Learning objectives
Understanding the workings and usefulness of R.E.N.A.L.
Nephrometry Score,
a cross-sectional imaging based systematic approach to help characterize renal masses and its complexity using images from (multiphasic contrast-enhanced) CT or MRI (preferably with,
possibly without contrast).
Background
Renal tumors are relatively common findings in daily clinical practice,
either incidentally discovered in cross sectional studies performed for other purposes or when investigating related signs and symptoms such as hematuria or flank pain.
Recent literature suggests a growing incidence which can,
at least in part,
be explained by technological advances and widespread availability of imaging studies.
Also noted is a tendency for increased detection of smaller tumors,
easy to understand in light of the same reasons stated above.
Renal cell carcinoma is the third...
Findings and procedure details
RENAL,
first developed by Kutikov and Uzzo in 2009,
is an acronym that encompasses 5 major anatomic considerations which determine surgical complexity associated with Nephron Sparing Surgery:
“R”adius (actually,
diameter in cm) is an obvious choice and illustrates the size of the tumor measured in cm at its widest diameter,
with categories dividing tumors smaller than 4cm,
between 4 and 7cm and over 7cm into 1,
2 or 3 points respectively (Fig.
1).
Some studies show this to be the parameter with higher interobserver consistency...
Conclusion
R.E.N.A.L.
Nephrometry Score is a useful scoring system that combines five of the most important tumor anatomic considerations and aims to help urologists plan surgical procedures according to a standardized approach,
attempting to make surgical options less subjective and offering up a solid base for future comparative studies.
Given the system’s reliance on cross-sectional imaging,
Radiologists are placed in a prime position to help guide and optimize patient care in order to strive for the highest possible rate of Nephron Sparing Surgery and a lower...
References
Parsons RB,
Canter D,
Kutikov A,
Uzzo RG.
RENAL nephrometry scoring system: the radiologist's perspective.
AJR Am J Roentgenol.
2012;199(3):W355-9.
Canter D,
Kutikov A,
Manley B,
et al.
Utility of the R.E.N.A.L.
nephrometry scoring system in objectifying treatment decision-making of the enhancing renal mass.
Urology.
2011;78(5):1089-94.
Aaron W.
P.
Maxwell,
Grayson L.
Baird,
Jason D.
Iannuccilli,
William W.
Mayo-Smith,
and Damian E.
Dupuy.
Renal Cell Carcinoma: Comparison of RENAL Nephrometry and PADUA Scores with Maximum Tumor Diameter for Prediction of Local Recurrence after Thermal Ablation....