Laboratory parameters of 1st order – obligatory laboratory tests.
- Small blood count (Hb value, platelet count).
- Differential blood count (neutrophil count).
- Inflammatory parameters – CRP (C-reactive protein) or ESR (erythrocyte sedimentation rate).
- Urine status (rapid test for: Nitrite, protein, hemoglobin, erythrocytes, leukocytes, urobilinogen) incl. sediment, if necessary urine culture (pathogen detection and resistogram, that is, testing of suitable antibiotics for sensitivity / resistance).
- Urine cytology – if malignant (malignant) change is suspected.
- Calcium i. S. [hypercalcemia (calcium excess): about 3% of patients].
- Liver parameters – alanine aminotransferase (ALT, GPT), aspartate aminotransferase (AST, GOT), glutamate dehydrogenase (GLDH) and gamma-glutamyl transferase (gamma-GT, GGT), alkaline phosphatase, bilirubin.
- LDL
- Renal parameters – urea, creatinine, cystatin C or creatinine clearance, as appropriate.
- Alkaline phosphatase (AP) isoenzymes, ostase, urinary calcium (tumor hypercalcemia (synonym: tumor-induced hypercalcemia (calcium excess), TIH) is one of the most common symptoms in paraneoplastic syndromes), PTHrP (parathyroid hormone-related protein; the constellation with decreased parathyroid hormone (PTH) and increased PTHrP is typical for tumor hypercalcemia) – if bone metastases are suspected.
Laboratory parameters 2nd order – optional laboratory tests.
- Punch cylinder biopsy (tissue sampling): at least 2 biopsies under ultrasound or CT guidance Indications:
- Unclear space-occupying lesion of the kidney when biopsy may influence treatment choice.
- Before ablative therapy (before removal of the diseased kidney).
- When there is no histopathological (“fine tissue”) confirmation of renal cell carcinoma and subtype to date; in this case, a biopsy should be taken from the primarius (primary tumor) or a metastasis (daughter tumor) before systemic therapy.
- In metastatic disease, a biopsy may be performed before planned cytoreductive nephrectomy (removal of a large portion of the tumor masses (to reduce tumor burden)).
Contraindications: cystic space lesions should not be biopsied.Possible complications: Hematoma (4.9%), pain (1.2%), macrohematuria (1.0%), pneumothorax (0.6%), and bleeding (0.4%).
- A study based on 2,979 patients with 3,113 biopsies assessed the validity of punctures as follows: Specificity (probability that actually healthy people who do not have the disease in question are also detected as healthy in the test) 96.2%, sensitivity (percentage of diseased patients in whom the disease is detected in the test, ie, a positive result occurs) 97.5%, which led to a positive predictive value of 99.8%; negative predictive value: even in the studies with the lowest potential for bias at only 72.7%.
