What initial investigations should I perform for a patient presenting with suspected renal cell carcinoma?

For a patient presenting with suspected renal cell carcinoma, initial investigations should include:

• Urinalysis to detect persistent haematuria after excluding urinary tract infection, as haematuria is a key symptom warranting further investigation and possible referral via a suspected cancer pathway ¹,²,³.
• Imaging of the renal tract, typically starting with an ultrasound scan of the kidneys and urinary tract to identify any masses or obstruction ¹,²,³.
• Referral to urology for further assessment if imaging suggests renal mass or obstruction, or if persistent haematuria is present ¹,²,³.
• Blood tests including renal function tests (serum creatinine, eGFR) to assess kidney function, and possibly serum calcium and phosphate if advanced disease or metabolic complications are suspected ¹,².

These investigations help confirm the diagnosis and guide urgent referral and management according to NICE suspected cancer guidelines ³.