The R.E.N.A.L. Nephrometry Score: A Comprehensive Standardized System for Quantitating Renal Tumor Size, Location and Depth

No AccessJournal of UrologyAdult Urology1 Sep 2009The R.E.N.A.L. Nephrometry Score: A Comprehensive Standardized System for Quantitating Renal Tumor Size, Location and Depth Alexander Kutikov and Robert G. Uzzo Alexander KutikovAlexander Kutikov More articles by this author and Robert G. UzzoRobert G. Uzzo More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2009.05.035AboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract Purpose: Treatment decisions for renal malignancies depend largely on qualitative data, including a description of tumor anatomy and the experience of the treating surgeon. Currently characterization of renal tumor anatomical elements is descriptive and lacks standardization. Surgical decision making and data set comparisons would be significantly enhanced by a consistent, reproducible system that quantitates the pertinent characteristics of localized renal lesions. We have developed and propose a standardized nephrometry scoring system (R.E.N.A.L. Nephrometry Score) to quantify the anatomical characteristics of renal masses on computerized tomography/magnetic resonance imaging. Materials and Methods: The nephrometry score is based on 5 critical and reproducible anatomical features of solid renal masses. Of the 5 components 4 are scored on a 1, 2 or 3-point scale with the 5th indicating the anterior or posterior location of the mass relative to the coronal plane of the kidney. We applied the R.E.N.A.L. Nephrometry Score to 50 consecutive masses resected at Fox Chase Cancer Center. Results: The R.E.N.A.L. Nephrometry Score consists of (R)adius (tumor size as maximal diameter), (E)xophytic/endophytic properties of the tumor, (N)earness of tumor deepest portion to the collecting system or sinus, (A)nterior (a)/posterior (p) descriptor and the (L)ocation relative to the polar line. The suffix h (hilar) is assigned to tumors that abut the main renal artery or vein. The nephrometry scoring system accurately classified the complexity of 50 consecutive tumors undergoing excision at our institution. Conclusions: Standardized reporting of renal tumor size, location and depth is essential for decision making and effective comparisons. The R.E.N.A.L. Nephrometry Score is a reproducible standardized classification system that quantitates the salient anatomy of renal masses. This novel approach for the systematic characterization of renal tumors provides a tool for meaningful comparisons of renal masses in clinical practice and in the urological literature. 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Nephrometry Scoring System for Predicting Outcomes and Complications of Percutaneous Ablation of 751 Renal TumorsJournal of Urology, VOL. 189, NO. 1, (30-35), Online publication date: 1-Jan-2013.Panumatrassamee K, Kaouk J, Autorino R, Lenis A, Laydner H, Isac W, Long J, Eyraud R, Kassab A, Khalifeh A, Hillyer S, Rizkala E, Haber G and Stein R (2012) Cryoablation Versus Minimally Invasive Partial Nephrectomy for Small Renal Masses in the Solitary Kidney: Impact of Approach on Functional OutcomesJournal of Urology, VOL. 189, NO. 3, (818-822), Online publication date: 1-Mar-2013.Khalifeh A, Autorino R, Hillyer S, Laydner H, Eyraud R, Panumatrassamee K, Long J and Kaouk J (2012) Comparative Outcomes and Assessment of Trifecta in 500 Robotic and Laparoscopic Partial Nephrectomy Cases: A Single Surgeon ExperienceJournal of Urology, VOL. 189, NO. 4, (1236-1242), Online