Fuhrman/WHO-ISUP Nuclear Grade for Renal Cell Carcinoma
Grades nuclear atypia in clear cell RCC to predict prognosis and guide surveillance intensity
- Highest activation tier
- Recommended
- How it is scored
- Scored in code; a stated value is compared only from the structured summary or a supplied value
- Scoring type
- classification
- Care settings
- Inpatient, Outpatient
When it activates
Scribeable activates a calculator from the encounter. The Fuhrman/WHO-ISUP Nuclear Grade for Renal Cell Carcinoma can activate when the transcript or pasted chart context documents any of these:
- Renal cell carcinoma grading
- RCC nuclear grade assignment
- Kidney cancer pathology grading
- Clear cell RCC prognosis
- RCC surveillance planning
A coded diagnosis can also activate it. ICD-10 prefixes carried by the registry: C64.
Inputs the note needs
1 input. Each is resolved from the transcript, the pasted chart context and charted labs; at this calculator’s tier a missing input is never requested, and a missing required input keeps the score out of the draft.
| Input | Type | Unit / options | Guidance |
|---|---|---|---|
| Fuhrman/WHO-ISUP nuclear grade (1-4) | exam |
Scoring
Grade 1: Small round uniform nuclei (~10 microns), inconspicuous/absent nucleoli. Grade 2: Slightly irregular nuclei (~15 microns) with nucleoli visible at 400x. Grade 3: Markedly irregular nuclei (~20 microns) with nucleoli prominent at 100x. Grade 4: Bizarre multilobed nuclei, heavy chromatin clumping, sarcomatoid/rhabdoid differentiation.
Interpretation
Grade 1: Excellent prognosis — 5-year CSS >95%. Active surveillance may be appropriate for small tumors. Grade 2: Good prognosis — 5-year CSS ~80-90%. Standard surveillance protocol. Grade 3: Intermediate prognosis — 5-year CSS ~60-70%. Enhanced surveillance, consider adjuvant therapy in clinical trials. Grade 4: Poor prognosis — 5-year CSS ~30-40%. Aggressive management, adjuvant immunotherapy (pembrolizumab for high-risk). WHO-ISUP grading (2012) replaced Fuhrman — based on nucleolar prominence, prognostically superior. Grade 4 includes any sarcomatoid or rhabdoid differentiation regardless of nucleoli.
Evidence
Sources carried in Scribeable's citation registry for this calculator; guideline version: Fuhrman 1982/WHO-ISUP 2012.
- Fuhrman SA et al. Prognostic significance of morphologic parameters in renal cell carcinomaFuhrman et al. (Nuclear Grading) 1982 · 1982 · link last verified 2026-03-28
- Delahunt B et al. The International Society of Urological Pathology (ISUP) grading system for renal cell carcinoma and other prognostic parametersISUP (Renal Cell Grading) 2012 · 2012 · WHO/ISUP · Consensus · link last verified 2026-03-28
How Scribeable handles it in the note
When an encounter activates the Fuhrman/WHO-ISUP Nuclear Grade for Renal Cell Carcinoma (its highest tier is recommended), Scribeable does not ask you for missing inputs. The score is computed in code from whatever inputs resolve from the transcript, the pasted chart context or charted labs; a computed value is written into the draft only when every required input already resolves.
The score is computed in code from the resolved inputs, not recalled by the language model. A stated Fuhrman/WHO-ISUP Nuclear Grade for Renal Cell Carcinoma value is compared against the computed one when the draft's structured summary carries it; a disagreement found there is flagged to the second drafting pass, which is instructed to correct the score and its interpretation, unless Scribeable has supplied the computed value to that pass, in which case the value the draft writes is checked against the supplied one and a detected difference is shown beside the note for you to adjudicate rather than silently rewritten.
Classified as a staging or classification system: activated strictly, because a wrong stage on the wrong patient is a documentation hazard.
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