Renal Cell Carcinoma

Renal cell carcinoma (RCC) is a tumor that arises from the lining of the renal tubular system within the renal cortex. Renal cell carcinoma is responsible for 80%–85% of all primary renal neoplasms. Most RCCs arise sporadically, but smoking, hypertension Hypertension Hypertension, or high blood pressure, is a common disease that manifests as elevated systemic arterial pressures. Hypertension is most often asymptomatic and is found incidentally as part of a routine physical examination or during triage for an unrelated medical encounter. Hypertension, and obesity Obesity Obesity is a condition associated with excess body weight, specifically with the deposition of excessive adipose tissue. Obesity is considered a global epidemic. Major influences come from the western diet and sedentary lifestyles, but the exact mechanisms likely include a mixture of genetic and environmental factors. Obesity are linked to its development. The disease usually presents asymptomatically. When symptoms finally arise, the tumor has already grown significantly and/or spread to other tissues. The classic clinical triad of RCC is flank pain Pain Pain has accompanied humans since they first existed, first lamented as the curse of existence and later understood as an adaptive mechanism that ensures survival. Pain is the most common symptomatic complaint and the main reason why people seek medical care. Physiology of Pain, hematuria, and a palpable abdominal renal mass, but this triad appears in only about 9% of cases. Affected individuals also commonly present with fever Fever Fever is defined as a measured body temperature of at least 38°C (100.4°F). Fever is caused by circulating endogenous and/or exogenous pyrogens that increase levels of prostaglandin E2 in the hypothalamus. Fever is commonly associated with chills, rigors, sweating, and flushing of the skin. Fever and/or anemia Anemia Anemia is a condition in which individuals have low Hb levels, which can arise from various causes. Anemia is accompanied by a reduced number of RBCs and may manifest with fatigue, shortness of breath, pallor, and weakness. Subtypes are classified by the size of RBCs, chronicity, and etiology. Anemia: Overview. Renal cell carcinoma is usually diagnosed via CT scan of the abdomen and pelvis Pelvis The pelvis consists of the bony pelvic girdle, the muscular and ligamentous pelvic floor, and the pelvic cavity, which contains viscera, vessels, and multiple nerves and muscles. The pelvic girdle, composed of 2 "hip" bones and the sacrum, is a ring-like bony structure of the axial skeleton that links the vertebral column with the lower extremities. Pelvis. Localized cases of RCC are commonly treated and cured with surgery, and advanced cases are treated with a combination of immunotherapy and/or molecular targeted therapy Targeted Therapy Targeted therapy exerts antineoplastic activity against cancer cells by interfering with unique properties found in tumors or malignancies. The types of drugs can be small molecules, which are able to enter cells, or monoclonal antibodies, which have targets outside of or on the surface of cells. Targeted Therapy and Other Nontraditional Antineoplastic Agents. The long-term prognosis for locally advanced or metastatic RCC is often poor.

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Editorial responsibility: Stanley Oiseth, Lindsay Jones, Evelin Maza

Table of Contents

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Overview

Definition

Renal cell carcinoma (RCC), also called hypernephroma and renal cell adenocarcinoma, is a type of cancer that originates from the lining of the small tubules of the renal cortex.

Epidemiology

  • Accounts for 80%–85% of all primary renal neoplasms
  • Incidence is highest in North America and the Czech Republic:
    • In North America, RCC is responsible for 76,000 new cases and 14,000 deaths each year.
    • In the United States, the incidence is highest in the White, Black, Hispanic, and American Indian populations and lowest in the Asian American and Pacific Islander populations.
  • Approximately twice as common in men as in women
  • Incidence is highest in the 6th to 8th decade of life, with a median age of 64.

