I’m lvl 100, all regions 100% done and I have 222 paragon points.
getting to tier 5 on all regions is possible while still missing some Lilith altars.
There are 4 Lilith altars that give paragon points. they have nothing to do with renown levels and as i said, you can still get tier 5 without them.
check to make sure you have ALL Lilith altars.