Focal segmental glomerulosclerosis in concurrent association with renal clear cell carcinoma

Malignancies are sometimes associated with the development of proteinuria and the nephrotic syndrome. A 59-year-old Caucasian male university professor was referred for evaluation of renal insufficiency to the nephrologist three months after unilateral radical nephrectomy for clear cell renal carcinoma. Post nephrectomy, he was found to have significant proteinuria with a 24-hour urine collection revealing 1.38 g of glomerular protein. Histological sections of the noncancerous areas of the resected kidney were then examined which revealed focal segmental glomerulosclerosis. The patient was given angiotensin-converting enzyme inhibitor therapy. Six years later, the 24-hour urine protein excretion was 0.32 g and there has been no recurrence of his renal carcinoma. Patients undergoing nephrectomy for renal carcinoma should have routine urinalysis and a 24-hour urine collection ordered if protein is detected. Noncancerous portions of renal tissue can be reviewed at tumor resection or nephrectomy, so that biopsy of the remaining kidney is not necessary.