Etiology

  • Most cases of RCC occur sporadically.
  • Only 4% of cases are associated with a genetic component.
  • Risk factors:
    • Smoking (associated with a higher incidence and more advanced disease)
    • Hypertension
    • Obesity (risk increases with ↑ BMI)
    • CKD CKD Chronic kidney disease (CKD) is kidney impairment that lasts for ≥ 3 months, implying that it is irreversible. Hypertension and diabetes are the most common causes; however, there are a multitude of other etiologies. In the early to moderate stages, CKD is usually asymptomatic and is primarily diagnosed by laboratory abnormalities. Chronic Kidney Disease, especially individuals with cystic disease of the kidney acquired through dialysis Dialysis Renal replacement therapy refers to dialysis and/or kidney transplantation. Dialysis is a procedure by which toxins and excess water are removed from the circulation. Hemodialysis and peritoneal dialysis (PD) are the two types of dialysis, and their primary difference is the location of the filtration process (external to the body in hemodialysis versus inside the body for PD). Overview and Types of Dialysis
    • Occupational exposure (e.g., cadmium, asbestos, petroleum by-products)
    • Prolonged ingestion of analgesic combinations (e.g., aspirin, NSAIDs, and acetaminophen Acetaminophen Acetaminophen is an over-the-counter nonopioid analgesic and antipyretic medication and the most commonly used analgesic worldwide. Despite the widespread use of acetaminophen, its mechanism of action is not entirely understood. Acetaminophen)
    • Genetics Genetics Genetics is the study of genes and their functions and behaviors. Basic Terms of Genetics: several hereditary diseases have been associated with RCC:
      • Inherited polycystic disease 
      • Von Hippel-Lindau syndrome (approximately 40% of patients develop RCC)
      • Tuberous sclerosis Tuberous sclerosis Tuberous sclerosis or tuberous sclerosis complex (TSC) is an autosomal dominant disorder with mainly neurocutaneous symptoms. Mutation in the TSC genes causes excessive tumor-like growths in the brain, eyes, heart, kidney, and lungs. Cutaneous manifestations include hypopigmentation (i.e., ash leaf spots, confetti lesions) or excessive growth (i.e., angiofibroma, shagreen patch). Tuberous Sclerosis (approximately 5% of patients develop RCC)
      • Hereditary leiomyomatosis and renal cancer syndrome (HLRCC)
      • Hereditary papillary renal cell carcinoma (HPRCC)
    • Cytotoxic chemotherapy
    • Chronic hepatitis C Hepatitis C Hepatitis C is an infection of the liver caused by the hepatitis C virus (HCV). The infection can be transmitted through infectious blood or body fluids and may be transmitted during childbirth or through IV drug use or sexual intercourse. Hepatitis C virus can cause both acute and chronic hepatitis, ranging from a mild to a serious, lifelong illness including liver cirrhosis and hepatocellular carcinoma (HCC). Hepatitis C Virus infection
    • Kidney stones

Pathologic Classification

The difference between benign and malignant masses in the kidney is determined by histologic criteria. According to the morphology, growth pattern, cell of origin, and histochemical and molecular basis, RCCs are classified into several types:

  • Clear cell (most common) 
  • Papillary
  • Chromophobe 
  • Oncocytic 
  • Collecting duct (very rare)
  • Translocation RCC (very rare)

Clear cell carcinoma

  • Incidence: 75%–85% of all renal tumors
  • Etiology: 
    • Most commonly sporadic
    • Genetic mutations:
      • Deletion of 3p
      • Gain of 5q
      • Monosomy or partial loss of 14q
    • Genetic pathway alterations:
      • VHL gene
      • PBRM1 gene
      • BAP1 gene
      • Inactivation of histone-modifying genes
      • Ubiquitin-mediated proteolysis pathway
      • Abnormalities in cellular division ( Ras RAS Renal artery stenosis (RAS) is the narrowing of one or both renal arteries, usually caused by atherosclerotic disease or by fibromuscular dysplasia. If the stenosis is severe enough, the stenosis causes decreased renal blood flow, which activates the renin-angiotensin-aldosterone system (RAAS) and leads to renovascular hypertension (RVH). Renal Artery Stenosis, p53)
  • Pathology/histologic appearance:
    • Arises from clear cells in the proximal tubular epithelium Epithelium The epithelium is a complex of specialized cellular organizations arranged into sheets and lining cavities and covering the surfaces of the body. The cells exhibit polarity, having an apical and a basal pole. Structures important for the epithelial integrity and function involve the basement membrane, the semipermeable sheet on which the cells rest, and interdigitations, as well as cellular junctions. Surface Epithelium
    • Mostly well differentiated
    • Large areas of gray-white necrosis and foci of hemorrhagic discoloration
    • Can have a trabecular or tubular growth pattern with cells of rounded or polygonal shape and granular or clear cytoplasm
    • May show cystic and/or solid areas
    • May show cellular atypia
  • Prognosis:
    • Depends on the stage at diagnosis
    • Poor prognosis with higher nuclear grade and/or sarcomatoid pattern
Renal clear cell carcinoma with sheet-like, solid clear cells

