New practice guidelines for localized renal masses

The new guidelines reflect important changes to the evaluation and management of localized renal masses.

Steven Campbell, MD, PhD
Steven Campbell, MD, PhD

The literature on the evaluation, management and surveillance of renal masses and localized renal cancers has been evolving rapidly in recent years and so have AUA guidelines.

A new guideline published in January 2021 combines and updates two earlier guidelines on follow-up for clinically localized renal neoplasms (2013) and on evaluation and management of renal masses and localized renal cancer (2017). Four of the recent guideline authors will discuss the updated guideline during “Evaluation and Management of Localized Renal Masses: A Case-Based Approach” on Friday afternoon.

“Practice patterns in evaluating and managing localized renal masses vary considerably,” said course director Steven Campbell, MD, PhD. “There is so much new information, even for the statements that were carried forward from the two earlier guidelines, that this new guideline brings new perspectives that will be very useful for urologists in their daily practice.”

Dr. Campbell is the lead author on the new guideline and professor of surgery at the Cleveland Clinic Glickman Urological and Kidney Institute. Course faculty include Robert G. Uzzo, MD, MBA, chair of surgical oncology at Fox Chase Cancer Center in Philadelphia; Phillip M. Pierorazio, MD, associate professor of urology and oncology at the Brady Urological Institute at Johns Hopkins University in Baltimore; and Christopher J. Weight, MD, MS, center director of urologic oncology at Cleveland Clinic.

The guideline panel conducted a comprehensive review of all evidence on the evaluation and management of localized renal masses published since the original guidelines. Dr. Campbell noted that there have been important changes to both the evaluation and the management of localized renal masses.

On the evaluation side, the current literature supports the use of MRI with contrast even in patients with severe chronic kidney disease or end-stage renal disease. The indications and rationale for active surveillance for patients with renal lesions are more granular than in earlier guidelines, and follow-up parameters for patients on active surveillance are more clearly defined.

The indications and considerations for renal mass biopsy are also more clearly defined. The new guideline gives clinicians expanded, more sharply focused indications for genetic counseling in specific subsets of patients.

Current recommendations emphasize the importance of partial nephrectomy and nephron-sparing surgical approaches over radical nephrectomy whenever possible. However, some patients are better served by radical nephrectomy and the guidelines now provide more granular recommendations regarding this issue.

For the first time, risk-based protocols for surveillance after intervention have been merged with recommendations for evaluation and management. In the past, surveillance was addressed in a separate document. Dr. Campbell noted that combining the three elements of evaluation, management and follow-up into a single document will make the new guideline more useful and accessible in daily practice.

“We would like to see more rational use of partial and radical nephrectomy and a better understanding of when to consider sending patients for genetic counseling,” Dr. Campbell said. “We are hoping that incorporating the risk-based surveillance protocols will be of added utility for the urologist in general practice.”

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