From the Research
Incidental multifocal renal cortical scarring found on CT scan in asymptomatic patients generally requires conservative observation without specific intervention, with a focus on monitoring renal function and addressing any underlying conditions that may impact kidney health. The management of such cases should prioritize the assessment of renal function through serum creatinine and estimated glomerular filtration rate (eGFR), along with urinalysis to check for proteinuria or hematuria 1. Blood pressure measurement is also crucial as hypertension can both cause and result from renal scarring.
Key Considerations
- Baseline assessment of renal function with serum creatinine and eGFR
- Urinalysis to check for proteinuria or hematuria
- Blood pressure measurement and management if necessary
- Follow-up imaging at 6-12 month intervals initially to ensure stability of the scarring pattern
Given the lack of strong, recent evidence directly addressing the management of incidental multifocal renal cortical scarring in asymptomatic patients, the approach is largely based on general principles of nephrology and the management of chronic kidney disease. The most recent study 1 highlights the importance of accurate assessment of kidney function, which can be relevant in the context of renal scarring, though it does not directly address the management of incidental scarring.
Additional Evaluation
No specific medications are indicated solely for asymptomatic renal scarring, though addressing any underlying conditions like hypertension or diabetes is essential. Nephrology consultation should be considered if there is evidence of declining renal function, increasing proteinuria, or progression of scarring on follow-up imaging. The use of measured GFR with an exogenous marker like iohexol may be considered in certain clinical scenarios where estimated GFR may be inaccurate 1.
Follow-Up
Follow-up imaging is typically recommended at 6-12 month intervals initially to ensure stability of the scarring pattern, with less frequent monitoring if stable. Renal cortical scarring often represents the end result of previous inflammatory processes, infections, or vascular events, and in truly asymptomatic patients with normal renal function, these findings rarely progress or require intervention beyond monitoring.