Renal clear cell carcinoma:
The tumor consists of sheet-like, solid clear cells. H&E × 100

Image: “Pathological images from patient” by Chen S, Jin B, Xu L, Fu G, Meng H, Liu B, Li J, Xia D. License: CC BY 4.0, cropped by Lecturio.

Papillary carcinoma

  • Incidence: 10%–15%
  • Etiology: 
    • Most commonly sporadic
    • MET gene mutations
    • FH gene mutation
  • Pathology/histologic appearance: 
    • Can arise from the proximal or distal convoluted tubules
    • Can be multifocal and/or bilateral
    • Usually hemorrhagic and cystic, especially if large
    • Made of cuboidal or low columnar cells that are arranged in papillary formations.
    • Interstitial foam cells and psammoma bodies may be present.
  • Prognosis: 
    • Type 1 papillary RCC has a favorable prognosis.
    • Type 2 papillary RCC has a poor prognosis.
Histology of papillary renal cell carcinoma

H&E-stained specimen showing characteristic histology of papillary renal cell carcinoma

Image: “Hematoxylin and Eosin staining of the tumor tissue showing characteristic histology of papillary renal cell carcinoma” by Alanee S, Dynda DI, Hemmer P, Schwartz B. License: CC BY 4.0

Chromophobe carcinoma

  • Incidence: 5%–10%
  • Etiology: 
    • Hypodiploid number of chromosomes
    • Up-regulated KIT oncogene
    • Up-regulated TERT gene
  • Pathology/histologic appearance: 
    • Arises from intercalated cells of the collecting ducts
    • Made up of pale, eosinophilic cells arranged in solid sheets around blood vessels
    • Perinuclear halos can be seen
  • Prognosis: 
    • Favorable prognosis (more than clear cell RCC)
    • Possibly due to presentation at an earlier stage
Sarcomatoid chromophobe renal cell carcinoma

Sarcomatoid chromophobe renal cell carcinoma

Image: “ Microphotograph showing sarcomatoid renal cell carcinoma” by Chakrabarti I, Giri A, Majumdar K, Anuradha DE. License: CC BY 2.0

Oncocytic carcinoma/oncocytomas

  • Incidence: 3%–7%
  • Etiology: 
    • Tuberous sclerosis Tuberous sclerosis Tuberous sclerosis or tuberous sclerosis complex (TSC) is an autosomal dominant disorder with mainly neurocutaneous symptoms. Mutation in the TSC genes causes excessive tumor-like growths in the brain, eyes, heart, kidney, and lungs. Cutaneous manifestations include hypopigmentation (i.e., ash leaf spots, confetti lesions) or excessive growth (i.e., angiofibroma, shagreen patch). Tuberous Sclerosis
    • Birt-Hogg-Dubé syndrome
  • Pathology/histologic appearance: 
    • Arises from intercalated cells of the collecting ducts
    • Composed of oncocytes, well-differentiated neoplastic cells that have a very eosinophilic cytoplasm due to numerous mitochondria.
  • Prognosis: 
    • Favorable prognosis
    • Behave as benign tumors
    • Rarely invasive or metastatic
High-grade oncocytic renal tumor

High-grade oncocytic renal tumor

Image: “High-grade oncocytic renal tumour — high mag” by Nephron Nephron The functional units of the kidney, consisting of the glomerulus and the attached tubule. Kidneys. License: CC BY-SA 4.0

