Everolimus is FDA approved for the treatment of<unk> s. Treatment should be considered for asymptomatic, growing<unk> s measuring larger than 3 cm in diameter.<unk> s do not normally require surgery unless life-threatening bleeding is present. Some centers may perform preventative selective embolisation of the<unk>  if it is more than 4 cm in diameter, due to the risk of hemorrhage. People with Tuberous Sclerosis are advised to have yearly renal scans, though patients with very stable lesions could be monitored less frequently. The research in this area is lacking. Even if no<unk>  is found, one can develop at any life stage. The<unk>  can grow rapidly. In Tuberous Sclerosis, typically, many<unk> s affect each kidney. Not uncommonly, more than one intervention may be required during lifetime. Since kidney function may already be impaired (up to half the kidney may be lost before function loss is detectable), preserving as much kidney as possible is vital when removing any lesion. Large<unk> s are treated by embolization, which reduces the risk of hemorrhage and can also shrink the lesion. A side effect of this treatment is postembolisation syndrome, severe pain and fever, but this is easily managed and lasts only a few days. A ruptured aneurysm in an<unk>  leads to blood loss that must be stopped (though embolisation) and compensated for (through intravenous fluid replacement). Therefore, removal of the affected kidney (nephrectomy) is strongly discouraged, though may occur if the emergency department is not knowledgeable about Tuberous Sclerosis. Embolisation involves inserting a catheter along the blood vessels to the tumour. The blood vessels are then blocked, typically by injecting ethanol or inert particles. The procedure can be very painful, so analgesics are used. The destroyed kidney tissue often causes postembolisation syndrome, which manifests as nausea, vomiting, fever, and abdominal pain, and lasts a few days. Embolisation (in general) has an 8% rate of morbidity and a 2.5% rate of mortality, so is not considered lightly. Patients with kidney loss should be monitored for hypertension (and treated for it if discovered) and avoid nephrotoxic drugs such as certain pain relievers and intravenous contrast agents. Such patients who are unable to communicate effectively (due to age or intellectual disability) are at risk of dehydration. Where multiple or large<unk> s have caused chronic kidney disease, dialysis is required. Robotic assisted partial nephrectomy has been proposed as a surgical treatment of a ruptured<unk>  combining the advantages both of a kidney preservation procedure and the benefits of a minimal invasive procedure without compromising the safety of the patient. Follow-up It is suggested that no follow-up is needed for<unk> -like incidental imaging findings measuring less than 1 or 2 cm. Alternatively, a renal ultrasonography every 3 or 4 years has been suggested for<unk> -like masses measuring less than 2 cm. For those measuring 2 to 4 cm, annual ultrasonography is recommended. Those over 4 cm are usually surgically removed, but for those that are not, it is recommended to perform an ultrasonography after 6 months, and then annually if stable.
Angiomyolipoma
Angiolipoma
Myelolipoma
Nephrogenic adenoma
Renal medullary fibroma
Renal oncocytoma
Papillary tumor
Oncocytoma