Renal cell carcinomas (RCCs) are the most common malignant tumor in Von Hippel-Lindau (VHL) disease, which is an inherited, autosomal dominant syndrome manifested by a variety of benign and malignant tumours. The major treatment is protect as much renal function as possible while avoiding metastasis. However, proper operative strategies are unclear. Therefore, we tracked the natural development of those renal tumours until that tumours were resected. We found that changing the surgery threshold from previous 3 cm to 4 cm appears to be a reasonable choice, which can decelerate kidney damage and decrease the economic burden. (By Dr. Kan Gong, https://jmg.bmj.com/content/early/2019/02/11/jmedgenet-2018-105567 )