Collecting or Bellini duct tumors

  • Incidence: very rare
  • Etiology: usually due to genetic abnormalities
  • Pathology/histologic appearance: 
    • Composed of irregular channels 
    • Epithelium is very atypical, with a hobnail pattern.
  • Prognosis: 
    • Poor
    • Commonly associated with metastatic and/or advanced disease
Collecting duct carcinoma

H&E-stained tissue sections demonstrating collecting duct carcinoma

Image: “Hematoxylin and eosin staining of tissue sections from the nephrectomy specimens demonstrating collecting duct carcinoma” by Tazi EM, Essadi I, Tazi MF, Ahellal Y, M’rabti H, Errihani H. License: CC BY 2.0

Translocation renal cell carcinoma

  • Incidence: 
    • Very rare
    • Occurs at a younger age and predominantly in women
  • Etiology: 
    • Due to a fusion of the TFE3, TFEB, or MITF genes to a number of other genes, including ASPSCR1, PRCC, SFPQ, and NONO
    • Presents in children with previous chemotherapy, autoimmune disorders, or bone marrow Bone marrow Bone marrow, the primary site of hematopoiesis, is found in the cavities of cancellous bones and the medullary canals of long bones. There are 2 types: red marrow (hematopoietic with abundant blood cells) and yellow marrow (predominantly filled with adipocytes). Composition of Bone Marrow transplant conditioning
  • Prognosis: 
    • Much worse prognosis than most other types of RCC because symptoms develop at a later stage
    • Resistant to targeted therapies
Translocation renal cell carcinoma

Translocation renal cell carcinoma, composed of clear cells with voluminous cytoplasm and distinct cell borders showing typical papillary architecture and hyalinized fibrous vascular cords

Image: “Translocation renal cell carcinoma” by Kmetec A, Jeruc J. License: CC BY 3.0

Clinical Presentation

Many cases present asymptomatically, leading to further progression of the diseases. Symptoms arise when the tumor has reached a significant size, invaded adjacent structures, or developed distant metastasis.

  • Classic triad of flank pain Pain Pain has accompanied humans since they first existed, first lamented as the curse of existence and later understood as an adaptive mechanism that ensures survival. Pain is the most common symptomatic complaint and the main reason why people seek medical care. Physiology of Pain, hematuria, and palpable abdominal mass (present in only 9% of cases)
  • Other symptoms:
    • Fever
    • Weight loss
    • Muscle wasting
    • Fatigue 
    • Secondary polycythemia
    • Anemia
    • Scrotal varicocele Varicocele A condition characterized by the dilated tortuous veins of the spermatic cord with a marked left-sided predominance. Adverse effect on male fertility occurs when varicocele leads to an increased scrotal (and testicular) temperature and reduced testicular volume. Varicocele, Hydrocele, and Spermatocele, usually left-sided
    • Involvement of the inferior vena cava Inferior vena cava The venous trunk which receives blood from the lower extremities and from the pelvic and abdominal organs. Mediastinum and Great Vessels ( IVC IVC The venous trunk which receives blood from the lower extremities and from the pelvic and abdominal organs. Mediastinum and Great Vessels):
      • Lower-extremity edema Edema Edema is a condition in which excess serous fluid accumulates in the body cavity or interstitial space of connective tissues. Edema is a symptom observed in several medical conditions. It can be categorized into 2 types, namely, peripheral (in the extremities) and internal (in an organ or body cavity). Edema
      • Ascites Ascites Ascites is the pathologic accumulation of fluid within the peritoneal cavity that occurs due to an osmotic and/or hydrostatic pressure imbalance secondary to portal hypertension (cirrhosis, heart failure) or non-portal hypertension (hypoalbuminemia, malignancy, infection). Ascites
      • Hepatic dysfunction
      • Pulmonary emboli
    • Paraneoplastic syndrome, which can lead to increased levels of the following hormones Hormones Hormones are messenger molecules that are synthesized in one part of the body and move through the bloodstream to exert specific regulatory effects on another part of the body. Hormones play critical roles in coordinating cellular activities throughout the body in response to the constant changes in both the internal and external environments. Hormones: Overview:
      • Erythropoietin Erythropoietin Glycoprotein hormone, secreted chiefly by the kidney in the adult and the liver in the fetus, that acts on erythroid stem cells of the bone marrow to stimulate proliferation and differentiation. Erythrocytes
      • Parathyroid hormone-related protein
      • Gonadotropins
      • Human placental lactogen
      • Adrenocorticotropic hormone–like substance
      • Renin
      • Glucagon
      • Insulin Insulin Insulin is a peptide hormone that is produced by the beta cells of the pancreas. Insulin plays a role in metabolic functions such as glucose uptake, glycolysis, glycogenesis, lipogenesis, and protein synthesis. Exogenous insulin may be needed for individuals with diabetes mellitus, in whom there is a deficiency in endogenous insulin or increased insulin resistance. Insulin
    • Hypercalcemia Hypercalcemia Hypercalcemia (serum calcium > 10.5 mg/dL) can result from various conditions, the majority of which are due to hyperparathyroidism and malignancy. Other causes include disorders leading to vitamin D elevation, granulomatous diseases, and the use of certain pharmacological agents. Symptoms vary depending on calcium levels and the onset of hypercalcemia. Hypercalcemia due to:
      • Lytic bone lesions
      • Parathyroid hormone-related protein
      • Elevated prostaglandins that promote bone resorption

