Editing Renal Mass and Localized Renal Cancer (2021) (section)

==== Investigations ====

*'''History and physical exam'''
* '''Laboratory (2):'''
*# '''Serum creatinine, eGFR'''
*# '''Urinalysis'''
** Other laboratory evaluations (e.g., complete blood count, lactate dehydrogenase, liver function tests, alkaline phosphatase and calcium level) may be obtained at the discretion of the clinician or if advanced disease is suspected.
** With significant nephron mass loss, hyperfiltration can occur resulting in glomerular damage, exacerbation of proteinuria and progressive sclerosis with further decline in GFR., Therefore, repeat assessment of blood pressure, eGFR, and proteinuria should be performed soon after nephrectomy then again in 3-6 months to assess for development or progression of CKD
** Patients found to have progressive renal insufficiency or proteinuria should be referred to nephrology
* '''Imaging'''
** '''Regional'''
*** '''Abdominal imaging'''
**** '''CT or MRI pre- and post-intravenous contrast preferred'''
**** See schedule below
** '''Distant'''
*** '''Chest'''
**** See schedule below
*** Bone scan
**** Not indicated in routine follow-up of treated malignant renal mass
**** Indications (3):
****# Bone pain
****# Elevated alkaline phosphatase
****# Radiographic findings suggestive of a bony neoplasm
*** CT/MRI brain and/or spine
**** Not indicated in routine follow-up of treated malignant renal mass
**** Indication (1):
****# Acute neurological signs or symptoms
** Other
*** Additional site-specific imaging can be ordered as warranted by clinical symptoms suggestive of recurrence or metastatic spread
*** Positron emission tomography (PET) scan should not be obtained routinely but may be considered selectively.
** '''Patients with findings suggesting a new renal primary or local recurrence of renal malignancy should undergo metastatic evaluation including chest and abdominal imaging.'''