23. Treatment of AML
Prophylactic surgery?
Size ≥4cm to prevent bleeding
High vascularity and/or
aneurysm ≥ 5mm
High suspicion of malignancy
24. Treatment of AML
Therapeutic interventions
Nephron sparing surgery
Selective renal artery embolization
Radiofrequency ablation
Radical nephrectomy
25. Potential issues in women
Female sex hormones promote
growth of renal AMLs and their
hemorrhagic complications during
pregnancy
Frequency of U/S surveillance
should increase
26. Renal cystic disease
The 2nd most common renal
manifestation in TSC
3 types :
Singe or multiple renal cysts
TSC2/PKD1 contiguous gene
syndrome
Glomerulocytic kidney disease
27. Chronic kidney disease
In absence of large AML, patients
may develop:
CKD
subnephrotic proteinuria
hypertension
ESRD
Renal biopsy often reveals FSGS
31. Cardiac Rhabdomyoma
detected on prenatal US
Benign tumor usually
undergo spontaneous
regression
Pulmonary (LAM)
Lymphangio-
leiomyomatosis
Manifestations are
similar to those with
interstitial lung
disease
33. EVEROLIMUS
FDA approved mTOR after ExIST-2 trail
50% reduction in AML volume in 3 month
Dose : 10 mg od for 38 weeks
Candidates :
patients with renal AML plus other organ
affected
Rapidly growing AMLs
Patients who underwent nephrectomy or
embolization