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

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

Posted: 16 August 2025Updated: 16 August 2025 Guideline-Aligned (High Confidence) Clinically Reviewed
Dr Kola Tytler MBBS CertHE MBA MRCGPClinical Lead • iatroX

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 renal masses or obstruction ,,.
  • 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 ,.
  • Referral to urology for further assessment and management if imaging or clinical findings suggest renal cancer, especially if persistent haematuria is present ,,.

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 .

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