Renal Parenchymal Disease

What is renal parenchymal disease?

Renal parenchymal disease is a group of conditions that damage your kidneys’ parenchyma (puh-RENG-kuh-muh). The parenchyma includes the parts of the kidney that helps them function. The two major parts of your renal parenchyma include the:

• Renal cortex. This is the outer part of your kidneys, where your nephrons begin. Your nephrons are very small filters for your blood that have two parts. One part is a blood vessel (glomeruli) and the other is a tube (renal tubules). Your glomeruli are the first stage of blood filtration. Your renal tubules reabsorb water, nutrients and minerals and remove wastes when you urinate (pee). Your renal cortex also creates erythropoietin (EPO). EPO is a hormone that helps make red blood cells in your bone marrow.
• Renal medulla. This is the inner part of your kidneys. It contains most of your nephrons.

Healthcare providers describe any conditions that affect your renal cortex or renal medulla as renal parenchymal disease. Other names for renal parenchymal disease include:

• Bilateral renal parenchyma diseases
• Kidney parenchymal disease
• Renal parenchyma of the kidney

What are the types of renal parenchymal disease?

When renal parenchymal disease starts suddenly, healthcare providers call it acute renal parenchymal disease. They call it chronic renal parenchymal disease when it develops slowly and lasts a long time.

Is renal parenchymal disease dangerous?

It depends on the cause. Mild cases of renal parenchymal disease may get better with treatment. Severe cases may cause kidney failure. Kidney failure is fatal without treatment.

What are the early warning signs of renal parenchymal disease?

The early stages of renal parenchymal disease don’t usually have warning signs. But as the disease gets worse and your kidneys stop working as well, you may develop symptoms, like:

• Blood in your pee (hematuria)
• Dry and itchy skin
• Feeling very tired (fatigue)
• Loss of appetite
• Low red blood cell levels (anemia)
• Nausea and vomiting
• Peeing more than usual
• Puffy eyes
• Swelling in your hands, feet and ankles (edema)

What causes renal parenchymal disease?

The most common causes of chronic renal parenchymal disease include high blood pressure and diabetes. But other conditions that may cause chronic renal parenchymal disease include:

• Autoimmune diseases, including lupus nephritis
• Glomerulonephritis
• Kidney cancer
• Polycystic kidney disease
• Sickle cell disease

Acute renal parenchymal disease causes may include:

• Anaphylaxis
• Bacterial infections
• Kidney stones
• Kidney tumors
• Pulmonary embolism
• Severe dehydration
• Viral infections

Some medications may also cause acute renal parenchymal disease, including:

• Angiotensin-converting enzyme (ACE) inhibitors
• Angiotensin II receptor blockers (ARBs)
• Nonsteroidal anti-inflammatory drugs (NSAIDs)

Who does renal parenchymal disease affect?

Anyone can get renal parenchymal disease. But you may have a greater risk if you have:

• A family history of renal parenchymal disease
• Diabetes
• Heart disease
• High blood pressure

You may also have a greater risk of developing renal parenchymal disease if you’re over 60 and regularly take over-the-counter (OTC) and prescription NSAIDs.

What are the complications of renal parenchymal disease?

Renal parenchymal disease complications may include:

• A buildup of acids in your body fluids (metabolic acidosis)
• High levels of phosphate (phosphorus) in your blood (hyperphosphatemia)
• High levels of potassium in your blood (hyperkalemia)
• Low red blood cell count
• Painful buildup of uric acid in your joints (gout)
• Weak bones (osteoporosis)
• Weakened immune system

How is renal parenchymal disease diagnosed?

A healthcare provider will review your medical history, ask about your symptoms, ask what medications you’re taking and conduct a physical exam. If they suspect renal parenchymal disease, they’ll order tests to confirm their diagnosis, which may include:

• Kidney function tests. These include blood tests and pee tests (urinalyses). Blood tests measure your estimated glomerular filtration rate (eGFR) and serum creatinine level (creatinine clearance test). Pee tests look for protein (proteinuria) and blood in your pee.
• Imaging tests. These help providers take a detailed look at your kidneys’ size and structure. They may order an ultrasound, MRI (magnetic resonance imaging) or CT scan (computed tomography scan).
• Kidney biopsy. A provider will take a small sample of your kidney tissue and study it in a lab. A kidney biopsy can reveal information that kidney function and imaging tests can’t identify.

