# R.E.N.A.L. nephrometry R.E.N.A.L. nephrometry Status: LIVE Price: $0.005 USDC `GET /api/calc/renal_nephrometry` HTML: https://magentlab.com/docs/renal-nephrometry Markdown: https://magentlab.com/docs/renal-nephrometry.md Not a medical device. Not a diagnosis, dose, or listing recommendation. ## What it computes Sum the Kutikov 2009 R.E.N.A.L. nephrometry score for a renal mass from four caller-assigned published item points (radius, exophytic/endophytic, nearness, location) and return the integer total (4–12) plus anterior and hilar descriptors. Does not return complexity bands. ## When to use When an agent has already assigned Kutikov 2009 radius, exophytic/endophytic properties, nearness to collecting system or sinus, anterior/posterior descriptor, polar-line location, and hilar abutment for a renal mass and needs the published integer sum, not a nephrectomy order, CT read, PADUA, or STONE nephrolithometry. ## When not to use - Not a medical device. magent does not measure diameter, exophytic fraction, nearness, polar lines, or hilar abutment. Radius, exophytic, nearness, anterior, location, and hilar are caller-assigned. - Not a nephrectomy order. The score is not a command to operate, choose partial versus radical nephrectomy, or select a surgical approach. - Not PADUA and not Okhunov 2013 STONE nephrolithometry. This tool is Kutikov 2009 R.E.N.A.L. nephrometry for renal masses. - Kutikov 2009 Table 1 scores R, E, N, and L (1–3 each). Anterior (a/p/x) and hilar suffix h are descriptors, not points. magent returns score and max_score only; it does not return low/moderate/high complexity bands. ## Formula ``` RENAL = radius (le_4 1, gt_4_lt_7 2, ge_7 3) + exophytic (ge_50 1, lt_50 2, entirely_endophytic 3) + nearness (ge_7 1, gt_4_lt_7 2, le_4 3) + location (entirely_polar 1, crosses_polar 2, gt_50_midline_or_between 3); anterior a|p|x 0 points; hilar suffix h boolean 0 points; Kutikov 2009 R.E.N.A.L. Nephrometry; sum 4-12; no published complexity bands ``` ## Citation [The R.E.N.A.L. Nephrometry Score: A Comprehensive Standardized System for Quantitating Renal Tumor Size, Location and Depth](https://doi.org/10.1016/j.juro.2009.05.035) Kutikov A, Uzzo RG J Urol. 2009;182(3):844-853 DOI: [10.1016/j.juro.2009.05.035](https://doi.org/10.1016/j.juro.2009.05.035) ## Worked example ### All minimum grades Given: `anterior=a, exophytic=ge_50, hilar=false, location=entirely_polar, nearness=ge_7, radius=le_4` 1. le_4 1 + ge_50 1 + ge_7 1 + entirely_polar 1; anterior a; hilar false 2. Score = 4 (max 12); renal_string 4a. No complexity band. Not a nephrectomy order ### All maximum grades Given: `anterior=x, exophytic=entirely_endophytic, hilar=true, location=gt_50_midline_or_between, nearness=le_4, radius=ge_7` 1. ge_7 3 + entirely_endophytic 3 + le_4 3 + gt_50_midline_or_between 3; anterior x; hilar true 2. Score = 12 (max 12); renal_string 12xh. No complexity band. Not a nephrectomy order ## Also searched as - RENAL score - R.E.N.A.L. nephrometry - Kutikov nephrometry - renal tumor nephrometry - Kutikov 2009 - RENAL nephrometry score - renal mass score - nephrometry score ## Parameters - `radius` (string, required): Caller-assigned maximal diameter in cm (Kutikov 2009 R, radius). le_4 (≤4 cm) scores 1; gt_4_lt_7 (>4 but <7 cm) scores 2; ge_7 (≥7 cm) scores 3. magent does not measure diameter or read CT. - `exophytic` (string, required): Caller-assigned exophytic/endophytic properties (Kutikov 2009 E). ge_50 (≥50% exophytic) scores 1; lt_50 (<50% exophytic) scores 2; entirely_endophytic (completely endophytic) scores 3. magent does not read CT. - `nearness` (string, required): Caller-assigned nearness of the deepest portion of the mass to the collecting system or sinus in mm (Kutikov 2009 N). ge_7 (≥7 mm) scores 1; gt_4_lt_7 (>4 but <7 mm) scores 2; le_4 (≤4 mm) scores 3. magent does not measure nearness or read CT. - `anterior` (string, required): Caller-assigned anterior/posterior descriptor (Kutikov 2009 A). a (anterior), p (posterior), or x (indeterminate). 