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.

18 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.


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