What initial investigations should I perform for a patient presenting

Guideline-aligned answer with reasoning, red flags and references. Clinically reviewed by Dr Kola Tytler MBBS CertHE MBA MRCGP.

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 ,,.
Imaging of the renal tract, typically starting with an ultrasound scan of the kidneys and urinary tract to identify any masses or obstruction ,,.
Referral to urology for further assessment if imaging suggests renal mass or obstruction, or if persistent haematuria is present ,,.
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 ,.

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

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