Should I refer a patient with a re-demonstrated left renal mass to a urologist (urinary tract specialist) or a nephrologist (kidney disease specialist)?

From the Guidelines

You should refer a patient with a re-demonstrated left renal mass to a urologist. Urologists are the appropriate specialists for evaluating and managing renal masses because they are surgically trained to perform procedures like partial or radical nephrectomies if the mass is determined to be cancerous. While nephrologists specialize in medical kidney diseases, urologists have specific expertise in kidney tumors and their surgical management, as recommended by the American Urological Association (AUA) guideline 1.

The urologist will likely order additional imaging such as a contrast-enhanced CT scan or MRI to better characterize the mass, assess for local invasion or metastasis, and determine if a biopsy is needed. They will also evaluate the patient's renal function and overall health status to determine the most appropriate treatment approach. Time is important with renal masses, so prompt referral is recommended, ideally within 1-2 weeks of identifying the mass. Make sure to send all relevant imaging studies and laboratory results with the referral to facilitate timely evaluation.

According to the AUA guideline, a referral to nephrology may be considered in patients with a high risk of CKD progression, including those with GFR < 45, confirmed proteinuria, diabetics with preexisting CKD, or whenever GFR is expected to be < 30 after intervention 1. However, for the initial evaluation and management of a renal mass, a urologist is the most appropriate specialist. The most recent AUA guideline also supports this approach, emphasizing the importance of a multidisciplinary team in the management of renal masses, but with the urologist leading the counseling process 1.

Key considerations in the management of renal masses include:

• Evaluating the patient's overall health status and comorbidities
• Assessing the oncologic potential of the mass
• Considering the relative efficacy and potential morbidities of various management strategies
• Referring to nephrology if there is a high risk of CKD progression, as recommended by the AUA guideline 1.

In summary, referral to a urologist is the most appropriate course of action for a patient with a re-demonstrated left renal mass, given their expertise in the surgical management of kidney tumors and the recommendations of the AUA guideline 1.

From the Research

Diagnosis and Treatment of Renal Masses

To determine whether a patient with a re-demonstrated left renal mass should be referred to a urologist or a nephrologist, it's essential to consider the role of each specialist in the diagnosis and treatment of renal masses.

• Urologists are specialists who focus on the diagnosis, treatment, and surgery of disorders related to the urinary tract, including kidneys, bladder, and prostate. They often perform biopsies and surgical procedures for renal masses 2, 3.
• Nephrologists, on the other hand, specialize in the diagnosis and treatment of kidney diseases, including those that affect kidney function. While they may be involved in the management of patients with renal masses, especially if there are concerns about kidney function, they are not typically the primary specialists for the surgical treatment of these masses.

Role of Biopsy in Renal Mass Diagnosis

Biopsy plays a crucial role in the diagnosis of renal masses, helping to differentiate between benign and malignant tumors. Studies have shown that biopsy results can significantly influence treatment decisions 4, 5, 6.

• A study published in the Journal of Endourology highlighted the importance of a multidisciplinary approach to renal mass biopsy, including the role of urologists, interventional radiologists, and other specialists 2.
• Another study emphasized the need for a preprocedural diagnosis, including biopsy, before percutaneous ablation of renal tumors to ensure that only malignant tumors are treated 6.

Referral Decision

Given the information above, a patient with a re-demonstrated left renal mass would likely benefit from referral to a urologist, as these specialists are primarily involved in the surgical treatment and management of renal masses.

• Urologists can perform biopsies and other diagnostic procedures to determine the nature of the renal mass and develop an appropriate treatment plan 2, 3.
• If the patient has underlying kidney disease or concerns about kidney function, concurrent consultation with a nephrologist may also be beneficial to ensure comprehensive care.