The postulated mechanisms for PNS in RCCs are elevated cytokines (especially IL-6), tumour secreting hepatotoxins and lysozymes (hepatic dysfunction/Stauffer syndrome), renin and IL-6 secretion by tumour cells (hypertension), erythropoietin secretion by tumour cells (polycythaemia), thrombopoietin secretion by tumour cells (thrombocytosis), chronic disease, poor nutritional status and increased iron-binding protein Lactoferrin (anaemia) (21). This evidence concerns the gene REN and anemia (phenotype).