr at 20. He is taking HB pressure medi and atorva for Cholesterol. Also on sodium bicarbonate and another medi for uric acid. Your kind advise please. Thank you very much!

    • Glad to know that the blog post was of help. Since the creatinine is high, you need to be on regular follow-up with a nephrologist.

  3. Excellent and comforting explanation. I am dealing with exactly this situation right now. I see a Specialist this Tuesday. I thought I was in big trouble before reading your excellent explanation. Thank very much!!!! My protein is 145mg/24 hrs & 4mg/dL. GFR 87, Creatinine 0.88mg/dL, BUN 15, BUN/Creatinine Ratio 17. My Ultrasound said I have Medical Renal Disease based the increased renal parenchymal echogenicity. What do you think?? Thanks again!!!! God Bless

    • Hi. Thanks for the comment. Glad to know that you found the post useful. I refrain from providing specific medical advice on the blog as it is not right to do so. Overall your reports appear to be fine but you still need to follow-up with your primary physician. All the best!

  4. thank you was very useful .my brother was

    diagnosed with bilateral renal parenchyma..waiting to get the urine and blood results tomorrow.I pray all is well

  5. डॉक्टर साहब आपका पूरा लेख मैंने पढ़ा बहुत ही अच्छा लगा और किडनी पेशेंट के लिए बहुत ही लाभदायक इंफॉर्मेशन आपने दी है इस प्रकार के लेख पढ़ने को बहुत कम मिलते हैं आपने किडनी के मरीजों के लिए एक संजीवनी बूटी तैयार कर दी है जिसे पढ़कर कर उन्हें हौसला आता है और जीने का मन करता है मैं भी उनमें से एक पेशेंट हूं आपका बहुत-बहुत धन्यवा

  6. Doctor, Wonderful. It has very detail explanation. Any non medical person can also understand with full clarity. We really appreciate for educating a comman man on medical.

  7. Thank you very much sir for this wonderful piece, it really widen up my knowledge on this particular subject matter because this is exactly what I was looking for. God bless you!

  8. Thanks Doctor. My dad is 65 years and he was diagnosed with Bilateral Chronic renal parachymal disease (grade 3). I want to know what he will eat and things to avoid please doctor. Help me. I don’t want my daddy to die.

    • Hello Mr.David. The exact diet depends on other parameters also like blood creatinine levels,etc. I will advise to consult a local dietician/nephrologist to get a personalized diet chart. Wish your dad all the best!

  9. Sincerely I’m a bit relieved 🥂🙏.
    I appreciate this piece. I’ve been battling with my scan result of 8.11-3.30cm and 10.6-4.44cm right and left respectively
    But after reading this I feel a better and confident. God bless you.
    Please can I talk to you privately

    • Mr.Precious — sorry for the late reply. Glad that the post is useful. You can email us if you still need to talk to Dr.Prashant C Dheerendra.

  10. Your most valuable blog has given me an insight to my ongoing problem with my kidney functioning. Thanks for your public service.

    • Hi. It only means an abnormal appearance of the kidneys on ultrasound. You will need more tests to understand the real significance.

  11. Sir, your explanation is excellent. Even a layman can understand after breaking down the different medical terminologies. Sir, can you help me to understand the general time gap ( days or months or years) taken for transformation of bilateral renal parenchymal disease- grade1 to grade 3.

  12. How you classify as Grade1 or 2 or 3 or 4 B/L Renal Parenchyma L disease.What is Egfr and VIT D tests.

    • Grades are based on the doctor’s assessment with grade 1 being mild and grade 4 being severe. Egfr test is for kidney function and vit-d is for measuring vit-d levels in the body.

  13. सकारात्मक प्रतिक्रिया के लिए आपका बहुत-बहुत धन्यवाद।

  14. Hello doctor,

    I have bilateral renal parenchymal changes. However, my creatinine is 0.95 and urine report is normal. I’m 26 years old. Should I be worried? I think I should get the test done from a different place.

    I had bladder issues which I had to undergo surgery for. My PVR was always 100+. Now, I’m doing better with just 30ml PVR.

  15. Hi doc,
    Im 33 years old diagnosed with bilateral renal parenchymal diseass with 1.2 creatinine and +1 protein in urine. Is this treatable?

  16. Very Helpful! Btw, just a quick/long question. Does bilateral renal parenchymal mean it’s CKD? I was diagnose with bilateral renal parenchymal to consider Pyelonephritis. I had blood in urine and my creatinine reached borderline during my diagnosis But after few days of treatment blood is gone in urine and creatinine is back to normal. The doctor advised me to come back after 3 months to repeat some tests. I am really worried of the word CKD, need your enlightenment please. I’m also suffering from anxiety disorder and this finding really is making it worse.


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