Hematuria with Renal mass

Chief complaint A 69 y/o male presents with the complaint of hematuria for 3-months duration. History No past medical or surgical history. No family history of malignancy. Examination Blood examination was normal. Chest x-ray normal. Serum creatinine 1.9 mg/dl was noted. USG shows left renal mass of 12 × 9 × 6 cm. Treatment What next should be done?

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Large renal mass at this age likely to be renal malignancy MRI is required for further evaluation of mass, CT scan is not possible because serum creatinine is raised This patient will ultimately require left nephrectomy, which may result in to further deterioration in renal function sometimes requiring dialysis, which need to be kept in mind

I agree with Dr Jayesh Would like to add Staging of tumour and whether operable/ inoperable Metastatic work up If operable Radical Nephhrectomy No role of Radiotherapy and Chemotherapy Immunotherapy can be considered In advanced cases

High possibility of Renal Cell Carcimoma , histologically Clear cell variant being commonest and better prognosis with early treatment Kindly refer to nephrologist for further managaement

Nit nephrologist it's urologist
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CT / PETCT abdomen CT guided biopsy from the mass Nephrectomy

Thank you ,Dr Bera
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Most likely a case of renal cell carcinoma.as it is the most common age of presentation. A MRI scan is indicated for staging of the disease. A radical nephrectomy is indicated. It is one of the tumours where radiotherapy and chemotherapy have less role A regular follow up is indicated. Targeted therapy do have some role post - operatively

CT biopsy not done in RCC as this is the strong possibility in this case. Biopsy only indicated if it is familial, bilateral and in metastatic disease to rule out renal tumor. Otherwise if non metastatic localised to kidney, go for Radical nephrectomy. And yeah crea is slightly raised may need of nephrology opinion ok n d follow up.

I am agree with@Dr. Jayesh Kalbhande Sir and @Dr. Krishnan Pichumani Sir.

Thank you,Dr Pranab Bera
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Lt renal mass with gross hematuria Go for biopsy and r/o renal neoplasm Adenocarcinoma

Renal mass CT scan CT guided biopsy Manage accordingly