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Kidneys

It is common for people living with Tuberous Sclerosis Complex to have kidney problems. Monitoring will help reduce the chances of serious problems

Around eight in every 10 people living with Tuberous Sclerosis Complex (TSC) will experience some kidney problems at some stage of their life.

Kidney problems are not common in early childhood but become more common as individuals get older.

Many people with TSC-related kidney issues have no significant problems. However, research from The TuberOus SClerosis registry to increase disease Awareness (TOSCA) shows that half of people with TSC-related kidney issues will need treatment of some kind by the time they are 40 years-old.

Treatment for TSC-related kidney issues is commonly pre-emptive intervention against growths in the kidneys.

Monitoring and timely intervention will prevent almost all serious late complications. This is why regular monitoring of the kidneys and their function in people living with TSC is important.

What are some of the main kidney problems a person living with TSC might have?

Renal AMLs are tumours made up of fat, muscle cells and abnormal blood vessels. It is thought that renal AMLs begin to grow very early in childhood, continuing to grow in size and number over time. Around eight in every 10 adults living with TSC have renal AMLs in both kidneys, though only around half of these people will experience issues that require treatment.

Renal AMLs can affect kidney function and obstruct the flow of urine. Renal AMLs can lead to higher blood pressure, which if left untreated can lead to a reduced kidney function and/or an increased likelihood of cardiovascular problems, including stroke or heart attack. People living with TSC and AMLs on both kidneys may also have reduced kidney function by middle-age, although it is not certain if this is as a direct result of the renal AMLs or other TSC-related issues.

Surveillance and pre-emptive intervention to prevent TSC-related kidney problems is effective and very important.

The size, rate of growth and location of renal AMLs can depend on whether treatment is required, though AMLs often grow slowly.

Around one in every four people living with TSC will develop a renal cyst at some point in their lives, as found by TOSCA. Renal cysts are often present at birth and are small sac-like lumps of fluid on the kidneys.

Ordinary ‘simple’ cysts usually do not need treatment alone, though blood pressure monitoring and regular checks for kidney function are recommended. Around one in 20 people living with TSC will develop ‘polycystic’ kidneys, meaning that they have a significantly high number of cysts on their kidneys. People with polycystic kidneys will require regular and specialist monitoring at dedicated kidney specialist centres.

How are the kidneys of a person living with TSC monitored?

It is important that a person living with TSC has their kidneys regularly monitored for TSC-related changes. This is because of the impact that TSC-related kidney problems can have. Typically, monitoring of the kidneys is done through Magnetic Resonance Imaging (MRI) or Computed Tomography (CT) every 1-3 years. MRI and CT scans are painless.

If kidney problems are found in a person living with TSC, their blood pressure and kidney function will also be monitored at regular intervals. This is usually done annually, though individual circumstances may differ.

How are kidney problems in a person living with TSC treated?

For some people, the presence of TSC-related kidney issues (such as AMLs) will not cause significant problems. However, for other people their TSC-related kidney issues will be serious and treatment recommended.

Depending on the individual circumstances of each person living with TSC-related kidney issues, treatment can include embolisation (blocking blood flow to growths on the kidneys), surgery or medication. In very rare cases, kidney dialysis (a procedure to remove waste products from the blood when the kidneys are not functioning correctly) or transplantation may be considered.

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