Do you pursue any additional testing in your patients with chronic kidney disease who are found to have "small hypodensities too small to characterize" on renal ultrasound?

Renal cell carcinoma in dialysis patients and to a lesser degree in patient with CKD is not uncommon. As such, I would like to re-image these patients after 6 months or so. Usually, these cancers grow slowly and don't cause major disease but it is variable.

Given the mortality of dialysis patients and natural history of renal cell carcinomas not sure that what we do to work up small hypodense areas will benefit patients especially if we jump immediately and create anxiety. Especially in the elderly where such lesions are most often seen.

Agree with repeat high-quality U/S 6m or so later, remembering that U/S is a tech-dependent (and body habitus dependent test) try to get the best tech to study area carefully, not just order U/S

Have a vague recollection that prior to CT's angios were used to characterize Hypernephromas; I think local injection of vasoconstrictor used?

Does anyone remember this?

Jorge Roman-Latorre MD Dallas TX