What happened, in summary

A 58-year-old man presented with visible blood in his urine and rapidly worsening kidney function. Kidney biopsy showed IgA nephropathy, and he eventually required dialysis. Because of his smoking history, recent blood clots and other findings, clinicians also investigated for an underlying cancer.

Imaging found right-upper-lung nodules, enlarged hilar nodes and a large retropharyngeal mass. Biopsies from cervical, subcarinal, pulmonary and mediastinal sites showed poorly differentiated metastatic carcinoma. Molecular analysis was most consistent with lung adenocarcinoma.

Chemotherapy was planned, but superior vena cava syndrome required thrombectomy and stent placement and delayed cancer treatment. He ultimately refused further medical treatment, including dialysis, and died from cardiopulmonary arrest before chemotherapy was started.