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Renal angiomyolipoma-patient characteristics and treatment with focus on active surveillance

Journal article
Authors J. Sward
O. Henrikson
D. Lyrdal
Ralph Peeker
Sven Lundstam
Published in Scandinavian Journal of Urology
ISSN 2168-1805
Publication year 2020
Published at Institute of Clinical Sciences, Department of Urology
Language en
Links dx.doi.org/10.1080/21681805.2020.17...
Keywords Angiomyolipoma, kidney, active surveillance, retroperitoneal bleeding, Tuberous sclerosis complex angioembolization, natural-history, management, diagnosis, embolization, experience, Urology & Nephrology
Subject categories Urology and Nephrology

Abstract

Objectives: To present a patient material of renal angiomyolipoma (AML) with focus on the risk of bleeding during active surveillance (AS). Methods: Medical records, 1999-2014, were studied and 98 patients (80 female, 18 men) with renal AML were identified. Eleven patients had tuberous sclerosis complex (TSC). Mean age was 54 (13-89) years. Results: Sixty patients (61%) were asymptomatic at presentation, 33 (34%) presented with flank pain and five (5%) with hematuria. Retroperitoneal bleeding or hematuria was diagnosed in 20 patients with a mean AML size of 74 mm (25-200 mm). Twenty-one patients were treated with angioembolization at time of diagnosis and 25 had surgery. Forty-five patients with sporadic AML (mean size 34 mm) and six with TSC (mean size 120 mm) were selected for AS. Only one patient with sporadic AML (46 mm) had a bleeding, whereas two of the six TSC patients had bleedings from three kidneys (AML 70-300 mm). In 25 patients (49%), the AML-size increased with 2.7 mm/year in sporadic and 5.4 mm/year in TSC-associated AML. Thirteen patients were treated with AE (including all six TSC-patients) and five with surgery in 22 kidneys due to AML-size in 16, bleeding in four and suspicion of cancer in two. Conclusion: Bleeding occurred in 20% of AML at presentation. In patients selected for AS, we found a very low risk of bleeding in sporadic AML justifying our cut off size of 50 mm to trigger intervention. In TSC-associated AML individually tailored follow-up is needed due to a higher intervention rate.

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