【AUA指南】肾肿瘤和局限性肾癌（《物种起源》
Guideline statements
指 南 荟 萃
EVALUATION AND DIAGNOSIS
评估和诊断
9月281. In patients with a solid or complex cystic renal mass, physicians should obtain high quality, multipha, cross-ctional abdominal imaging to optimally characterize and clinically stage the renal mass. Characterization of the renal mass should include asssment of tumor complexity, degree of contrast enhancement (whereapplicable), and prence or abnce of fat. (Clinical Principle)
1. 对于肾实性或复杂的肾囊性肿块，医生应获得高质量的、多期的、横断面的腹部影像学，以最佳的描述和临床分期。肾脏肿块的表征应包括评估肿瘤的复杂程度、造影增强程度（如果适用），以及是否存在脂肪。 (临床原则)
2. In patients with suspected renal malignancy, physicians should obtain comprehensive metabolic panel, complete blood count, and urinalysis. Metastatic evaluation should include chest imaging to evaluate for possible thoracic metastas. (Clinical Principle)
2.对于怀疑肾脏恶性肿瘤的病人，医生应进行全面的代谢检查、全血细胞计数和尿检。转移评估应包括胸部成像，以评估胸部转移的可能。(临床原则)
3. For patients with a solid or complex cystic renal mass, physicians should assign CKD stage bad on GFR and degree of proteinuria. (Expert Opinion) 安徒生童话读后感50字
3.对于实性或复杂肾囊性肿块的患者，医生应根据GFR和蛋白尿程度确定CKD分期。(专家意见)
COUNSELING
建议
4. In patients with a solid or Bosniak 3/4 complex cystic renal mass, a urologist should lea
羊舍d the counling process and should consider all management strategies. A multidisciplinary team should be included when necessary. (Expert Opinion)
4.对于实性或Bosniak 3/4级复杂肾囊性肿块的患者，泌尿科医生应主导咨询过程，并应考虑到所有的治疗策略，必要时应组织一个多学科小组。(专家意见)熏肉怎么做好吃
5. Physicians should provide counling that includes current perspectives about tumor biology and a patientspecific risk asssment inclusive of x, tumor size/complexity, histology (when obtained), and imaging characteristics. For cT1a tumors, the low oncologic risk of many small renal mass should be reviewed. (Clinical Principle)
5. 医生应提供建议，包括当前对肿瘤生物学的观点和包括性别、肿瘤大小/复杂性、组织学（获得后）和影像学特征在内的患者特定风险评估。对于cT1a期肿瘤，许多小肾肿瘤的低肿瘤风险应加以回顾。(临床原则)
对人生的感悟
对数歌6. During counling of patients with a solid or Bosniak3/4 complex cystic renal mass, physicians must review the most common and rious urologic and non-urologic morbiditi
es of each treatment pathway and the importance of patient age, comorbidities/frailty, and life expectancy. (Clinical Principle)
6. 在为实性或Bosniak 3/4级复杂肾囊性肿块患者提供建议时，医生必须考虑每种治疗途径中最常见、最严重的泌尿系和非泌尿系疾病、以及患者年龄、并发症/虚弱和预期寿命的重要性。 (临床原则)
7. Physicians should review the importance of renal functional recovery related to renal mass management, including the risk of progressive CKD, potential short- or long-term need for renal replacement therapy, and long -term overall survival considerations. (Clinical Principle)
7. 医生应该考虑肾脏功能恢复与肾脏肿块手术相关的重要性，包括进展性慢性肾脏疾病（CKD）的风险，潜在的需要短期或长期肾脏替代治疗，以及考虑长期的总体生存。(临床原则)
8. Physicians should consider referral to nephrology in patients with a high risk of CKD pr
ogression. Such patients may include tho with eGFR less than 45 ml/min/1.73m2, confirmed proteinuria, diabetics with preexisting CKD, or whenever eGFR is expected to be less than 30 ml/min/1.73m2 after intervention. (Expert Opinion)
8. 对于CKD进展风险高的患者，医生应考虑转诊到肾病科。这些患者应该包括eGFR小于45 ml/min/1.73m2的患者、确诊蛋白尿患者、伴有CKD的糖尿病患者，或干预后eGFR预计小于30 ml/min/1.73m2的患者。(专家意见)
9. Physicians should recommend genetic counling for all patients ≤ 46 years of age with renal malignancy and consider genetic counling for patients with multifocal or bilateral renal mass, or if personal or family history suggests a familial renal neoplastic syndrome. (Expert Opinion)
9. 医生应建议所有≤46岁的肾恶性肿瘤患者进行遗传咨询，并建议对多灶性或双侧肾肿块患者进行遗传咨询，或个人或家族病史提示家族性肾肿瘤综合征。(专家意见)
RENAL MASS BIOPSY (RMB)
肾肿块活检
10. Renal mass biopsy should be considered when a mass is suspected to be hematologic, metastatic, inflammatory, or infectious. (Clinical Principle)
10. 当怀疑肿块是来源于血液系统、转移性、炎症或感染性时，应考虑肾肿块活检。(临床原则)
11. In the tting of a solid renal mass, RMB is not required for: 1) young or healthy patients who are unwilling to accept the uncertainties associated with RMB; or 2) older or frail patients who will be managed conrvatively independent of RMB findings. (Expert Opinion)
11.以下情况，对肾实性肿块活检是不要求的:1)不愿接受肾肿块活检引发相关不确定性的年轻或健康患者;2)不依赖肾肿块活检结果，进行保守治疗的老年或体弱多病患者。(专家意见)
12. When considering the utility of RMB, patients should be counled regarding rational
哈姆雷斯e, positive and negative predictive values, potential risks and non-diagnostic rates of RMB. (Clinical Principle)
12. 在告知肾肿块活检的利弊时，应向患者告知肾肿块活检的理论依据、阳性和阴性概率、潜在风险和漏诊率。 (临床原则)
