Patients with overt disease present with gross hematuria (red or "smoky" urine), headache, and generalized symptoms such as anorexia, nausea, vomiting, and malaise.·Swelling of the renal capsule can cause flank or back pain.Physical examination: Hypervolemia, edema, and hypertension.Complications;· · · · Congestive heart failure and Pulmonary ed