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

Treatment of renal angiomyolipoma (AML) seeks to reduce related complications and preserve kidney function. The purpose of this article is to perform an updated literature review on the diagnosis, therapeutic options, and criteria for invasive intervention in patients with renal AML. The primary search protocol was executed using the PubMed, Embase and LILACS databases with the Mesh terms "angiomyolipoma", "kidney", “kidney neoplasm”, “diagnosis” and "therapeutics". The search was limited to articles published within the last 20 years, written in English and Spanish. All titles and abstracts were assessed by two of the authors and included according to their contribution to the objective of the article. Some additional references were included given their clinical and historical relevance. Computerized tomography is the standard diagnostic method for renal AML; definitive diagnosis is made by histopathology. The management of choice in the vast majority of 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 is a pathology that can be managed with AS most of the time, while women of childbearing age, those with growth >0.25 cm/year, intralesional aneurysms >5 mm, and clinically significant symptoms 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.