Assessment of proteinuria

fever

elevated temperature >38.0°C (100.4°F)

recent strenuous exercise

no specific findings

dysuria; cloudy, foul-smelling urine; urinary urgency; urinary frequency

flank tenderness (if pyelonephritis); bladder tenderness on palpation

recent instrumentation or trauma to urological system

gross haematuria

usually children and adolescents

no specific findings

most common in children and older people but occurs at all ages; often sudden onset with marked oedema; may be associated with non-steroidal anti-inflammatory drugs (NSAIDs), interferon, lithium, lymphoma, bee stings, stem cell transplant

marked oedema; BP often normal to low

more common in black people and in patients with HIV infection; can be secondary to hypertension, diabetes, prior renal injury, obesity, bisphosphonates, heroin use

oedema; hypertension

more common in older adults; may be associated with non-steroidal anti-inflammatory drugs (NSAIDs), gold, penicillamine, adenocarcinoma, systemic lupus erythematosus, hepatitis B, hepatitis C, syphilis, stem cell transplant, solid organ malignancy

oedema; often hypertensive

idiopathic is rare; generally history of another disease such as systemic lupus erythematosus, hepatitis C, post-infectious glomerulonephritis, endocarditis, cryoglobulinaemia, thrombotic microangiopathy, C3 glomerulopathy

oedema; often hypertensive; may have evidence of arthritis/rash/other end-organ involvement with systemic lupus erythematosus; murmur with endocarditis; tea-coloured urine with post-infectious glomerulonephritis

most common glomerulonephritis worldwide; high incidence in Asian populations; history of gross haematuria associated with upper respiratory infection; history of Crohn's disease or coeliac disease; more common in males

rarely oedema and hypertension; often discovered incidentally while assessing microscopic haematuria; may have purpuric skin lesions

history of rash, photosensitivity, oral ulcers, arthritis, serositis, renal disease, neurological changes (psychosis, seizures), haematological disease

malar rash; arthritis; oedema; hypertension; oral ulcers; pleural effusion; neuropathy; Raynaud's phenomenon

recent history of infection; can occur with virtually any infectious agent; classic description is post-streptococcal; Staphylococcus aureus super-antigens can result in rapid acute kidney injury

oedema; hypertension; tea-coloured urine in some cases

recent nephrotoxic injury such as hypotension, non-steroidal anti-inflammatory drugs (NSAIDs), aminoglycosides, amphotericin B, zoledronic acid, oral phosphate bowel preparations, intravenous contrast, mechanical ventilation, ischaemia

no specific findings

exposure to typical offending medications such as non-steroidal anti-inflammatory drugs (NSAIDs), antibiotics, allopurinol, proton pump inhibitors; uveitis in the tubulointerstitial nephritis and uveitis syndrome; infectious agents (e.g., viruses); systemic disease (e.g., sarcoidosis, Sjogren's disease)

may have rash and fever; anterior uveitis in tubulointerstitial nephritis and uveitis syndrome

history of benign prostatic hyperplasia, kidney stones, urinary retention, gynaecological cancer; may have decreased, normal, or increased urine output; flank or suprapubic pain

palpable bladder may be present; enlarged prostate on rectal examination

overweight; history of hypertension, insulin resistance/diabetes, dyslipidaemia

BP ≥130/85 mmHg; waist ≥102 cm (40 inches) in men or 89 cm (35 inches) in women

increases with duration of diabetes; retinopathy is typically present

retinopathy; neuropathy; often hypertensive with macrovascular complications

long-standing history of hypertension

evidence of hypertensive end-organ damage (e.g., retinopathy, left ventricular hypertrophy)

multi-organ disorder; rash, neuropathy, headache, stroke, change in mental status, shortness of breath, haemoptysis, abdominal pain, acute renal failure

specific organ involvement dictates findings; typically multiple systems are involved simultaneously

muscle pain; recent crush injury; prolonged immobility; viral infection; use of drugs such as statins and cocaine; inborn errors of muscle metabolism may present in young adults

muscle tenderness; dark urine

worsening of pre-existing chronic kidney disease; development of new-onset hypertension and/or oedema during pregnancy (e.g., pre-eclampsia); visual disturbances; upper abdominal pain; headache; possible thrombotic thrombocytopenic purpura-haemolytic uraemic syndrome (TTP-HUS)

