Dr Kola Tytler MBBS CertHE MBA MRCGPClinical Lead • iatroX
For a patient presenting with suspected glomerulonephritis, initial investigations should focus on assessing kidney function and identifying key markers such as proteinuria and haematuria.
- Urine Tests:
- Perform a urine albumin:creatinine ratio (ACR) for the initial detection of proteinuria NICE NG203. A confirmed ACR of 3 mg/mmol or more is considered clinically important NICE NG203.
- Use reagent strips to test for haematuria, evaluating further for results of 1+ or higher NICE NG203.
- If persistent haematuria is present alongside an ACR of 30 mg/mmol or more, a urinary tract infection (UTI) should be excluded NICE CKS,NICE CKS.
- Blood Tests:
- Measure serum creatinine to estimate the glomerular filtration rate (eGFR) NICE NG203. If an eGFR result of less than 60 ml/min/1.73 m2 is found in an adult not previously tested, repeat the test within 2 weeks to confirm NICE NG203.
- In adults with acute illness, investigate for acute kidney injury by measuring serum creatinine if symptoms or signs of nephritis (such as oedema or haematuria) are present NICE NG148.
- Imaging:
- Consider offering a renal ultrasound scan if there is visible or persistent invisible haematuria, or if the eGFR is less than 30 ml/min/1.73 m2 (GFR category G4 or G5) NICE NG203.