Most new cases of localized RCC are detected incidentally as an enhancing renal mass on cross–sectional imaging. Options for the management of renal masses include excision by partial or radical nephrectomy,ablation or active surveillance in the elderly or infirmed.Nephrometry scoring system represents the first method introduced to attempt to standardize the reporting of salient anatomy of an enhancing renal mass as well as provide a platform to objectify treatment decision–making, minimizing individual subjectivity and judgment.Increasing evidence suggests a relationship may exist between renal mass anatomy and pathologyand it has important prognostic value for disease outcome.

Methods: This study was designed as a hospital based prospective study with the aim to study the use of R.E.N.A.L. Nephrometry score in evaluating treatment options of solid renal masses and in predicting tumor histology and grade.

Results:Out of 40 patients, 19 patients underwent partial nephrectomy and 21 patients underwent radical nephrectomy.Tumors with increasing Nephrometry Score sums as well as increasing individual component scores were more likely to undergo RN than PN.Patients undergoing an open PN had more complex lesions as quantified by Nephrometry.The proportion with clear cell histology also increased with R.E.N.A.L score, from 2/6 (33.3%) in patients with  low R.E.N.A.L scores ( 4–6) up to 15/17 (88.24%) for patients with high R.E.N.A.L scores( 10–12) .

Conclusion:The R.E.N.A.L. nephrometry score of a solid renal mass shows a significant association with our choice of surgery.As the complexity of lesion(nephrometry score)  increases the rate of radical nephrectomy increases and rate of partial nephrectomy decreases.Proportion with clear cell histology and Fuhrman’s grade also increases with R.E.N.A.L score.