RENAL nephrometry scoring system

Dr Henry Knipe and Dr Gayaman Dissanayake et al.

The RENAL nephrometry scoring system was developed to categorize renal masses into low, intermediate and high complexity, based on cross-sectional imaging findings. It would help in decision making, patient counseling, surgical planning, patient follow-up as well as academic reporting.


Scoring is based on five basic radiological features of the mass. This score was originally developed according to the MDCT features on an IVU protocol but it can also be calculated according to MRI features.

  • R: radius (maximum diameter) in centimeters (cm) in any axis:
    •  ⩽ 4: 1 point
    • < 4 but >7: 2 points
    • ⩾ 7: 3 points
  • E: exophytic/endophytic tumor location:
    • ⩾50% exophytic: 1 point
    •  <50% exophytic: 2 points
    •  100% endophytic: 3 points
  • N: nearness to renal collecting system or renal sinus measured in millimeters (mm) as the shortest distance from the deepest point of tumor:
    • ⩽ 4: 1 point
    • < 4 but >7: 2 points
    • ⩾ 7: 3 points
  • A: anterior or posterior location- this is assessed axial view:
    • no points are given
    • descriptors “a”, “p” or “x”
  • ​​L: location relative to polar lines
    • entirely below inferior pole or entirely above superior pole: 1 point
    • mass crosses polar line: 2 points
    • 50% of mass is across polar line or mass is entirely between polar lines or mass crosses axial midline: 3 points
  •  h: mass that touches the main renal vein or artery are given the suffix “h”. (this is to define the hilar location and does not allocate any point)
Nephrostomy score grading
  • score of 4-6: low complexity
  • score of 7-9: moderate complexity
  • score of 10-12: high complexity
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Article information

rID: 67120
System: Urogenital
Synonyms or Alternate Spellings:
  • R.E.N.A.L. nephrometry scoring system

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