research in this area is lacking. Even if no Angiomyolipoma is found, one can develop at any life stage. The Angiomyolipoma can grow rapidly. In Tuberous Sclerosis, typically, many Angiomyolipomas 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 Angiomyolipomas 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 Angiomyolipoma 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 angiomyolipomas have caused chronic kidney disease, dialysis is required. Robotic assisted partial nephrectomy has been proposed as a surgical treatment of a ruptured Angiomyolipoma 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 Angiomyolipoma-like incidental imaging findings measuring less than 1 or 2 cm. Alternatively, a renal ultrasonography every 3 or 4 years has been suggested for angiomyolipoma-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,