Diagnosis and Staging

Diagnosis

  • 1st-line: CT scan of the abdomen and pelvis Pelvis The pelvis consists of the bony pelvic girdle, the muscular and ligamentous pelvic floor, and the pelvic cavity, which contains viscera, vessels, and multiple nerves and muscles. The pelvic girdle, composed of 2 "hip" bones and the sacrum, is a ring-like bony structure of the axial skeleton that links the vertebral column with the lower extremities. Pelvis to show characteristics of RCC, as opposed to a simple renal cyst:
    • Thickened, irregular or smooth wall
    • Septations
    • Enhancement after contrast injection
  • Ultrasonography may also be performed.
  • MRI used if CT and/or ultrasonography inconclusive
  • A biopsy is performed after the imaging diagnosis and must be evaluated for the extent of local invasion and metastatic disease prior to surgery.
Two illustrative cases for selection of roi location

Two illustrative cases for selection of region of interest (ROI; approximately 1 cm in diameter):
(a) An ROI was placed in the well-enhancing part in left renal clear cell carcinoma in a 37-year-old female patient.
(b) An ROI was placed in left renal cell carcinoma in a 46-year-old female patient.

Image: “Two illustrative cases for selection of ROI location” by Scientific Reports. License: CC BY 4.0

Staging Staging Cancer is the 2nd leading cause of death in the US after cardiovascular disease. Many malignancies are treatable or curable, but some may recur. Thus, all malignancies must be assigned a grade and stage in order to guide management and determine prognosis. Grading, Staging, and Metastasis

RCCs vary greatly in the extent of disease at presentation.

  • Localized to the kidney: 65%
  • Regional (lymph nodes): 17%
  • Metastatic disease: 16%
  • Unstaged: 3%
Table: TNM staging of renal cell carcinoma
Stage Definition Subdivision
Tumor stage
T0 No evidence of primary tumor
T1 < 7 cm in the greatest dimension, confined to the kidney
  • 1a: < 4 cm
  • 1b: > 4 cm and < 7 cm
T2 > 7 cm in the greatest dimension, confined to the kidney
  • 2a: > 7 cm and < 10 cm
  • 2b: > 10 cm
T3 Extends into major veins Veins Veins are tubular collections of cells, which transport deoxygenated blood and waste from the capillary beds back to the heart. Veins are classified into 3 types: small veins/venules, medium veins, and large veins. Each type contains 3 primary layers: tunica intima, tunica media, and tunica adventitia. Veins or perinephric tissues, but not into the adrenal gland or beyond the Gerota fascia (anterior perirenal fascia)
  • 3a: invades into renal vein branches or perirenal/renal sinus fat
  • 3b: invades the subdiaphragmatic IVC IVC The venous trunk which receives blood from the lower extremities and from the pelvic and abdominal organs. Mediastinum and Great Vessels
  • 3c: invades the supradiaphragmatic IVC IVC The venous trunk which receives blood from the lower extremities and from the pelvic and abdominal organs. Mediastinum and Great Vessels
T4 Invades beyond the Gerota fascia and/or into the adrenal gland
Regional lymph nodes
N0 No metastasis to regional lymph nodes
N1 Metastasis to regional lymph nodes
Distant metastasis
M0 No distant metastasis
M1 Metastasis to distant lymph nodes and/or organs