How is renal parenchymal disease treated?

Renal parenchymal disease treatment depends on a number of factors, including:

• The exact cause and severity of renal parenchymal disease
• Your age and overall health

Your treatment options may include:

• Avoiding NSAIDs and other medications that may make renal parenchymal disease worse
• Avoiding tobacco, including smoking, vaping and chewing tobacco
• Getting regular physical activity
• Maintaining a weight that’s healthy for you
• Taking medications to help manage blood pressure, cholesterol and diabetes
• Working with a renal dietitian to come up with kidney-friendly eating patterns that limit protein, reduce blood cholesterol levels and limit salt (sodium) and potassium

Severe renal parenchymal disease may require:

• Corticosteroids
• Dialysis
• Immunosuppressants
• Kidney transplant

Can renal parenchymal disease be prevented?

You can’t prevent all causes of renal parenchymal disease. But you may be able to reduce your chances by:

• Being active for at least 30 minutes five days a week
• Limiting your alcohol consumption
• Maintaining a healthy weight for you
• Making regular visits to a healthcare provider if you have a high risk of renal parenchymal disease
• Quitting smoking
• Reducing your salt consumption
• Taking NSAIDs only as directed

What can I expect if I have renal parenchymal disease?

You’ll need to work with your treatment team to slow kidney damage for as long as possible. This may include:

• Maintaining kidney-healthy eating patterns
• Monitoring your blood sugar and blood pressure
• Regularly scheduling appointments with a kidney specialist (nephrologist) to monitor your kidney health
• Taking your medications exactly as your provider prescribes them

What is the life expectancy of a person with renal parenchymal disease?

If you have renal parenchymal disease, your life expectancy depends on the severity of the disease, your age, sex assigned at birth and overall health. Your life expectancy is lowest if you have severe kidney damage. If you’re on dialysis, the average life expectancy is 5 to 10 years.

Talk to a healthcare provider. They can give you a better idea of what to expect according to these factors.

What is the life expectancy of someone with end-stage renal disease?

The average life expectancy of someone with end-stage renal disease is 5 to 10 years. But many people live longer than that with proper treatment or a kidney transplant. Many people live 20 to 30 years after a provider diagnoses them with end-stage renal disease.

What foods should be avoided with renal parenchymal disease?

It’s important to talk to a renal dietitian if you have renal parenchymal disease. They’ll work with you to develop an eating plan that helps support your kidney health. You should avoid foods that have salt, protein, phosphorus and potassium. This may include:

• Avocados
• Bananas
• Canned foods
• Chips and pretzels
• Citrus fruits and juices, including oranges
• Dried fruits
• Processed meats
• Spinach

When should I see a healthcare provider?

Schedule regular appointments with a healthcare provider if you have diabetes, high blood pressure or another disease that may lead to renal parenchymal disease. Early detection and an understanding of your risks can help prevent kidney damage from getting worse.

When should I go to the ER?

Renal parenchymal disease symptoms typically don’t appear until kidney damage is severe. Reach out to a provider right away if you:

• Develop frequent muscle cramps
• Don’t have an appetite
• Feel very tired
• Have difficulty focusing or sleeping
• Have itchy skin
• Have hiccups that won’t go away
• Have swelling in your hands, ankles or feet
• Pee more or less than usual

What questions should I ask a healthcare provider?

It may be helpful to ask your provider:

• How do you know I have renal parenchymal disease?
• How severe is it?
• What treatment do you recommend?
• What can I do to help take care of my kidneys?
• Can you recommend a renal dietitian?
• Can you recommend a support group for people with renal parenchymal disease?

Can you live 20 years with stage 3 kidney disease?

It depends on your age. But on average, if you’re assigned male at birth (AMAB) and have stage 3 kidney disease, your life expectancy is about 24 years. If you’re assigned female at birth (AFAB) and have stage 3 kidney disease, your life expectancy is about 28 years.

How long does it take to go from stage 4 kidney disease to stage 5?

One study shows that, on average, people spend over four years in stage 4 kidney disease before it progresses to stage 5.