Angiomyolipomas (AML)
What are angiomyolipomas?
Angiomyolipomas are the most common type of benign renal tumour. Most commonly affecting women over age 50, they are sometimes found within other abdominal organs but most often appear in the kidneys.
On their own, angiomyolipomas are not dangerous and do not usually develop into cancer, being made mostly of blood vessels and fat tissue. However, some grow in ways that cause the blood vessels to dilate and burst, leading to life-threatening internal haemorrhage.
Sandhurst Urology offers diagnosis, management, and medical intervention for angiomyolipomas from our clinic in Bendigo. To book an appointment, please ask your GP for a referral or call us directly.
Symptoms of angiomyolipomas
Angiomyolipoma symptoms can vary widely depending on their size and makeup. Most sufferers do not have obvious symptoms, particularly if the AML is small. If symptoms do present, they may include:Anaemia
- Discomfort or pain in the abdomen, back, or sides
- Urinary tract infections
- A lump in the abdomen that you can feel
- Blood in the urine
- High blood pressure
If your angiomyolipoma causes a blood vessel to rupture, you may experience:
- Acute abdominal or back pain
- Nausea and vomiting
- Haemorrhage
- Shock (20–30% of people presenting to the emergency room with AML are suffering from shock)
If you have been previously diagnosed with an angiomyolipoma and develop these symptoms, head immediately to your nearest hospital emergency department.
Remember that your own experience with angiomyolipomas is individual – you may not experience every symptom and may experience slightly different symptoms to those specified. For further advice and diagnosis, book an appointment at Sandhurst Urology.
Diagnosing angiomyolipomas
Many angiomyolipomas are diagnosed accidentally, through an imaging test meant to look for another condition, such as tuberous sclerosis. If your doctor believes you have an angiomyolipoma, they may order some of the following tests to thoroughly assess it:
- CT scan – this test uses a series of x-rays to gain clear images of your kidneys and other abdominal organs. Your doctor uses these to assess the angiomyolipoma from multiple angles and determine the best course of treatment.
- MRI scan – these use magnetic waves to visualise the kidney, and are particularly useful in evaluating angiomyolipomas which have a high concentration of fat cells.
- Ultrasound – a test using sound waves to visualise the abdominal organs in real-time. Your doctor may be able to provide this in their rooms.
- Kidney biopsy – this is not generally needed for diagnosing an angiomyolipoma, but your doctor may request one if they do not know whether the tumour is cancerous.
Preventing angiomyolipomas
Since angiomyolipomas are though to be caused by genetic disorders, there is no reliable way to prevent them from forming.
As with any condition, always seek medical guidance to prevent and treat angiomyolipomas effectively. Ask your GP for a referral to Sandhurst Urology for individualised advice.
Treatments for angiomyolipomas
Many angiomyolipomas do not require treatment at all, particularly if they are small. Instead, many doctors will recommend ongoing monitoring. This involves regular check-ups and kidney scans (usually every 3–4 years) to ensure the angiomyolipoma does not become dangerous.
Your doctor may recommend treatment if you have a symptomatic angiomyolipoma, a large one (over 4cm), or if you are a woman and plan to become pregnant (as pregnancy hormones may cause them to grow). Your doctor may also recommend having it removed if you live rurally and would not be able to access treatment in time if it burst.
If your angiomyolipoma is caused by tuberous sclerosis, your doctor may prescribe an mTOR-inhibiting medication such as everolimus. These medications prevent the AML from growing further and may help it shrink.
Some limited studies have shown that a high-fat ketogenic diet can make angiomyolipoma develop faster in rats, though it is not yet known whether the diet has similar effects on humans.
Medical interventions for angiomyolipomas
Treatments offered through Sandhurst Urology’s Bendigo clinic include:
- Nephrectomy – removing your affected kidney, in turn removing the angiomyolipoma.
- Partial nephrectomy – removing only the section of your kidney including the angiomyolipoma, sparing as much of the kidney’s healthy part as possible.
- Radiofrequency ablation – a process which uses heat to destroy abnormal tissue. While you are sedated, a surgeon uses a small metal rod to apply high heat to the AML, potentially cauterising its blood vessels and burning away the tumour.
Renal artery embolization – this process involves blocking off arteries which supply blood to the tumour, usually using tiny metal coils placed inside blood vessels. In addition to preventing the angiomyolipoma from rupturing and causing significant internal bleeding, it can cause the angiomyolipoma to gradually shrink and die from lack of blood flow.
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