How do I determine the appropriate referral pathway for a patient with a renal mass identified on imaging?

To determine the appropriate referral pathway for a patient with a renal mass identified on imaging, consider the patient's age and clinical features, particularly the presence of haematuria.

Refer people aged 45 years and over using a suspected cancer pathway referral (to be seen within 2 weeks) if they have a renal mass accompanied by unexplained visible haematuria without urinary tract infection, or visible haematuria that persists or recurs after treatment of urinary tract infection, as this suggests possible renal cancer.

If the renal mass is identified incidentally without these features, clinical judgement and local protocols should guide referral, but urgent referral is warranted if there is suspicion of malignancy.

For children with a palpable abdominal mass or unexplained enlarged abdominal organ, consider very urgent referral (within 48 hours) for specialist assessment for Wilms' tumour.

Discussion with a specialist (e.g., by telephone or email) is advised if there is uncertainty about the need or urgency of referral.