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Updated AUA Guidelines Focus on Renal Masses and Localized Renal Cancer

By: Jocelyn Solis-Moreira, MS
Posted: Friday, June 11, 2021

The American Urological Association (AUA) has revised its 2013 clinical guidelines on renal cell carcinoma to incorporate recent research findings regarding the evaluation, management, and follow-up care of adults with clinically localized sporadic renal masses that may indicate renal cell carcinoma. The amended guidelines also expand on the treatment and surveillance of solid-enhancing renal tumors and Bosniak III and IV complex cystic renal masses. (Bosniak III cystic renal lesions are considered to be indeterminate in malignant potential, and Bosniak IV cysts are considered to be malignant until proven otherwise.)

“We believe this revised guideline will provide a useful, evidence-based clinical reference for the medical and surgical management of renal masses and localized renal cancer,” said Steven C. Campbell, MD, PhD, Chair of the Renal Mass Guideline Panel, in an AUA press release.

Notable updates include the following:

  • Recommendation for genetic counseling: Clinicians should recommend genetic counseling for any of the following: all patients ≤ 46 years of age with renal malignancy, those with multifocal or bilateral renal masses, or whenever (1) the personal or family history suggests a familial renal neoplastic syndrome; (2) there is a first-or second-degree relative with a history of renal malignancy or a known clinical or genetic diagnosis of a familial renal neoplastic syndrome (even if kidney cancer has not been observed): or (3) the patient’s pathology demonstrates histologic findings suggestive of such a syndrome.
  • Renal mass biopsy: Evidence-based statement advises counseling of patients regarding rationale, positive and negative predictive values, potential risks, and nondiagnostic rates of renal mass biopsy.
  • Radical nephrectomy: Clinicians should consider radical nephrectomy for patients with a solid or Bosniak III or IV complex cystic renal mass whenever increased oncologic potential is suggested by tumor size, renal mass biopsy (if obtained), and/or imaging.

For more information on the amended clinical guidelines, visit auanet.org/Guidelines.



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