Management and Prognosis

Management

  • Localized, nonmetastatic disease requires surgery, which is curative in stages I–III. 
    • Partial nephrectomy
    • Radical nephrectomy
    • Enucleation
    • Thermal ablation
  • Metastatic disease: 
    • If metastasis has already developed, the disease is usually unresectable.
    • Immunotherapy with or without molecularly targeted therapy Targeted Therapy Targeted therapy exerts antineoplastic activity against cancer cells by interfering with unique properties found in tumors or malignancies. The types of drugs can be small molecules, which are able to enter cells, or monoclonal antibodies, which have targets outside of or on the surface of cells. Targeted Therapy and Other Nontraditional Antineoplastic Agents:
      • Nivolumab plus ipilimumab 
      • Pembrolizumab plus axitinib 
      • Nivolumab plus cabozantinib 
      • Molecularly targeted therapy Targeted Therapy Targeted therapy exerts antineoplastic activity against cancer cells by interfering with unique properties found in tumors or malignancies. The types of drugs can be small molecules, which are able to enter cells, or monoclonal antibodies, which have targets outside of or on the surface of cells. Targeted Therapy and Other Nontraditional Antineoplastic Agents: vascular endothelial growth factor (VEGF) tyrosine kinase inhibitors (e.g., cabozantinib, lenvatinib plus everolimus, nivolumab) 

Prognosis

  • Depends on:
    • Type of renal cell carcinoma
    • Extent and size of the tumor at the time of detection
  • Sarcomatoid appearance indicates poor prognosis.
  • The 5-year survival rate of patients with kidney cancer has increased in recent years because of advancements in technology allowing for the detection of more tumors incidentally and at smaller sizes:
    • Localized: 93%
    • Regional: 70%
    • Distant metastasis: 13%
    • Combined survival rate: 75%

