Reduction of postembolization syndrome after ablation of renal angiomyolipoma

Approximately 75% of patients with tuberous sclerosis complex develop renal anglomyolipomas. These hamartomatous lesions distort and damage renal parenchyma and can lead to hemorrhage. To reduce the risk of hemorrhage, transarterial embolization is used to necrose the angiomyolipoma while sparing normal renal tissue. Although an effective renal-sparing procedure, embolization most often Is associated with an inflammatory response that causes significant fever and pain that can last for several days despite the use of acetaminophen. Reported cases show that 49 of 55 patients who underwent embolization developed this syndrome. The use of such nonsteroidal anti-inflammatory drugs as aspirin is contraindicated because of their adverse effects on platelet function. To reduce pain and fever associated with postembolization syndrome (PES), we changed our clinical management of patients postembolization to include a tapering dose of prednisone over a 2-week period. Nine patients underwent this pharmacological intervention, and one patient abstained. All patients were monitored for pain and fever. Only two patients treated with steroids developed fever, which was assuaged with acetaminophen, and no patient reported pain. The tapering dose of prednisone was well tolerated, and there were no postprocedure Infections. The use of a short-term tapering dose of prednisone appeared to reduce PES compared with the reported literature and improved patient comfort. (C) 2002 by the National Kidney Foundation, Inc.