The rare family cases are encountered in young patient’s, frequently affected by bilateral tumors. The family risk exists for Von Hippel-Lindau disease and Bourneville tuberous sclerosis.
The classic signs (hematuria pains, tumor) usually reveal voluminous and evolved cancers.
When blood is spotted in urine, during all micturition, often accompanied with clots, it is a classic sign of total hematuria. This indicates that the tumor, developed initially from a nephron of the kidney parenchyma is invading the kidney cavities, the calyx or the kidney pelvis, and it occurs often late in the natural evolution of the disease.
Also the lumbar or flank pains are in relation with necrosis of part of a voluminous tumor or a bleeding in the tumor.
The mass of the cancerous kidney is rarely voluminous enough to be discovered by the patient himelf with self examination. The anatomical situation of the normal kidney is thoraco-abdominal. Posterior organ, located in the lumbar fossa, the healthy kidney is usually hidden behind the last ribs and is not palpable during clinical examination.
A varicocele (increase in volume of the scrotum in relation to “varicose veins” of the spermatic cord) recently developped, especially if it is left situated, indicates that the presence of a kidney tumor must examined.
A long-term fever, with which a complete assessment cannot determine if it originates from an infection, is also a relatively late sign.
As the polycythemia (increase of the concentration of red blood cells in the blood = opposite of anaemia), it suggests an important malignant spread.
This fever lowers with the surgical ablation of the cancerous kidney and reappears with metastatic recurrences.