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Histologic Patterns and Germline Genetic Testing Outcomes in Presumed Sporadic Bilateral Renal Masses
Kieran Lewis1, Jason M Scovell1, Eran N Maina1
1Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, Ohio.
Urology Practice
|January 8, 2026
Summary
Bilateral renal masses (BRM) show strong histologic concordance. Genetic testing for BRM is underutilized with low diagnostic yield, suggesting selective testing is appropriate for specific patient groups.
Area of Science:
- Urology
- Medical Genetics
- Oncology
Background:
- Bilateral renal masses (BRM) are often associated with inherited syndromes.
- Current guidelines recommend genetic counseling for all BRM patients.
- The utility of genetic testing in sporadic BRM cases is unclear.
Purpose of the Study:
- To characterize histologic pairings between index and contralateral renal masses.
- To evaluate the value of genetic testing across different histologic subgroups of BRM.
Main Methods:
- Retrospective review of 527 patients surgically treated for BRM (2002-2024).
- Assessment of histologic concordance between bilateral renal masses.
- Comparison of genetic testing adherence and outcomes across histologic groups.
Main Results:
- High histologic concordance observed: 78% clear cell, 70% papillary, 74% oncocytic.
- Only 21% of patients were referred for genetic counseling; 13% underwent testing.
- Pathogenic variants found in only 4 patients (hereditary papillary renal carcinoma, Birt-Hogg-Dubé, tuberous sclerosis); none in bilateral clear cell group.
Conclusions:
- Strong histologic concordance exists in sporadic bilateral renal masses.
- Genetic testing for BRM is underutilized and has a low diagnostic yield.
- Selective genetic testing, prioritizing specific patient profiles, may be more beneficial.
