THE MANIFESTATIONS of cancer, in general, and of hypernephroma, specifically, present many diagnostic problems. Polycythemia,1,2 fever,3 and hypercalcemia4 have been noted in association with localized adenocarcinoma of the kidney. However, the presence of abnormal liver function as the presenting finding in primary adenocarcinoma of the kidney is less well recognized.5,6 We wish to present a case which illustrates the importance of these less well recognized blood chemical abnormalities which may contribute to early diagnosis and possible cure of renal cancer. Report of a Case The patient was a 48-year-old iron construction worker who entered the hospital with complaints of fatigue, fever, and weight loss. Three months before admission he developed fatigue, profuse night sweats, afternoon fever, and progressive weight loss of 35 lb (15.9 kg). At a local hospital he was found to be anemic, to have persistent microscopic hematuria, and an elevated serum alkaline phosphatase.