0 points; echoed as anterior. magent does not read CT. - `location` (string, required): Caller-assigned location relative to polar lines (Kutikov 2009 L). entirely_polar (entirely above the upper polar line or entirely below the lower polar line) scores 1; crosses_polar (mass crosses a polar line) scores 2; gt_50_midline_or_between (>50% of the mass is across a polar line, or the mass crosses the axial renal midline, or the mass is entirely between the polar lines) scores 3. magent does not read CT. - `hilar` (boolean, required): Caller-assigned hilar suffix (Kutikov 2009). true means the mass abuts the main renal artery or vein (suffix h). Boolean, not points. magent does not read CT. ## Bulk (POST) POST the same path with a JSON items array. The first item is the GET unit; each additional item is $0.002. Invalid items return HTTP 400 before settlement. Method: `POST /api/calc/renal_nephrometry` Max items: 25 Price: unit_amount + extra_item_amount * (n - 1) (unit 5000 atomic, extra 2000 atomic) Status: PREVIEW - 1 to 25 items. Each item uses the same keys as the GET query parameters. - POST of 1 item costs the same as GET. Lists longer than 25: chunk into multiple POSTs. Extra items still execute; do not pad dummy rows. - The first invalid item fails the whole request (index in the 400 JSON). You are not charged. - HTTP 200 is {count, path, items}. Each items[i] is the GET 200 body for that row. - Catalog misses (empty matches, found=false) stay paid 200s inside that slot. - x402 resource URL is this path plus n and body_sha256. Browsers that prefer text/html get the same paywall as GET; Pay retries POST with the same items. Example request: ```json { "items": [ { "anterior": "a", "exophytic": "ge_50", "hilar": "false", "location": "entirely_polar", "nearness": "ge_7", "radius": "le_4" }, { "anterior": "a", "exophytic": "ge_50", "hilar": "false", "location": "entirely_polar", "nearness": "ge_7", "radius": "le_4" } ] } ``` Human paywall (two-item fixture): https://api.magentlab.com/paywall/bulk/renal-nephrometry Example 200: ```json { "count": 2, "path": "/api/calc/renal_nephrometry", "items": [ { "location": "entirely_polar", "r": 1, "l": 1, "n": 1, "components": [ { "value": "le_4", "factor": "radius", "points": 1, "present": true }, { "value": "ge_50", "factor": "exophytic", "points": 1, "present": true }, { "value": "ge_7", "factor": "nearness", "points": 1, "present": true }, { "value": "entirely_polar", "factor": "location", "points": 1, "present": true } ], "e": 1, "radius": "le_4", "disclaimer": "Not a medical device. Deterministic published-formula or published-code output for autonomous agents. A licensed clinician remains responsible for patient care and billing submissions.", "citation": { "authors": "Kutikov A, Uzzo RG", "doi": "10.1016/j.juro.2009.05.035", "id": "kutikov-2009", "pmid": "19616235", "source": "J Urol. 2009;182(3):844-853", "title": "The R.E.N.A.L. Nephrometry Score: A Comprehensive Standardized System for Quantitating Renal Tumor Size, Location and Depth" }, "formula": "renal_nephrometry", "formula_expression": "RENAL = radius (le_4 1, gt_4_lt_7 2, ge_7 3) + exophytic (ge_50 1, lt_50 2, entirely_endophytic 3) + nearness (ge_7 1, gt_4_lt_7 2, le_4 3) + location (entirely_polar 1, crosses_polar 2, gt_50_midline_or_between 3); anterior a|p|x 0 points; hilar suffix h boolean 0 points; Kutikov 2009 R.E.N.A.L. Nephrometry; sum 4-12; no published complexity bands", "max_score": 12, "score": 4, "anterior": "a", "exophytic": "ge_50", "hilar": false, "nearness": "ge_7", "renal_string": "4a" }, { "location": "entirely_polar", "r": 1, "l": 1, "n": 1, "components": [ { "value": "le_4", "factor": "radius", "points": 1, "present": true }, { "value": "ge_50", "factor": "exophytic", "points": 1, "present": true }, { "value": "ge_7", "factor": "nearness", "points": 1, "present": true }, { "value": "entirely_polar", "factor": "location", "points": 1, "present": true } ], "e": 1, "radius": "le_4", "disclaimer": "Not a medical device. Deterministic published-formula or published-code output for autonomous