Clinical history and physical examination are important initial steps in evaluating patients with asymptomatic proteinuria, especially the history of diabetes, hypertension, family history of kidney disease, history of collagen disorder, arthritis, or recurrent urinary tract infections, symptoms of hematuria, abdominal pain, urinary symptoms, ankle or facial swelling and use of medications, like non-steroidal anti-inflammatory agents, including COX-2 inhibitors. Physical examination should include measurement of blood pressure, assessment for peripheral edema, skin rash, renal angle fullness or tenderness.

The initial test to perform is a complete urinalysis, including microscopic examination to assess for associated true hematuria and casts, if clinically indicated. Quantification of urine protein either by spot urine protein/creatinine ratio or 24-hr urine for total protein. Measure serum creatinine to assess renal function. Then, as clinically required, perform additional investigations such as: abdominal ultrasound, A1C, collagen workup, serum immunoglobulins, anti-HCV, and ANCA. Consultation with a nephrologist should be considered to assess or rule out primary renal disease, as some patients may require kidney biopsy.

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