hypertension; oedema; bruising/petechiae (with TTP-HUS)

chronic inflammatory diseases such as rheumatoid arthritis, restrictive heart disease, liver failure, and familial Mediterranean fever; plasma cell dyscrasia such as multiple myeloma or monoclonal gammopathy of renal significance

oedema; hypertension; may have carpal tunnel syndrome; capillary fragility; autonomic insufficiency

plasma cell dyscrasia such as multiple myeloma or monoclonal gammopathy of undetermined significance

oedema; hypertension; autonomic insufficiency

plasma cell dyscrasia such as multiple myeloma or monoclonal gammopathy; hepatitis C; some patients have underlying lymphoma

oedema; hypertension

rapidly progressive renal failure, haemoptysis, haematuria; often has positive smoking history

crackles; may have gross haematuria

can be inherited; may have underlying multiple myeloma, heavy metal exposure, or medications such as tenofovir

microcephaly, hypogonadism, and café au lait spots with congenital disease; adult-onset symptoms specific to underlying aetiology

chronic kidney disease in childhood with nephronophthisis; may have flank pain or haematuria with polycystic kidney disease (PKD); cerebral haemorrhage/stroke in PKD

palpable kidneys in PKD; retinitis pigmentosa in some forms of nephronophthisis; polydactyly in Bardet-Biedl syndrome

usually asymptomatic; may have history of kidney stones; if also hypercalcaemic, may have nausea, constipation, psychosis, polyuria, weakness

if hypercalcaemic, may have change in mental status, generalised weakness

X-linked recessive: typically only males are affected; polyuria and nocturia in childhood; kidney stones; chronic kidney disease; rickets; nephrocalcinosis

few physical findings

has been associated with aristolochic acid ingestion, which is a component of some Chinese herbs and weight loss medications and is a part of wheat used for bread in the Balkan region

few physical findings; may have gross haematuria with underlying urological malignancy

plasma cell dyscrasia, such as multiple myeloma or monoclonal gammopathy of undetermined significance; rapid onset of renal failure

oedema; hypertension

X-linked genetic deficiency of alpha-galactosidase-A; burning sensation of the hands with exercise and heat, eye disease, peripheral and coronary arterial disease, congestive heart failure, hypohidrosis, gastrointestinal dysmotility, renal failure, and fever

corneal clouding; hypertension; poor circulation; angina; angiokeratomas; hypohidrosis; obesity; telangiectasia; angiokeratomas; corneal deposits

recent Escherichia coli infection; diarrhoea; in cases of atypical HUS, there is history of HUS/thrombotic thrombocytopenic purpura; positive family history; history of complement regulatory protein mutations; prior bone marrow transplant; associated with medications such as ciclosporin, gemcitabine, and bevacizumab (vascular endothelial growth factor inhibitor); pregnancy or postnatal state

oedema; hypertension; petechial rash or purpura; fever

recent infection; mental status changes ranging from headache and confusion to seizures; history of TTP; positive family history; prior bone marrow transplant; associated with medications such as ciclosporin, clopidogrel, and gemcitabine

oedema; hypertension, petechial rash or purpura; fever; focal neurological deficits, and coma

usually within first 5 years of scleroderma diagnosis with diffuse skin involvement; patients often taking prednisone; new-onset hypertension and rapidly worsening renal function; may have gastrointestinal dysmotility and pulmonary hypertension

often marked hypertension (often abrupt onset); masked facies of scleroderma; tapered digits with tight skin

history of industrial/environmental exposure; old paint and moonshine are common sources for lead poisoning; may have neuropathy, hypertension, abdominal pain, psychiatric symptoms, gout, rash

gout, neuropathy, developmental delay, hyperkeratosis, hypertension

history of smoking and obesity

obesity, oedema

history of monoclonal gammopathy

oedema

history of muscle pain and weakness

muscle weakness

most common in patients with nephrotic syndrome (primarily membranous nephropathy), antiphospholipid antibody syndrome, and other inherited prothrombotic defects; extrinsic compression of the renal vein by retroperitoneal fibrosis or aortic aneurysm; history of trauma or severe dehydration; in children presents with acute flank pain

haematuria, oedema