New Trends and Evidence for the Management of Renal Angiomyolipoma: A Comprehensive Narrative Review of the Literature

Abstract

Treatment of renal angiomyolipoma (AML) seeks to reduce related complications and preserve kidney function. The purpose of this article was to perform an updated literature review on the diagnosis, therapeutic options, and criteria for invasive intervention in patients with renal AML. Computerized tomography is the standard diagnostic method for renal AML, while definitive diagnosis is made by histopathology. The management of choice in most cases is active surveillance (AS), with a clinical and imaging follow-up protocol. In high-risk cases, therapeutic management should be considered, with alternatives such as selective arterial embolization (SAE), nephron-sparing surgery (NSS), and mTOR inhibitors in selected patients. Renal AML in women of childbearing age, those with growth >0.25 cm/year, intralesional aneurysms >5 mm, and clinically significant symptoms may qualify for active treatment. Despite the limitations derived from the available evidence, it is possible to consider SAE, NSS, and the use of mTOR inhibitors as management alternatives for selected patients.

Keywords: angiomyolipoma; diagnosis; kidney neoplasms; review; therapeutics.

Figure 1:

Literature review algorithm.

Figure 2:

Proposed updated management algorithm. RCC – renal cell carcinoma; AML – angiomyolipoma; TSC – tuberous sclerosis complex; MRI – magnetic resonance imaging; US – ultrasound; CT – computerized tomography. *Associated with other risk factors, according to medical criteria. **See characteristics and risk factors in “epithelioid AML.”