Last reviewed: 28 Oct 2020
Last updated: 14 Oct 2020



History and exam

Key diagnostic factors

  • presence of risk factors
  • haematuria
  • oedema
  • hypertension

Other diagnostic factors

  • oliguria
  • anorexia
  • nausea
  • malaise
  • weight loss
  • fever
  • skin rash
  • arthralgia
  • haemoptysis
  • abdominal pain
  • sore throat
  • hypervolaemia

Risk factors

  • group A beta-haemolytic Streptococcus
  • respiratory infections
  • gastrointestinal infections
  • hepatitis B
  • hepatitis C
  • infective endocarditis
  • HIV
  • systemic lupus erythematosus (SLE)
  • systemic vasculitis
  • Hodgkin's lymphoma
  • lung cancer
  • colorectal cancer
  • non-Hodgkin's lymphoma
  • leukaemia
  • thymoma
  • haemolytic uraemic syndrome
  • drugs

Diagnostic investigations

1st investigations to order

  • urinalysis and urine microscopy
  • comprehensive metabolic profile
  • glomerular filtration rate (GFR)
  • full blood count
  • lipid profile
  • spot urine albumin:creatinine ratio (ACR)
  • ultrasound of kidneys
More 1st investigations to order

Investigations to consider

  • erythrocyte sedimentation rate (ESR) or C-reactive protein (CRP)
  • complement levels
  • rheumatoid factor
  • anti-neutrophil cytoplasmic antibody
  • anti-glomerular basement membrane (GBM) antibody
  • antistreptolysin O antibody
  • antihyaluronidase
  • anti-DNase
  • anti-double-stranded DNA
  • antinuclear antibody
  • cryoglobulins
  • hepatitis C virus and hepatitis B serology
  • HIV serology
  • electrophoresis
  • drug screen
  • renal biopsy
  • antiphospholipase A2 receptor antibodies
  • computed tomographic scan of chest and abdomen
More investigations to consider

Treatment algorithm


Professor of Practice (Medicine)

Director of Clinical Academic Training

Imperial College London

Consultant Nephrologist

Imperial College Healthcare NHS Trust




JL declares that he has no competing interests.

Dr Jeremy Levy would like to gratefully acknowledge Dr Padmanabhan Premkumar, Dr Priyanka Sharma, and Dr Ajay Kumar, previous contributors to this topic. PP, PS, and AK declare that they have no competing interests.

Peer reviewersVIEW ALL

Department Chairman

Nephrology and Hypertension

Cleveland Clinic Foundation




MS declares that he has no competing interests.

Teaching Fellow

Keele University Medical School




PN declares that he has no competing interests.

Consultant Nephrologist

Gloucestershire Royal Hospital




RB declares that he has no competing interests.

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