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renal mass
Etiology:
1) renal cysts (65-70%)
2) infected cyst, abscess
3) polycystic kidney disease
4) renal carcinoma
5) angiomyolipoma [5] (<= 1 cm)
Epidemiology:
- 50% of population > 5 years of age has >= 1 renal mass [4]
Clinical manifestations:
- generally asymptomatic, incidental finding
Laboratory:
1) urinalysis
2) serum creatinine, serum urea nitrogen
3) complete blood count, (infection, anemia)
Radiology:
1) ultrasound (0%, 21%, 28%)*
- determines if mass is cystic or solid [1]
2) contrast-enhanced computed tomography (47%, 60%, 75%)*
- involvement of surrounding tissue
- invasion of the renal vein
- regional lymphadenopathy
3) magnetic resonance imaging
* Percentages of renal lesions detected, 0-5 mm, 5-10 mm, 10-15 mm in size, respectively
* < 2% of hyperechoic lesions <= 1 cm in size may represent renal carcinoma [5]
Management:
1) see specific etiology
2) preoperative needle biopsy
a) generally not recommended for resectable lesion
- concern for 'seeding' the pertoneum
b) useful if imaging studies inconclusive
General
mass lesion
kidney disease; renal disease
References
- Medical Knowledge Self Assessment Program (MKSAP) 16,
American College of Physicians, Philadelphia 2012
- Chen DY, Uzzo RG.
Evaluation and management of the renal mass.
Med Clin North Am. 2011 Jan;95(1):179-89
PMID: 21095421
- Agency for Healthcare Research and Quality (AHRQ)
Executive Summary - Feb. 24, 2016
Management of Renal Masses and Localized Renal Cancer
https://www.effectivehealthcare.ahrq.gov/search-for-guides-reviews-and-reports/?pageaction=displayproduct&productID=2186
- Thomas S, Grimm L, Brady MP
Renal Cell Carcinoma: Recognition and Follow-up.
Medscape. April 18, 2016
http://reference.medscape.com/features/slideshow/renal-cell-carcinoma
- Doshi AM et al.
Do incidental hyperechoic renal lesions measuring up to 1 cm
warrant further imaging? Outcomes of 161 lesions.
AJR Am J Roentgenol 2017 Aug; 209:346.
PMID: 28609114
http://www.ajronline.org/doi/10.2214/AJR.16.17490