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Kluiving MW, Peeters EFHI, Lely TA, van Oorschot N, de Ranitz-Greven WL. The effect of pregnancy on renal angiomyolipoma; a world of knowledge to gain, specifically in women with TSC. BMC Nephrol 2024; 25:113. [PMID: 38519911 PMCID: PMC10960455 DOI: 10.1186/s12882-024-03483-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2023] [Accepted: 01/25/2024] [Indexed: 03/25/2024] Open
Abstract
BACKGROUND Women are counseled preconceptionally about the potential risks of rAML progression and chance of complications during and due to pregnancy. However, a systematic search investigating the evidence on which this advice is based does not exist. The aim of this systematic review is to determine the effect of pregnancy on renal angiomyolipoma (rAML) size and risk of haemorrhage in patients with tuberous sclerosis complex (TSC). METHODS We searched PubMed, EMBASE, Medline and ClinicalTrials.gov using terms for "renal angiomyolipoma" and "pregnancy". English-language articles published between January 1st 2000, and December 31st 2020 of which full-text was available were included. The initial search resulted in 176 articles. After the screening process we included 45 case reports and 1 retrospective study. For the retrospective study we assessed the risk of bias using the Newcastle-Ottawa Scale. We included articles about renal AML and pregnancy with and without an established diagnosis of TSC. From these articles we recorded the rAML sizes and rAML complications. RESULTS Seven case reports, from a total of 45 case reports, provided follow-up data on renal AML size (these were all cases of renal AML without a known diagnosis of TSC). Of these cases, renal AML size decreased in one patient, was stable in one patient, increased in three patients and fluctuated in two others. Renal AML size of women who suffered a haemorrhage were significantly larger (12.1 ± 4.6 cm) than rAMLs of women who did not suffer a haemorrhage (8.3 ± 3.2 cm). Data from the retrospective study showed no difference in renal complications between the women with and without a history of pregnancy. Haemorrhage occurred in 30% of the women with a history of pregnancy (n = 20) and in 11% in the patients without a history of pregnancy (n = 2), however this retrospective study had methodological limitations. CONCLUSION The effect of pregnancy on renal AML size and complications in patients with TSC is unclear. More research is needed to determine the risk of pregnancy on TSC-associated kidney disease in TSC patient.
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Affiliation(s)
- Marlou W Kluiving
- Department of Internal Medicine, Center of Expertise for Tuberous Sclerosis Complex, University Medical Center Utrecht, Utrecht, The Netherlands.
| | - Evelien F H I Peeters
- Department of Internal Medicine, Center of Expertise for Tuberous Sclerosis Complex, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Titia A Lely
- Department of Obstetrics and Gynecology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Niek van Oorschot
- Department of Radiology, St. Antonius Hospital, Nieuwegein, The Netherlands
| | - Wendela L de Ranitz-Greven
- Department of Internal Medicine, Center of Expertise for Tuberous Sclerosis Complex, University Medical Center Utrecht, Utrecht, The Netherlands
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Ahn T, Roberts MJ, Navaratnam A, Chung E, Wood ST. Wunder-women: Systematic review of causes, treatment and outcomes of Wunderlich syndrome during pregnancy. JOURNAL OF CLINICAL UROLOGY 2019. [DOI: 10.1177/2051415818759367] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Objective: The objective of this article is to conduct a contemporary literature review on Wunderlich syndrome, or spontaneous renal haemorrhage (SRH), among pregnant women to describe contemporary aetiology, investigations and management patterns. Methods: A systematic review of MEDLINE and CENTRAL in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines was performed. All articles, including case reports and case series on SRH published from 2000 to 2016, were included. Full-text manuscripts describing SRH among pregnant women were reviewed for clinical parameters, which were collated and analysed. Results: Twenty cases of SRH in pregnant women were identified. The median age and gestation were 32.1 years and 26.5 weeks, respectively, with SRH most commonly occurring in the third trimester (nine patients; 45%) and due to renal neoplasm, specifically angiomyolipoma (AML; 12 patients; 60%), followed by renal artery aneurysm (RAA; five patients; 25%). Surgical intervention (55%) was most commonly used for acute SRH. Foetal demise was not uncommon (15%). Conclusions: SRH in pregnant women is an uncommon but complex urological and obstetric emergency with potentially catastrophic consequences. A multidisciplinary approach is key to timely diagnosis and appropriate management considering the well-being both of mother and foetus. Pre-emptive diagnosis and intervention may reduce complications. Level of evidence: 4
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Affiliation(s)
