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      Calc Function

    • Calcs that help predict probability of a diseaseDiagnosis
    • Subcategory of 'Diagnosis' designed to be very sensitiveRule Out
    • Disease is diagnosed: prognosticate to guide treatmentPrognosis
    • Numerical inputs and outputsFormula
    • Med treatment and moreTreatment
    • Suggested protocolsAlgorithm





    Chief Complaint


    Organ System


    Patent Pending

    Fuhrman Nuclear Grade for Clear Cell Renal Carcinoma

    Provides prognostic grading system for tumor cells based on physical cellular appearance.
    When to Use
    Why Use

    Patients with clear cell RCC and pathology assessment available.

    The Fuhrman Nuclear Grade is a pathology component of renal cell cancers and an independent predictor of cancer-specific survival. Virtually all data are from chart or database reviews and predate modern targeted therapies, but typically worsening nuclear grade correlates with worsening prognosis.

    There are no validated scoring systems for predicting survival in clear cell RCC. Using the Fuhrman grade or scoring systems that integrate it may help delineate categories of survival time better than clinical judgment alone.

    Small (~10µm)
    Larger (~15µm)
    Even larger (~20µm)
    Round, uniform
    Irregularities in outline
    Obvious irregular outline
    Absent, inconspicuous
    Visible at x400
    Prominent at x100


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    Next Steps
    Creator Insights


    The Fuhrman grade, like most other predictors for clear cell RCC prognosis, has not been prospectively tested and validated. However retrospective findings across studies are fairly consistent and Fuhrman grade is now a necessary component of some other scoring systems. The numerical survival estimates, it should be noted, are likely to be different in patients receiving targeted modern therapy.


    We are unaware of validated management algorithms using the score.

    Critical Actions

    The Fuhrman grade is not known to be accurate for individual survival prediction and should be considered a general guide rather than a reliable predictor. Consistency in pathological grading is critical.

    About the Creator
    Dr. Susan A. Fuhrman
    Are you Dr. Susan A. Fuhrman?
    Dr. Nathalie Rioux-Leclercq
    Are you Dr. Nathalie Rioux-Leclercq?