The Nephrologist's Perspective in Evaluation and Management of Localized Renal Masses: Core Curriculum 2025

The evaluation and management of renal masses, predominantly of the clear cell renal cell carcinoma subtype, have been evolving over the past several years and demanding greater attention from nephrologists. Oncologic survival of localized tumors approaches 100%, where survival is more closely tied to underlying comorbidities including chronic kidney disease (CKD). Early diagnosis and thus increasing prevalence related to incidental discovery of renal masses allows greater emphasis on nephron-sparing procedures and for residual kidney function preservation. Compared with radical nephrectomy, partial nephrectomy is associated with higher survival and greater preservation of kidney function. Ablative therapies and active surveillance are alternative options for patients with higher surgical risk. Although it is not in the purview of the nephrologist to determine the exact therapy, our role in the preservation of kidney function for these patients who have CKD risk factors or with underlying CKD is crucial for the well-being of the patient. Early nephrology partnership in a multidisciplinary approach with the treatment team including the urologist, radiologist, pathologist, and potentially the oncologist (with advanced disease) is the ideal treatment strategy for eradication of their kidney cancer while optimizing conditions for maximal kidney function preservation.