Kidney disease presents in a number of different ways and to a variety of practitioners. The presentation can be non-specific, and a high index of suspicion is required to allow early detection and intervention. A systematic clinical assessment is vital to facilitate the timely referral and appropriate management of renal disease. The history and examination should be tailored to the type of presentation, and is dictated by the degree of chronicity of the disease process. In all cases, the urine dipstick is a crucial part of the clinical examination.