Examinations in renal diseases (eGFR, proteinuria, haematuria, imaging, renal biopsy)

1. Big picture

Renal diseases are often clinically silent until late. Therefore, the examiner wants a structured diagnostic approach:

Renal assessment = kidney function + urine abnormality + imaging + histology when needed

The core questions are:

1. Is renal function reduced? → serum creatinine, estimated glomerular filtration rate (eGFR), urea, electrolytes.
2. Is there kidney damage despite normal eGFR? → albuminuria/proteinuria, haematuria, casts, imaging abnormalities.
3. Is the pattern glomerular, tubular/interstitial, vascular, or obstructive?
4. Is it acute kidney injury (AKI) or chronic kidney disease (CKD)?
5. Does the patient need urgent nephrology referral or renal biopsy?

A patient may have severe renal disease with a “normal” creatinine if they are elderly, cachectic, or have low muscle mass. Always interpret creatinine through eGFR + urine findings + clinical context.

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