Differential Diagnosis

  • Benign renal tumor:
    • Angiomyolipoma: appears on imaging as an enhancing mass containing macroscopic fat and no calcifications. Small angiomyolipomas with minimal fat are difficult to characterize on imaging and often require further evaluation. Associated with tuberous sclerosis, especially if bilateral. 
    • Metanephric adenoma: rare, benign lesions that are more common in women than in men. Often discovered incidentally, but can present with pain Pain Pain has accompanied humans since they first existed, first lamented as the curse of existence and later understood as an adaptive mechanism that ensures survival. Pain is the most common symptomatic complaint and the main reason why people seek medical care. Physiology of Pain, hematuria, or a palpable mass. Can be difficult to differentiate on histology from papillary RCC or epithelial-predominant Wilms tumor Wilms tumor Wilms tumor is a malignancy caused by proliferation of metanephric blastema in the kidneys and is the most common renal malignancy in children. Wilms tumor usually arises sporadically, but it can also occur as a result of a specific congenital anomaly like WAGR syndrome, Denys-Drash syndrome, or Beckwith-Wiedemann syndrome. Wilms tumor commonly presents as a firm, nontender, smooth mass that does not cross the midline. Wilms Tumor.
  • Metastatic disease: cancer from another source that spreads to the kidney. Metastatic disease often presents with multiple renal lesions with borderline enhancement and widespread metastatic disease.
  • Lymphoma: hematologic malignancy that can involve the kidney. Percutaneous biopsy should be done to differentiate lymphoma from RCC. Renal involvement in hematologic malignancies is found at autopsy in about ⅓ of terminal lymphoma or leukemia patients. Renal involvement should be suspected in patients with massive retroperitoneal lymphadenopathy Lymphadenopathy Lymphadenopathy is lymph node enlargement (> 1 cm) and is benign and self-limited in most patients. Etiologies include malignancy, infection, and autoimmune disorders, as well as iatrogenic causes such as the use of certain medications. Generalized lymphadenopathy often indicates underlying systemic disease. Lymphadenopathy, splenomegaly Splenomegaly Splenomegaly is pathologic enlargement of the spleen that is attributable to numerous causes, including infections, hemoglobinopathies, infiltrative processes, and outflow obstruction of the portal vein. Splenomegaly, or lymphadenopathy Lymphadenopathy Lymphadenopathy is lymph node enlargement (> 1 cm) and is benign and self-limited in most patients. Etiologies include malignancy, infection, and autoimmune disorders, as well as iatrogenic causes such as the use of certain medications. Generalized lymphadenopathy often indicates underlying systemic disease. Lymphadenopathy elsewhere in the body or in atypical retroperitoneal regions. 
  • Renal abscess or focal pyelonephritis Pyelonephritis Pyelonephritis is infection affecting the renal pelvis and the renal parenchyma. This condition arises mostly as a complication of bladder infection that ascends to the upper urinary tract. Pyelonephritis can be acute or chronic (which results from persistent or chronic infections). Typical acute symptoms are flank pain, fever, and nausea with vomiting. T Pyelonephritis and Perinephric Abscess: a variety of infectious and inflammatory conditions can mimic RCC, including acute and chronic pyelonephritis Pyelonephritis Pyelonephritis is infection affecting the renal pelvis and the renal parenchyma. This condition arises mostly as a complication of bladder infection that ascends to the upper urinary tract. Pyelonephritis can be acute or chronic (which results from persistent or chronic infections). Typical acute symptoms are flank pain, fever, and nausea with vomiting. T Pyelonephritis and Perinephric Abscess and renal abscess. Axial imaging often shows perineal inflammatory changes. Clinical symptoms, such as chills, fever Fever Fever is defined as a measured body temperature of at least 38°C (100.4°F). Fever is caused by circulating endogenous and/or exogenous pyrogens that increase levels of prostaglandin E2 in the hypothalamus. Fever is commonly associated with chills, rigors, sweating, and flushing of the skin. Fever, flank pain Pain Pain has accompanied humans since they first existed, first lamented as the curse of existence and later understood as an adaptive mechanism that ensures survival. Pain is the most common symptomatic complaint and the main reason why people seek medical care. Physiology of Pain, or pyuria aid in the diagnosis. Renal mass biopsy or aspiration with drain placement can aid in the diagnosis. Serial imaging to demonstrate the resolution of the mass may also be required after the treatment.

References

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  2. American Cancer Society. What is kidney cancer? https://www.cancer.org/cancer/kidney-cancer/about/what-is-kidney-cancer.htm
  3. National Cancer Institute Surveillance, Epidemiology, and End Results (SEER) Program. (2020). Cancer stat facts: kidney and renal pelvis cancer. https://seer.cancer.gov/statfacts/html/kidrp.html
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  6. Motzer, R.J. (2018). Renal cell carcinoma. In Jameson, J., et al. (Eds.). Harrison’s Principles of Internal Medicine, 20th ed. McGraw-Hill. https://accessmedicine-mhmedical-com.aucmed.idm.oclc.org/content.aspx?bookid=2129&sectionid=192016249
  7. Pierorazio, P.M., Campbell, S.C. (2021). Diagnostic approach, differential diagnosis, and management of a small renal mass. UpToDate. Retrieved Feb 17, 2021, from https://www.uptodate.com/contents/diagnostic-approach-differential-diagnosis-and-management-of-a-small-renal-mass
  8. Richie, J.P. (2021). Definitive surgical management of renal cell carcinoma. UpToDate. Retrieved Feb 17, 2021, from https://www.uptodate.com/contents/definitive-surgical-management-of-renal-cell-carcinoma
  9. Atkins, M.B. (2020). Clinical manifestations, evaluation, and staging of renal cell carcinoma. UpToDate. Retrieved July 15, 2021, from https://www.uptodate.com/contents/clinical-manifestations-evaluation-and-staging-of-renal-cell-carcinoma
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