agents. A licensed clinician remains responsible for patient care and billing submissions.", "citation": { "authors": "Kutikov A, Uzzo RG", "doi": "10.1016/j.juro.2009.05.035", "id": "kutikov-2009", "pmid": "19616235", "source": "J Urol. 2009;182(3):844-853", "title": "The R.E.N.A.L. Nephrometry Score: A Comprehensive Standardized System for Quantitating Renal Tumor Size, Location and Depth" }, "formula": "renal_nephrometry", "formula_expression": "RENAL = radius (le_4 1, gt_4_lt_7 2, ge_7 3) + exophytic (ge_50 1, lt_50 2, entirely_endophytic 3) + nearness (ge_7 1, gt_4_lt_7 2, le_4 3) + location (entirely_polar 1, crosses_polar 2, gt_50_midline_or_between 3); anterior a|p|x 0 points; hilar suffix h boolean 0 points; Kutikov 2009 R.E.N.A.L. Nephrometry; sum 4-12; no published complexity bands", "max_score": 12, "score": 4, "anterior": "a", "exophytic": "ge_50", "hilar": false, "nearness": "ge_7", "renal_string": "4a" } ] } ``` ## Response fields - `formula` (string): renal_nephrometry - `formula_expression` (string): Exact expression used - `score` (integer): Kutikov 2009 R.E.N.A.L. nephrometry integer sum 4-12 (R+E+N+L). Anterior and hilar are not added. Not a nephrectomy order. No published complexity band. - `max_score` (integer): 12 - `r` (integer): Radius points 1-3 (Kutikov 2009 R) - `e` (integer): Exophytic/endophytic points 1-3 (Kutikov 2009 E) - `n` (integer): Nearness points 1-3 (Kutikov 2009 N) - `l` (integer): Location points 1-3 (Kutikov 2009 L) - `radius` (string): Caller-assigned radius used (le_4, gt_4_lt_7, or ge_7) - `exophytic` (string): Caller-assigned exophytic used (ge_50, lt_50, or entirely_endophytic) - `nearness` (string): Caller-assigned nearness used (ge_7, gt_4_lt_7, or le_4) - `anterior` (string): Caller-assigned anterior descriptor used (a, p, or x). 0 points. - `location` (string): Caller-assigned location used (entirely_polar, crosses_polar, or gt_50_midline_or_between) - `hilar` (boolean): true when the mass abuts the main renal artery or vein (suffix h). Not scored. - `renal_string` (string): Kutikov 2009 notation: {score}{anterior} plus h if hilar (for example 4a or 12xh) - `components` (array): Per-item Kutikov 2009 R, E, N, L points - `citation` (object): Kutikov and Uzzo J Urol 2009 citation - `disclaimer` (string): Not-a-device notice ## Example JSON Frozen fixture. Not a live lookup. ```json { "location": "entirely_polar", "r": 1, "l": 1, "n": 1, "components": [ { "value": "le_4", "factor": "radius", "points": 1, "present": true }, { "value": "ge_50", "factor": "exophytic", "points": 1, "present": true }, { "value": "ge_7", "factor": "nearness", "points": 1, "present": true }, { "value": "entirely_polar", "factor": "location", "points": 1, "present": true } ], "e": 1, "radius": "le_4", "disclaimer": "Not a medical device. Deterministic published-formula or published-code output for autonomous agents. A licensed clinician remains responsible for patient care and billing submissions.", "citation": { "authors": "Kutikov A, Uzzo RG", "doi": "10.1016/j.juro.2009.05.035", "id": "kutikov-2009", "pmid": "19616235", "source": "J Urol. 2009;182(3):844-853", "title": "The R.E.N.A.L. Nephrometry Score: A Comprehensive Standardized System for Quantitating Renal Tumor Size, Location and Depth" }, "formula": "renal_nephrometry", "formula_expression": "RENAL = radius (le_4 1, gt_4_lt_7 2, ge_7 3) + exophytic (ge_50 1, lt_50 2, entirely_endophytic 3) + nearness (ge_7 1, gt_4_lt_7 2, le_4 3) + location (entirely_polar 1, crosses_polar 2, gt_50_midline_or_between 3); anterior a|p|x 0 points; hilar suffix h boolean 0 points; Kutikov 2009 R.E.N.A.L. Nephrometry; sum 4-12; no published complexity bands", "max_score": 12, "score": 4, "anterior": "a", "exophytic": "ge_50", "hilar": false, "nearness": "ge_7", "renal_string": "4a" } ``` ## Errors - HTTP 400 `invalid_renal_nephrometry`: radius must be le_4, gt_4_lt_7, or ge_7; exophytic must be ge_50, lt_50, or entirely_endophytic; nearness must be ge_7, gt_4_lt_7, or le_4; anterior must be a, p, or x; location must be