Various Nephrometry Scoring System

Individual tumor characteristics should be considered in the preprocedural period. Several renal nephrometry scoring systems have been developed to facilitate the standardized, quantitative assessment of tumor complexity based on radiologic features.

R.E.N.A.L nephrometry scoring sytem:

Parameter123
Radius (cm)≤45-6≥7
Exophytic or Endophytic≥ 50% exophytic< 50% exophytic100% endophytic
Nearness to collecting system/renal sinus (mm)≥ 7 5-6 ≤ 4
Anterior or Posteriora = anterior, p = posterior, x = cannot assign, h = when tumor touches renal artery or vein
Location relative to Polar linesEntirely above or below the lower polar line< 50% cross polar line> 50% mass is across polar line, mass is entirely between polar lines
4-6 Low complexity group
7-9 Moderate complexity group
10-12 High complexity group
Polar lines are regions of kidney above and below which the medial portion of renal parenchyma is met by renal sinus fat, vessel or the collecting system.

PADUA nephrometry scoring sytem:​

Parameter123
Radius (cm)≤44.1-7>7
Exophytic or Endophytic≥ 50% exophytic< 50% exophytic100% endophytic
Renal RimLateralMedial
Renal SinusNot involvedInvolved
Urinary collecting systemNot involvedDislocated/Inflitrated
Longitudinal (polar) location Superior/InferiorMiddle
Anterior or Posteriora = anterior, p = posterior
6-7 Low risk group
8-9 Moderate risk group
≥ 10 High risk group

P-RAC nephrometry scoring sytem:​​

Parameter123
Radius (cm)< 33-4>4
Exophytic or Endophytic≥ 50% exophytic< 50% exophytic100% endophytic
Nearness to collecting system (mm)≥ 76.9-4.1≤4
Distance to nearest structure (cm)> 1.5 > 1 cm but ≤1.5 {1.5 multiplier applied to individual scoring in case of sensitive organ - small bowel, colon, pancreas, ureter or renal vasculature}≤ 1 {1.5 multiplier applied to individual scoring in case of sensitive organ - small bowel, colon, pancreas, ureter or renal vasculature}
Anterior or Posteriora = anterior, p = posterior
4 - 6 Low complexity group
7 - 9 Moderate complexity group
≥ 10 High complexity group

(MC)2 scoring system:

ParameterCriteriaScore
Radius (cm)≤ 2.5 cm
> 2.5 cm		2.5 points
0.1 points / mm tumor diameter
Central tumor locationYes
No		1.5 points
0 points
History of myocardial infarctionYes
No		2.5 points
0 points
History of complicated diseaseYes
No		3 points
0 points
< 5 Low risk for major complication
5 - 8 Moderate risk for major complication
≥ 9 High risk for major complication

DAP scoring system:

Parameter123
Diameter Scoring (cm)< 2.4 2.4 - 4.4 > 4.4
Axial Distance Scoring (cm)> 1.5 ≤ 1.5 Overlap
Polar distance Scoring (cm)> 2 ≤ 2Overlap
Combine A and P score for tumor location and centrality
  1. Rosaleen B. Parsons, Daniel Canter, Alexander Kutikov, Robert G. Uzzo. RENAL Nephrometry Scoring System: The Radiologist’s Perspective. (2012) American Journal of Roentgenology. 199 (3): W355-9. 
  2. Canter D, Kutikov A, Manley B, Egleston B, Simhan J, Smaldone M, Teper E, Viterbo R, Chen DY, Greenberg RE, Uzzo RG. Utility of the R.E.N.A.L. nephrometry scoring system in objectifying treatment decision-making of the enhancing renal mass. (2011) Urology. 78 (5): 1089-94.
  3. Kutikov A, Uzzo RG. The R.E.N.A.L. nephrometry score: a comprehensive standardized system for quantitating renal tumor size, location and depth. (2009) The Journal of urology. 182 (3): 844-53. 
  4. Ficarra V, Novara G, Secco S, et al. Preoperative aspects and dimensions used for an anatomical (PADUA) classification of renal tumours in patients who are candidates for nephron-sparing surgery. Eur Urol 2009;56(5):786–793.
  5. Mansilla AV, Bivins EE Jr, Contreras F, Hernandez MA, Kohler N, Pepe JW. CT-Guided Microwave Ablation of 45 Renal Tumors: Analysis of Procedure Complexity Utilizing a Percutaneous Renal Ablation Complexity Scoring System. J Vasc Interv Radiol 2017;28(2):222–229.
  6. Schmit GD, Schenck LA, Thompson RH, et al. Predicting renal cryoablation complications: new risk score based on tumor size and location and patient history. Radiology 2014;272(3):903–910.
  7. Simmons, Matthew N et al. “Diameter-axial-polar nephrometry: integration and optimization of R.E.N.A.L. and centrality index scoring systems.” The Journal of urology vol. 188,2 (2012): 384-90. doi:10.1016/j.juro.2012.03.123
 
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