RENAL-CELL CARCINOMA PRESENTING AS NEPHROTIC SYNDROME

A 64-year-old woman presenting with a history of increasing oedema was found to have nephrotic syndrome with a 24-hour urinary protein excre tion of 20.7 g and renal impairment with an initial serum creatinine l evel of 197 mu mol/l (2.16 mg/dl). A renal tumour was demonstrated by ultrasound scanning and subsequent nephrectomy revealed a renal carcin oma extending as far as the resected end of the renal vein. Histology of the kidney not involved by the tumour showed normal light microscop ic appearances, with electron microscopy demonstrating foot process fu sion, suggesting a diagnosis of minimal-change nephropathy. Nephrotic syndrome is a rare complication of renal cell carcinomas, and it is pa rticularly uncommon for minimal change nephropathy to be associated wi th solid tumours.