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

=== Required ===
* '''<span style="color:#ff0000">History and physical</span>'''
* '''<span style="color:#ff0000">Imaging:</span>'''
** '''<span style="color:#ff0000">Regional: multiphase, cross-sectional abdominal imaging</span>'''
*** '''in ALL patients with a solid or complex cystic renal mass''' i.e. ultrasound alone is inadequate imaging of a solid or complex cystic renal mass
** '''<span style="color:#ff0000">Distant: chest x-ray</span>''' in patients with suspected renal malignancy
*** Not indicated in patients with suspected or confirmed benign renal masses
*** <span style="color:#ff0000">'''Indications for CT chest (3):'''</span>
***# <span style="color:#ff0000">'''Pulmonary symptoms'''</span>
***# <span style="color:#ff0000">'''Abnormal CXR'''</span>
***# <span style="color:#ff0000">'''High-risk disease, defined by (5):'''</span>
***##<span style="color:#ff0000">'''Presence of thrombi'''</span>
***##<span style="color:#ff0000">'''Presumed adenopathy'''</span>
***##<span style="color:#ff0000">'''Larger tumor size'''</span>
***##<span style="color:#ff0000">'''Infiltrative appearance'''</span>
***##<span style="color:#ff0000">'''Extensive tumor necrosis'''</span>
* '''<span style="color:#ff0000">Labs (3):</span>'''
*# '''<span style="color:#ff0000">CBC</span>'''
*# '''<span style="color:#ff0000">Urinalysis (including assessment of proteinuria)</span>'''
*# '''<span style="color:#ff0000">Comprehensive metabolic panel (electrolytes, liver function tests, assessment of GFR)</span>'''
*#; '''<span style="color:#ff0000">GFR and degree of proteinuria should be used assign CKD stage''' in patients with a solid or Bosniak 3/4 complex cystic renal mass, as this will influence management</span>
* '''<span style="color:#ff0000">Other</span>'''
**'''<span style="color:#ff0000">Referral for genetic counseling, if indicated</span>'''
*** '''<span style="color:#ff0000">Indications for genetic counseling (5):</span>'''
***# '''<span style="color:#ff0000">Age ≤ 46 years with renal malignancy</span>'''
***# '''<span style="color:#ff0000">Multifocal or bilateral renal masses</span>'''
***# '''<span style="color:#ff0000">Family history (first-or second-degree relative) with a history of renal malignancy</span>'''
***# '''<span style="color:#ff0000">Personal or family history suggests a familial RCC syndrome (even if kidney cancer has not been observed)</span>'''
***# '''<span style="color:#ff0000">Pathology demonstrates histologic findings suggestive of such a familial RCC syndrome</span>'''
***#* Hybrid oncocytic/chromophobe tumors are suggestive of BHD
** '''<span style="color:#ff0000">Referral to nephrology, if indicated</span>'''
*** '''<span style="color:#ff0000">Indications for referral to nephrology in a patient with a renal mass undergoing intervention (4):</span>'''
***# '''<span style="color:#ff0000">Estimated GFR < 45 mL/min/1.73m2</span>'''
***# '''<span style="color:#ff0000">Confirmed proteinuria</span>'''
***# '''<span style="color:#ff0000">Diabetics with pre-existing CKD</span>'''
***# '''<span style="color:#ff0000">When eGFR is expected to be <30 mL/min/1.73m2 after intervention</span>'''