Counseling a patient with a kidney mass

A urologist should lead the counseling process and should consider all management strategies. A multidisciplinary team should be included when needed.

Counseling should include current perspectives about tumor biology and a patient-specific oncologic risk assessment. For cT1a tumors, the low oncologic risk of many small renal masses should be reviewed.

Counseling should review the most common and serious urologic and non-urologic morbidities of each treatment pathway and the importance of patient age, comorbidities/frailty, and life expectancy.

Physicians* should review the importance of kidney functional recovery related to kidney mass management, including risk of progressive CKD, potential short/long-term need for dialysis, and long-term overall survival considerations.

Consider referral to nephrology in patients with a high risk of CKD progression, including those with GFR <45 mL/minute/1.73 m², confirmed proteinuria, diabetics with preexisting CKD, or whenever GFR is expected to be <30 mL/minute/1.73 m² after intervention.

Genetic counseling to assess for a hereditary kidney cancer syndrome is recommended for the following clinical scenarios:

All patients with kidney cancer ≤46 years of age
Multifocal or bilateral lesions
A personal or family history suggesting an inherited kidney cancer syndrome
A first- or second-degree relative with a history of kidney cancer or a known clinical or genetic diagnosis of a hereditary kidney cancer syndrome (even if kidney cancer has not been observed)
If the patient's pathology demonstrates histologic findings suggestive of a hereditary kidney cancer syndrome

CKD: chronic kidney disease; GFR: glomerular filtration rate.

* Based on patient and tumor characteristics, a multidisciplinary team may include (but is not limited to) nephrology, diagnostic and interventional radiology, pathology, medical oncology, and genetics.

Adapted with permission of AUA from: Campbell SC, Clark PE, Chang SS, et al: Renal Mass and Localized Renal Cancer: Evaluation, Management, and Follow-Up: AUA Guideline Part I. J Urol 2021; 206: 199. Copyright © 2021 American Urological Association.

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Counseling a patient with a kidney mass