Last reviewed: 7 Apr 2021
Last updated: 20 Feb 2019



History and exam

Other diagnostic factors

  • incidental proteinuria or abnormal renal function
  • xanthelasma
  • foamy urine
  • fatigue/malaise
  • anorexia
  • Muehrcke lines

Risk factors

  • male sex
  • age >40 years
  • HLA-DR3
  • autoimmune disease
  • hepatitis B and C
  • syphilis
  • solid organ carcinoma
  • medications
  • sarcoidosis
  • postrenal transplantation

Diagnostic investigations

1st investigations to order

  • urinalysis
  • urine protein to creatinine ratio
  • serum BUN
  • serum creatinine
  • creatinine clearance
  • serum albumin
  • lipid profile

Investigations to consider

  • serum or plasma LFTs
  • hepatitis B and C serology
  • ANA, antidouble-stranded DNA
  • complement levels
  • anti-SS-B, anti-SS-A
  • anti-PLA2R autoantibodies
  • anti-Thrombospondin type 1 domain–containing 7A (THSD7A) autoantibodies
  • renal ultrasound with renal artery Doppler study
  • renal biopsy

Treatment algorithm



Department of Internal Medicine

Division of Nephrology

University of Iowa Hospitals and Clinics

Iowa City



MS receives royalties from McGraw-Hill as an editor of the book DeGowin's Diagnostic Examination.

Professor Manish Suneja would like to gratefully acknowledge Dr Aash Bhatt, a previous contributor to this topic. AB declares that he has no competing interests.

Peer reviewersVIEW ALL

Medical Director

Blood Management

Cleveland Clinic




AK has received a fee for speaking about perioperative blood management from Ortho-Biotech and has also received reimbursement from for the education webcast of the same presentation.

Professor of Nephrology

Institute of Urology and Nephrology

University College London




GN declares that he has no competing interests.

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