Correspondence

Treatment of Renal Angiomyolipoma

N Engl J Med 1998; 339:1400November 5, 1998

Article

To the Editor:

Salama and Pusey (June 25 issue)1 elegantly illustrate the renal findings in a 16-year-old girl with tuberous sclerosis, bilateral renal angiomyolipomas, and spontaneous right renal hemorrhage. She underwent a right nephrectomy. Unfortunately, she then had a solitary kidney — one that is involved with angiomyolipoma.

In 1977, transcatheter embolization was used at our institution to control renal hemorrhage in a patient with angiomyolipoma.2 The patient was a 27-year-old woman with tuberous sclerosis who had undergone a right nephrectomy because of a hemorrhaging angiomyolipoma. Seven months later, she was admitted with left renal hemorrhage due to angiomyolipoma. The left kidney was huge and diffusely involved with angiomyolipoma. This time, we used Gelfoam particles to occlude the portions of the kidney that had the most bizarre vasculature on angiographic studies. The patient has had no subsequent bleeding. A computed tomographic scan obtained at the age of 44 years showed little change in renal size.

Small series of patients with renal involvement from angiomyolipoma have been treated with this procedure for bleeding. Soulen et al.3 reported the results in their 5 patients and reviewed the results in 21 others described in the literature, Hamlin et al.4 reported the results in their 5 patients, and Lee et al.5 reported the results in their 15 patients. In these patients bleeding was generally infrequent and renal function was preserved.

Since renal angiomyolipoma is frequently bilateral, particularly in patients with tuberous sclerosis, every effort should be made to salvage the renal parenchyma. Transcatheter embolization can stop acute hemorrhaging, usually prevents future hemorrhaging, and most important, preserves renal function.

Douglas C. Smith, M.D.
Loma Linda University Medical Center, Loma Linda, CA 92354

5 References

1. 1

   Salama AD, Pusey CD. Tuberous sclerosis. N Engl J Med 1998;338:1886-1886
   Full Text | Web of Science | Medline

2. 2

   Moorhead JD, Fritzsche P, Hadley HL. Management of hemorrhage secondary to renal angiomyolipoma with selective arterial embolization. J Urol 1977;117:122-123
   Web of Science | Medline

3. 3

   Soulen MC, Faykus MH Jr, Shlansky-Goldberg RD, Wein AJ, Cope C. Elective embolization for prevention of hemorrhage from renal angiomyolipomas. J Vasc Interv Radiol 1994;5:587-591
   CrossRef | Web of Science | Medline

4. 4

   Hamlin JA, Smith DC, Taylor FC, McKinney JM, Ruckle HC, Hadley HR. Renal angiomyolipomas: long-term follow-up of embolization for acute hemorrhage. Can Assoc Radiol J 1997;48:191-198
   Web of Science | Medline

5. 5

   Lee W, Kim TS, Chung JW, Han JK, Kim SH, Park JH. Renal angiomyolipoma: embolotherapy with a mixture of alcohol and iodized oil. J Vasc Interv Radiol 1998;9:225-261
   CrossRef | Web of Science | Medline

Author/Editor Response

Dr. Salama replies:

To the Editor: In our patient, partial nephrectomy was not possible because of the operative findings. There were two tumor masses. The superior tumor was easily dissected from the rest of the normal kidney, but the posterior (hilar) tumor was large, and the ureter and dilated pelvis were stretched over its surface. Because the renal vein and arteries passed through this tumor mass, salvage of the remaining kidney was not possible. The surgeon therefore elected to clamp and tie off the vessels and remove the entire kidney.

Alan Salama, M.D.
Imperial College School of Medicine, London W12 0NN, United Kingdom

Citing Articles (2)

Citing Articles

1. 1

   Shen-Yang Lee, Hsiang-Hao Hsu, Yung-Chang Chen, Chen-Chih Huang, Yon-Cheong Wong, Li-Jen Wang, Cheng-Keng Chuang, Chih-Wei Yang. (2009) Evaluation of Renal Function of Angiomyolipoma Patients After Selective Transcatheter Arterial Embolization. The American Journal of the Medical Sciences 337:2, 103-108
   CrossRef

2. 2

   Michael J. Schwartz, Eric B. Smith, David W. Trost, E. Darracott Vaughan. (2007) Renal artery embolization: clinical indications and experience from over 100 cases. BJU International 99:4, 881-886
   CrossRef