From the Research
For an incidental finding of renal cortical scarring on CT scan in a patient without urinary complaints, follow-up is recommended to assess and monitor kidney function, as renal scarring can be associated with hypertension and progressive kidney disease. The patient should undergo a comprehensive metabolic panel (CMP) to evaluate kidney function, particularly blood urea nitrogen (BUN) and creatinine levels, as serum creatinine levels can reflect renal excretion, generation, intake, and metabolism 1. Additionally, a urinalysis should be performed to check for proteinuria, hematuria, or signs of infection. Consider a urine protein-to-creatinine ratio to quantify any protein excretion. Blood pressure measurement is crucial as renal scarring can be associated with hypertension. If kidney function is abnormal or there is significant proteinuria, referral to a nephrologist is warranted. Renal cortical scarring typically represents permanent damage from previous inflammation, infection (such as pyelonephritis), or reflux nephropathy, and while the scarring itself cannot be reversed, monitoring kidney function is essential to prevent further deterioration, as emphasized by the importance of clinical reasoning in the era of evidence-based medicine 2. The patient should be educated about maintaining adequate hydration and promptly treating urinary tract infections to prevent additional kidney damage, following the principles of evidence-based research to ensure worthwhile and valuable clinical practice 3.
Some key points to consider in the follow-up of renal cortical scarring include:
- Obtaining a CMP to assess kidney function
- Performing a urinalysis to check for proteinuria, hematuria, or signs of infection
- Measuring blood pressure to assess for hypertension
- Referring to a nephrologist if kidney function is abnormal or there is significant proteinuria
- Educating the patient on maintaining adequate hydration and promptly treating urinary tract infections
- Annual monitoring of kidney function and blood pressure if kidney function is normal and there is no proteinuria, as this approach is supported by the precautionary principle, which suggests erring on the side of caution in the absence of certainty 4, 5.