- Thomas Ahn
- Department of Urology, Princess Alexandra Hospital, Australia
| | - Matthew J Roberts
- Department of Urology, Princess Alexandra Hospital, Australia
- Faculty of Medicine, The University of Queensland, Australia
- Centre for Clinical Research, The University of Queensland, Australia
| | | | - Eric Chung
- Department of Urology, Princess Alexandra Hospital, Australia
- Faculty of Medicine, The University of Queensland, Australia
- AndroUrology Centre, Australia
| | - Simon T Wood
- Department of Urology, Princess Alexandra Hospital, Australia
- Faculty of Medicine, The University of Queensland, Australia
- Centre for Kidney Disease Research, Translational Research Institute, Australia
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Ng TL, Chu RWH, Leung CLH, Chan WKW, Cho CL, Law IC, Kan CF, Ho LY, Au WH. Spontaneous rupture of renal angiomyolipoma during pregnancy: A report of two cases and literature review. SURGICAL PRACTICE 2018. [DOI: 10.1111/1744-1633.12314] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Affiliation(s)
- Tsz-Leung Ng
- Department of Surgery; Queen Elizabeth Hospital; Hong Kong
| | | | | | | | - Chak-Lam Cho
- Department of Surgery; Kwong Wah Hospital; Hong Kong
| | - In-Chak Law
- Department of Surgery; Kwong Wah Hospital; Hong Kong
| | - Chi-Fai Kan
- Department of Surgery; Queen Elizabeth Hospital; Hong Kong
| | - Lap-Yip Ho
- Department of Surgery; Queen Elizabeth Hospital; Hong Kong
| | - Wing-Hang Au
- Department of Surgery; Queen Elizabeth Hospital; Hong Kong
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Patil SR, Pawar PW, Sawant AS, Savalia AJ, Tamhankar AS. Wunderlich Syndrome due to Ruptured Pseudoaneurysm of Angiomyolipoma in First Trimester: A Rare Case Report. J Clin Diagn Res 2017; 11:PD16-PD18. [PMID: 28764248 DOI: 10.7860/jcdr/2017/25399.10141] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2016] [Accepted: 04/21/2017] [Indexed: 11/24/2022]
Abstract
Angiomyolipoma (AML) is a rare benign tumour of kidney which demonstrates rapid growth during pregnancy due to hormonal stimulation, leading to rupture. Majority of reported ruptured AMLs are in third trimester. We report a case of ruptured angiomyolipoma at 10th week of gestation, the earliest rupture known in singleton pregnancy. The AML had pseudo-aneurysm formation with extra-tumoural rupture during pregnancy, a finding never reported in literature yet. The patient had active bleeding with expanding peri-nephric haematoma during initial two days of conservative management. Hence, after counselling and taking prior informed written consent for Medical Termination of Pregnancy (MTP), computed tomography scan of abdomen with angiography followed by emergency coil embolization of the bleeding right upper polar segmental artery was done. After stabilization, MTP was done at 12th week of gestation. Counselling and consent for continuing or aborting the pregnancy is of utmost importance for best possible outcome for patient and foetus.
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Affiliation(s)
- Sunil Raghunath Patil
- Senior Registrar, Department of Urology, Lokmanya Tilak Municipal Medical College, Sion, Mumbai, Maharashtra, India
| | - Prakash Wamanrao Pawar
- Associate Professor, Department of Urology, Lokmanya Tilak Municipal Medical College and General Hospital, Mumbai, Maharashtra, India
| | - Ajit Somaji Sawant
- Professor and Head, Department of Urology, Lokmanya Tilak Municipal Medical College and General Hospital, Mumbai, Maharashtra, India
| | - Abhishek Jaysukhbhai Savalia
- Senior Registrar, Department of Urology, Lokmanya Tilak Municipal Medical College and General Hospital, Mumbai, Maharashtra, India
| | - Ashwin Sunil Tamhankar
- Senior Registrar, Department of Urology, Lokmanya Tilak Municipal Medical College and General Hospital, Mumbai, Maharashtra, India
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Ao L, Ogasahara E, Okuda Y, Hirata S. Spontaneous rupture of renal angiomyolipoma during pregnancy. BMJ Case Rep 2017; 2017:bcr-2016-217284. [PMID: 28062422 DOI: 10.1136/bcr-2016-217284] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023] Open
Abstract
A renal angiomyolipoma (AML) is a rare benign tumour of kidney origin. Pregnancy is known to be associated with an increased risk of tumour rupture causing hypovolaemic shock, which is usually managed surgically or through an embolisation procedure. However, having surgery during pregnancy predisposes the mother to a preterm delivery, and the unknown influences of radiation exposure to the fetus make the management of such cases very challenging. A 30-year-old pregnant woman had a sudden onset of gross haematuria at the 20th week of her pregnancy. The MRI showed a 10 cm mass suggestive of AML in the left kidney, with evidence of an intrarenal haematoma. To avoid an iatrogenic preterm delivery and unnecessary fetal exposure to radiation, conservative management was conducted until 34 weeks of gestation, when she came to our hospital reporting of flank pain. An endovascular treatment was performed immediately after an emergency caesarean delivery.
