Surgery for a kidney mass

Partial nephrectomy (PN) and nephron-sparing approaches

Prioritize PN for the management of the cT1a kidney mass when intervention is indicated.

Prioritize nephron-sparing approaches for patients with an anatomic or functionally solitary kidney, bilateral tumors, known familial RCC, preexisting CKD, or proteinuria.

Consider nephron-sparing approaches for patients who are young, have multifocal masses, or have comorbidities that are likely to impact kidney function in the future.

Radical nephrectomy (RN)

Clinicians should offer RN whenever increased oncologic potential is suggested by increased tumor size, kidney mass biopsy, and/or imaging characteristics. In this setting, RN is preferred if all of the following criteria are also met:

High tumor complexity such that PN would be challenging even in experienced hands.
No preexisting CKD or proteinuria.
Normal contralateral kidney and new baseline eGFR will likely be >45 mL/min/1.73 m² even if RN is performed.

Patients who do not meet all these criteria should alternatively be evaluated for PN unless there are overriding concerns about the safety and oncologic efficacy of PN.

RCC: renal cell carcinoma; CKD: chronic kidney disease; eGFR: estimated glomerular filtration rate.

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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Surgery for a kidney mass