entirely_polar, crosses_polar, or gt_50_midline_or_between (Kutikov 2009 R.E.N.A.L.). Returned before settlement; you are not charged. - HTTP 400 `invalid_flag`: boolean clinical flags must be true or false Returned before settlement; you are not charged. - HTTP 400 `invalid_items`: POST body must be a JSON object with only an items array Returned before settlement; you are not charged. - HTTP 400 `invalid_item_count`: items must be an array of 1 to 25 objects Returned before settlement; you are not charged. - HTTP 400 `invalid_item`: each items entry must be a JSON object Returned before settlement; you are not charged. Shared HTTP 402 and 503: https://magentlab.com/docs/payments ## Related tools - [STONE nephrolithometry](https://magentlab.com/docs/stone-nephrolithometry) — Sum the Okhunov 2013 STONE nephrolithometry score for kidney calculi (PCNL) from five caller-assigned published item points and return the integer total (5–13). Does not return stone-free-rate bands. ## Payment Unpaid requests return HTTP 402 even if query parameters or POST items are missing or invalid, so CDP and agents can index the path. After a PAYMENT-SIGNATURE, invalid params return HTTP 400 JSON before settlement. magent does not charge. Fix the params, then request a new 402 quote for that complete URL. Catalog misses (empty matches, found=false) are valid paid 200s. - GET the tool with Accept: application/json (do not send Accept: text/html unless you want the human paywall). - HTTP 402 means you have not paid. Decode the base64 PAYMENT-REQUIRED header. HTTP 503 is not a new quote. - Sign accepts[0] (exact, EIP-3009) with validBefore = now + maxTimeoutSeconds (600 seconds), or accepts[1] (batch-settlement deposit/voucher) on product GET. Ping and POST {items} stay exact. Magent retries transient facilitator 429/5xx before answering. - Retry the same URL with PAYMENT-SIGNATURE (base64 JSON of accepted and payload). Magent attaches canonical extensions.bazaar on CDP verify/settle; echoing 402 bazaar is optional. - Success is HTTP 200 JSON plus PAYMENT-RESPONSE. exact settles before the tool. batch-settlement verifies (and deposit-settles) before the tool and commits the charge after HTTP 2xx. HTTP 503: retry the same PAYMENT-SIGNATURE. Mint a new exact nonce only after a new HTTP 402. - offered `exact` on eip155:8453: Fixed-price USDC on Base. The buyer authorizes the advertised amount (EIP-3009). magent settles before the tool runs (paymentFlow upfront). extra.assetTransferMethod=eip3009 extra.paymentFlow=upfront. - offered `batch-settlement` on eip155:8453: Payment-channel vouchers claimed later in batches. Exact stays accepts[0]. Same-path POST {items} is still exact. extra.assetTransferMethod=eip3009 extra.paymentFlow=authorization. - not offered `upto`: Not offered. Usage-based: buyer authorizes a ceiling, seller settles the actual amount after work. Reserved for a future metered tool. Not for current calculators or code search. Same-path POST {items} is still scheme exact: one EIP-3009 authorization for GET unit plus $0.002 per extra item. That is not x402 batch-settlement (payment channels / vouchers). Shared HTTP 402 and 503 table: https://magentlab.com/docs/payments Stdio MCP (one process per host): https://magentlab.com/docs/mcp ## Guarantees - HTTP 402 is unpaid, including a missing query. After PAYMENT-SIGNATURE, invalid parameters return HTTP 400 before settlement. You are not charged. HTTP 402 never includes the tool JSON. - exact: settlement finishes before the tool (paymentFlow upfront). batch-settlement: verify/deposit before the tool; chargedCumulativeAmount commits after HTTP 2xx. Uncertain or failed settlement fails closed (HTTP 503). Retry the same PAYMENT-SIGNATURE. - HTTP 402 is unpaid only. Do not sign a second authorization because of a 503. - Execution is timeout-bounded and concurrency-capped. - Calculator inputs are stored encrypted for allowlisted operators (Magent Console). They are not in public logs, SSH lookups, catalog, or rollups. Request logs store path without query.