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Affiliation(s)
- Li Ao
- Department of Obstetrics and Gynecology, University of Yamanashi, Chuo, Yamanashi, Japan
| | - Eriko Ogasahara
- Department of Obstetrics and Gynecology, University of Yamanashi, Chuo, Yamanashi, Japan
| | - Yasuhiko Okuda
- Department of Obstetrics and Gynecology, University of Yamanashi, Chuo, Yamanashi, Japan
| | - Shuji Hirata
- Department of Obstetrics and Gynecology, University of Yamanashi, Chuo, Yamanashi, Japan
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Lole Harris BH, Walsh JL, Nazir SA. Wünderlich ist nicht so Wunderbar: Bilateral Angiomyolipomas and Wünderlich Syndrome Requiring Emergency Embolization in a Patient without Tuberous Sclerosis. Ann Vasc Surg 2016; 34:270.e7-270.e11. [PMID: 27177703 DOI: 10.1016/j.avsg.2015.12.014] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2015] [Revised: 12/14/2015] [Accepted: 12/15/2015] [Indexed: 11/25/2022]
Abstract
Bilateral renal angiomyolipomata are rare and usually associated with tuberous sclerosis. Renal angiomyolipomata can rupture spontaneously giving rise to (potentially catastrophic) retroperitoneal hemorrhage (Wünderlich syndrome). We present a very rare case of bilateral renal angiomyolipomata in an individual without tuberous sclerosis, presenting with life-threatening hemorrhage. The patient had emergency embolization of the bleeding angiomyolipoma and received elective embolization of a contralateral lesion. A follow-up brain magnetic resonance imaging showed no tubers but revealed a pituitary adenoma of uncertain significance.
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Affiliation(s)
| | - Jason Leo Walsh
- American University of Beirut Medical Centre, Vascular Medicine Program, Beirut, Lebanon
| | - Sarfraz Ahmed Nazir
- Department of Radiology, Horton Hospital, Oxford University Hospitals NHS Trust, Oxford, UK
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Çetin C, Büyükkurt S, Demir C, Evrüke C. Renal angiomyolipoma during pregnancy: Case report and literature review. Turk J Obstet Gynecol 2015; 12:118-121. [PMID: 28913054 PMCID: PMC5558375 DOI: 10.4274/tjod.32848] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2015] [Accepted: 04/14/2015] [Indexed: 12/15/2022] Open
Abstract
Renal angiomyolipoma is a rare tumor that can be either sporadic or found together with tuberous sclerosis or pulmonary lymphangioleiomyomatosis. These tumors are hormone sensitive and therefore tend to grow during pregnancy and their main complication is the risk of rupture. Optimal management is still controversial because there are very few cases reported in the literature. We expect that the case of our patient, who delivered her baby vaginally at 36 weeks of gestation and underwent definitive treatment (nephrectomy) thereafter, to further enhance the knowledge about the management of these rare tumors during pregnancy.
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Affiliation(s)
- Cihan Çetin
- Çukurova University Faculty of Medicine, Department of Obstetrics and Gynecology, Adana, Turkey
| | - Selim Büyükkurt
- Çukurova University Faculty of Medicine, Department of Obstetrics and Gynecology, Adana, Turkey
| | - Cansun Demir
- Çukurova University Faculty of Medicine, Department of Obstetrics and Gynecology, Adana, Turkey
| | - Cüneyt Evrüke
- Çukurova University Faculty of Medicine, Department of Obstetrics and Gynecology, Adana, Turkey
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