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 renal masses or obstruction ¹,²,³.
• Blood tests including renal function tests (serum creatinine and eGFR) to assess kidney function, and possibly serum calcium and phosphate if advanced disease or metabolic complications are suspected ¹,².
• Referral to urology for further assessment and management if imaging or clinical findings suggest renal cancer, especially if persistent haematuria is present ¹,²,³.

These investigations align with NICE guidance on suspected cancer recognition and referral, which recommends urgent referral for suspected urological cancers when persistent haematuria is found ³.