Overview of three decades of management patterns of renal angiomyolipomas

To analyze clinical and radiological features and trends in the management pattern of renal angiomyolipomas (AML) in a tertiary care center over a 30-year period.

We retrospectively reviewed the charts of patients referred to our institutions from 1992 to 2022 with final diagnosis of AML. Demographics, clinical presentation, radiological findings, renal function status, and treatment options were recorded. Clinical presentation and management trends were described over the study period. Moreover, impact of tumor size on presentation and management was studied by considering 4cm as cut-off point.

Overall, three hundred and ninety-two patients (mean age 61.7±16.9years) were included in the analysis. An incidental diagnosis occurred in 75.2% of cases. Of all, 277 (70.5%) and 115 (29.5%) patients were respectively managed with active treatment and surveillance. Partial nephrectomy represented the first elected surgical approach (49%). Presenting tumor size continuously decreased over the study period (P<0.001). Treatment options have shifted, with significant trending towards less invasive approaches such as angio-embolization or active surveillance. Overtreatment remains an issue.

In the current era AMLs are smaller and more likely to be diagnosed readily because of the widespread utilization of different imaging modalities. Despite a significant shift in the management toward active surveillance, overtreatment is still overused.