Date:
Patient:
Reason for Visit:
Follow-up for renal angiomyolipoma (AML)
Assessment of tumor size and stability
Evaluation for symptoms or complications
Management plan discussion
History:
Presenting Illness:
Date of initial AML diagnosis
Size and location of AML on initial imaging
Presence of tuberous sclerosis complex (TSC) (associated with AML in some cases)
Current symptoms (e.g., abdominal pain, flank pain, hematuria)
Past Medical History (PMH):
Underlying medical conditions (e.g., hypertension, chronic kidney disease)
Prior surgeries or interventions for AML
Family History:
History of TSC in first-degree relatives
Social History:
Smoking history (risk factor for complications)
Physical Exam:
General: Assess for signs of abdominal pain, tenderness, or masses.
Abdominal: Palpate for flank masses or tenderness.
Blood Pressure: Evaluate for hypertension (potential complication).
Diagnostic Tests (may be ordered depending on clinical presentation):
Imaging Studies:
Renal ultrasound: Readily available, monitors AML size and identifies potential complications (bleeding).
CT scan with contrast: Provides detailed view of the AML, useful for following size and characteristics. MRI scan (may be used in some cases): Can differentiate AML from other tumors.
Assessment:
Tumor size and stability: Compare to previous imaging studies to assess growth or stability.
Presence of symptoms: Evaluate for pain, hematuria, or other concerning symptoms.
Risk of complications: Based on tumor size, location, and presence of TSC. Potential complications include bleeding, development of malignant features (rare).
Management plan:
Active surveillance: For small, asymptomatic AMLs with no TSC.
Minimally invasive interventions: Embolization or ablation to reduce blood supply or destroy the AML (for larger tumors, with symptoms, or in TSC patients).
Partial nephrectomy: Surgical removal of part of the kidney containing the AML (for large, symptomatic tumors or high risk of complications).
Plan:
Management approach based on assessment:
Active surveillance: Schedule periodic imaging (ultrasound or CT scan) to monitor tumor size.
Referral to a urologist: For discussion of intervention options (embolization, ablation, or surgery) if indicated.
Management of symptoms: Pain medication or other supportive measures as needed.
Blood pressure control: Important for overall health and may reduce risk of complications.
Patient education: Provide information about AML, risk factors, potential complications, and surveillance or treatment options.
Discuss the importance of regular follow-up and reporting any new symptoms promptly.
If TSC is present, address the association with AML and potential need for additional monitoring.
Follow-up:
Schedule for follow-up appointments based on risk:
More frequent visits for patients with larger AMLs, TSC, or on active surveillance.
Less frequent visits for patients with small, stable AMLs and no TSC.
Repeat imaging studies at defined intervals to monitor tumor size and stability.
Disclaimer: This information is for educational purposes only and should not be interpreted as medical advice. Please consult with a qualified healthcare professional for diagnosis and treatment of renal angiomyolipoma