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kidney neoplasm
Etiology:
- Malignant tumors
- renal cell carcinoma
- squamous cell carcinoma of the collecting system
- transitional cell carcinoma of the renal pelvis or collecting system
- metastatic tumor from another primary site
- breast, lung, adrenal
- fibrosarcoma
- lymphoma
- nephroblastoma
- Benign masses
- renal calculi/nephrolithiasis [kidney stones]
- acute focal bacterial nephritis
- renal tuberculosis
- infrarenal hematoma
- multi-locular renal cyst
- angiomyolipoma
- oncocytoma
- renal adenoma
Pathology:
- the only reliable way to rule out renal cell carcinoma is to remove the entire lesion surgically & examine the complete specimen
- biopsy of renal mass is of little, if any, role in ruling out renal cell carcinoma
Clinical manifestations:
- symptoms
- flank pain (40-50%)
- blood-tinged urine - most common presenting complaint
- report of palpable mass in flank
- night sweats
- bone pain (suggests metastasis)
- fatigue
- unintentional weight loss
- signs
- hematuria (gross or microscopic)
- fever of undetermined origin (FUO)
- left varicocele (sudden onset)
- paraneoplastic syndrome
- neuromyopathy
- protein-losing enteropathy
Laboratory:
- Urinalysis for hematuria
- Complete blood count (CBC)
- hypochromic anemia
- erythrocytosis with paraneoplastic syndrome
- liver function tests
- serum alkaline phosphatase (serum ALP)
- serum gamma glutamyl transferase (serum GGT)
- abnormal liver enzyme results may indicate metastatic disease
- diminished serum albumin with protein-losing enteropathy
- serum Ca+2 may be increases with paraneoplastic syndrome
Radiology:
- bone scan is indicated if serum alkaline phosphatase (ALP) is abnormal
- computed tomography (CT) scan
- areas of fat identified in the tumor during abdominal CT, suggest angiomyolipoma
- abdominal CT provides staging information including
- extent of disease
- liver metastasis
- inferior vena cava (IVC) disease.
- head or chest CT if metastases suspected
- chest x-ray (CXR) (rule out pulmonary metastases)
- abdominal ultrasound (US)
- differentiating between cysts & masses
- abdominal magnetic resonance imaging (MRI)
- if CT scan is indeterminate in ruling out inferior vena cava (IVC) disease.
Management:
- see specific etiology
- angiomyolipoma (unequivocal diagnosis on CT scan)
a) if lesion <4 cm, observation is appropriate
b) if the lesion equals > 4 cm & patient is asymptomatic, observation may be appropriate
c) if the lesion > 4 cm & the patient is symptomatic
- angiographic embolization or surgical removal
- solid renal mass, seen on radiographic studies without evidence of systemic spread of the neoplasm
a) partial (nephron-sparing) or radical nephrectomy
b) alternately, percutaneous biopsy & pathology analysis
c) percutaneous cryoablation may be indicated for incidental renal neoplasm in poor surgical candidate [1]
Interactions
disease interactions
Specific
malignant kidney neoplasm (kidney cancer)
renal oncocytoma; renal oxyphilic adenoma
General
kidney disease; renal disease
urologic neoplasm
References
- Atwell TD et al,
Percutaneous renal cryoablation: Experience treating 115
tumors.
J Urol 2008, 179:2136
PMID: 18423719