Hypernephroma is more common in males, with a male to female ratio of 2:1. The tumour may spread locally to involve the renal veins and as the left testicular vein drains directly into the renal vein, the carcinoma may rarely be complicated by a left-sided varicocoele. Acute tubular necrosis is characterized by acute oliguric, potentially reversible, renal failure. Maximal recovery of renal function is in the range of 80%, which usually occurs in the first year.Pathological features include swelling and pallor of the kidneys, with tubular epithelial necrosis. Patients with liver and renal disease are more prone to lactic acidosis of this type due to impaired metabolism and excretion. Respiratory symptoms precede renal failure and usually manifest as an upper respiratory tract infection associated with SOB and haemoptysis due to intrapulmonary haemorrhage. Chronic infection produces an obstructive uropathy, chronic pyelonephritis, renal failure, and contraction of the bladder.