publication date: 1-Apr-2013.Lane B, Golan S, Eggener S, Tobert C, Kahnoski R, Kutikov A, Smaldone M, Whelan C, Shalhav A and Uzzo R (2013) Differential Use of Partial Nephrectomy for Intermediate and High Complexity Tumors May Explain Variability in Reported Utilization RatesJournal of Urology, VOL. 189, NO. 6, (2047-2053), Online publication date: 1-Jun-2013.Gorin M, Ball M, Pierorazio P, Tanagho Y, Bhayani S, Kaouk J, Rogers C, Stifelman M, Khalifeh A, Kumar R, Sivarajan G and Allaf M (2013) Outcomes and Predictors of Clinical T1 to Pathological T3a Tumor Up-Staging after Robotic Partial Nephrectomy: A Multi-Institutional AnalysisJournal of Urology, VOL. 190, NO. 5, (1907-1911), Online publication date: 1-Nov-2013.Young E, Castle S, Gorbatiy V and Leveillee R (2012) Comparison of Safety, Renal Function Outcomes and Efficacy of Laparoscopic and Percutaneous Radio Frequency Ablation of Renal MassesJournal of Urology, VOL. 187, NO. 4, (1177-1182), Online publication date: 1-Apr-2012.Rini B, Garcia J, Elson P, Wood L, Shah S, Stephenson A, Salem M, Gong M, Fergany A, Rabets J, Kaouk J, Krishnamurthi V, Klein E, Dreicer R and Campbell S (2012) The Effect of Sunitinib on Primary Renal Cell Carcinoma and Facilitation of Subsequent SurgeryJournal of Urology, VOL. 187, NO. 5, (1548-1554), Online publication date: 1-May-2012.Wang H, Zhu Y, Yao X, Zhang S, Dai B, Zhang H, Shen Y, Wang C and Ye D (2012) External Validation of a Nomogram Using RENAL Nephrometry Score to Predict High Grade Renal Cell CarcinomaJournal of Urology, VOL. 187, NO. 5, (1555-1560), Online publication date: 1-May-2012.Simhan J, Smaldone M, Tsai K, Li T, Reyes J, Canter D, Kutikov A, Chen D, Greenberg R, Uzzo R and Viterbo R (2012) Perioperative Outcomes of Robotic and Open Partial Nephrectomy for Moderately and Highly Complex Renal LesionsJournal of Urology, VOL. 187, NO. 6, (2000-2004), Online publication date: 1-Jun-2012.Cost N, Lubahn J, Granberg C, Sagalowsky A, Wickiser J, Gargollo P, Baker L, Margulis V and Rakheja D (2012) Pathological Review of Wilms Tumor Nephrectomy Specimens and Potential Implications for Nephron Sparing Surgery in Wilms TumorJournal of Urology, VOL. 188, NO. 4S, (1506-1510), Online publication date: 1-Oct-2012.Ellison J, Montgomery J, Wolf J, Hafez K, Miller D and Weizer A (2012) A Matched Comparison of Perioperative Outcomes of a Single Laparoscopic Surgeon Versus a Multisurgeon Robot-Assisted Cohort for Partial NephrectomyJournal of Urology, VOL. 188, NO. 1, (45-50), Online publication date: 1-Jul-2012.Simmons M, Hillyer S, Lee B, Fergany A, Kaouk J and Campbell S (2012) Nephrometry Score is Associated with Volume Loss and Functional Recovery After Partial NephrectomyJournal of Urology, VOL. 188, NO. 1, (39-44), Online publication date: 1-Jul-2012.Simmons M, Hillyer S, Lee B, Fergany A, Kaouk J and Campbell S (2012) Diameter-Axial-Polar Nephrometry: Integration and Optimization of R.E.N.A.L. and Centrality Index Scoring SystemsJournal of Urology, VOL. 188, NO. 2, (384-390), Online publication date: 1-Aug-2012.Buethe D, Moussly S, Lin H, Yue B, Rodriguez A, Spiess P and Sexton W (2012) Is the R.E.N.A.L. 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Volume 182Issue 3September 2009Page: 844-853 Advertisement Copyright & Permissions© 2009 by American Urological AssociationKeywordscarcinomanephrectomyanatomyclassificationrenal cellMetricsAuthor Information Alexander Kutikov More articles by this author Robert G. Uzzo More articles by this author Expand All Advertisement PDF downloadLoading ...