title: Follow-up for Clinically Localized Renal Neoplasms: AUA Guideline.
abstract: OBJECTIVE
  The purpose of this guideline is to provide a clinical framework for follow-up of clinically localized renal neoplasms undergoing active surveillance, or following definitive therapy.
  
  
  METHODS
  A systematic literature review identified published articles in the English literature between January 1999 and 2011 relevant to key questions specified by the Panel related to kidney neoplasms and their follow-up (imaging, renal function, markers, biopsy, prognosis). Study designs consisting of clinical trials (randomized or not), observational studies (cohort, case-control, case series) and systematic reviews were included.
  
  
  RESULTS
  Guideline statements provided guidance for ongoing evaluation of renal function, usefulness of renal biopsy, timing/type of radiographic imaging and formulation of future research initiatives. A lack of studies precluded risk stratification beyond tumor staging; therefore, for the purposes of postoperative surveillance guidelines, patients with localized renal cancers were grouped into strata of low- and moderate- to high-risk for disease recurrence based on pathological tumor stage.
  
  
  CONCLUSIONS
  Evaluation for patients on active surveillance and following definitive therapy for renal neoplasms should include physical examination, renal function, serum studies and imaging and should be tailored according to recurrence risk, comorbidities and monitoring for treatment sequelae. Expert opinion determined a judicious course of monitoring/surveillance that may change in intensity as surgical/ablative therapies evolve, renal biopsy accuracy improves and more long-term follow-up data are collected. The beneficial impact of careful follow-up will also need critical evaluation as further study is completed.
authors.affiliation: American Urological Association Education and Research, Inc., Linthicum, Maryland, USA.
authors.forename: Sherri M
authors.initials: SM
authors.lastname: Donat
authors.forename: Mireya
authors.initials: M
authors.lastname: Diaz
authors.forename: Jay Todd
authors.initials: JT
authors.lastname: Bishoff
authors.forename: Jonathan A
authors.initials: JA
authors.lastname: Coleman
authors.forename: Philipp
authors.initials: P
authors.lastname: Dahm
authors.forename: Ithaar H
authors.initials: IH
authors.lastname: Derweesh
authors.forename: S Duke
authors.initials: SD
authors.lastname: Herrell
authors.forename: Susan
authors.initials: S
authors.lastname: Hilton
authors.forename: Eric
authors.initials: E
authors.lastname: Jonasch
authors.forename: Daniel W
authors.initials: DW
authors.lastname: Lin
authors.forename: Victor E
authors.initials: VE
authors.lastname: Reuter
authors.forename: Sam S
authors.initials: SS
authors.lastname: Chang
mesh_terms: D014408:Biomarkers, Tumor / Q000032:analysis; D001706:Biopsy; D003952:Diagnostic Imaging; D005500:Follow-Up Studies; D006801:Humans; D007677:Kidney Function Tests; D007680:Kidney Neoplasms / Q000473:pathology* / Q000628:therapy*; D009364:Neoplasm Recurrence, Local / Q000473:pathology; D011379:Prognosis
chemical_list: D014408:Biomarkers, Tumor
keywords: ALP; BUN; CBC; CKD; CT; CXR; FDA; FNA; Food and Drug Administration; LDH; LFTs; MRI; NSF; PET; RCC; US; alkaline phosphatase; blood urea nitrogen; chest x-ray; chronic kidney disease; complete blood count; computerized tomography; eGFR; epidemiology; estimated glomerular filtration rate; fine needle aspiration; follow-up studies; lactate dehydrogenase; liver function tests; magnetic resonance imaging; nephrogenic systemic fibrosis; positron emission tomography; renal cell carcinoma; renal neoplasm; ultrasound