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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.

bilateral-renal-parenchymal-disease-ultrasound-picture
The ultrasound picture looks something like this

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

  • bilateral: means seen in both the kidneys
  • renal: means pertaining to the kidney
  • parenchymal: means pertaining to the substance of the kidney
  • disease: is self-explanatory

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

THAT’S IT!

That is what the report means: the kidneys look abnormal on the ultrasound. Ultrasound doesn’t give any information about the working of the kidneys.

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.

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.

Hence, the most important question is : How well are the kidneys working? The answer to that question comes from two other simple test: blood levels of urea and creatinine. These tests are collectively called as “kidney function tests(KFT)” or “renal function tests(RFT).”

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

So, if these blood tests are normal, then your nephrologist will not give too much importance to the changes on ultrasound. On the other hand, if these tests are abnormal, then further testing/evaluation may be necessary.

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!