MDCalc

RENAL Nephrometry Score

Categorizes renal masses by complexity for surgical decision-making.

Use cross-sectional imaging (CT or MRI, not ultrasound).

Radius (cm)
Largest diameter in any single plane
Exophytic/endophytic
% mass exophytic (protruding out) vs. endophytic (contained) relative to renal parenchyma
Nearness to collecting system or sinus (mm)
Measure shortest distance
Anterior/posterior
Primary location of tumor relative to coronal plane at level of hilar vessels
Location relative to polar lines
Hilar tumor
Touching renal artery or vein

Result:

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Advice

Consider competing risks of morbidity and mortality, oncologic prognosis, and patient preference to inform decision-making and to risk-stratify management strategies.

Management

Management of small renal masses:

  • Management strategies typically include:
    1. Surgical intervention.
      • Partial nephrectomy (PN).
        • Minimally invasive surgery (MIS) vs. open surgery.
      • Radical nephrectomy (RN).
        • MIS vs. open.
    2. Ablative intervention.
      • Cryoablation.
      • Radiofrequency ablation.
    3. Active surveillance (structured expectant management)
  • Impact of RENAL score on surgical decision-making:
    1. PN vs. RN: Higher complexity score more likely to undergo RN.
    2. MIS vs. open: High complexity scores more likely to undergo open surgical approaches.
    3. Active surveillance vs. intervention: High complexity score more likely to undergo surgical intervention.
Critical Actions

Not to be used with ultrasound imaging—requires cross-sectional imaging (i.e., CT or MRI).

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