What criteria should I use to determine when to refer a child with Minimal Change Disease to a specialist?

To determine when to refer a child with Minimal Change Disease (MCD) to a specialist, the criteria for referring children and young people with Chronic Kidney Disease (CKD) should be used, as these guidelines do not specify MCD directly ³. Referral for specialist assessment is indicated if any of the following are present:

• An albumin:creatinine ratio (ACR) of 3 mg/mmol or more, confirmed on a repeat early morning urine sample ³.
• Haematuria ³.
• Any decrease in estimated glomerular filtration rate (eGFR) ³.
• Hypertension ³.
• Known or suspected rare or genetic causes of CKD ³.
• Suspected renal artery stenosis ³.
• Renal outflow obstruction ³.

Additionally, if there are concerns about a child with CKD but they do not meet the criteria for direct specialist referral, it is appropriate to consider discussing management with a specialist via letter, email, telephone, or virtual meeting ³.

For cases involving renal outflow obstruction, referral to urological services should be arranged, unless urgent treatment is required (for example, for hyperkalaemia, severe uraemia, acidosis, or fluid overload) ³. Emergency admission may be necessary if the child is in urinary retention, has severe hyperkalaemia (potassium greater than 6 mmol/L), severe uraemia, or signs of fluid overload or dehydration ¹,². Immediate referral to a nephrologist, paediatric nephrologist, or critical care specialist is also indicated if the child meets criteria for renal replacement therapy, such as hyperkalaemia, metabolic acidosis, symptoms or complications of uraemia (e.g., pericarditis or encephalopathy), fluid overload, or pulmonary oedema, that are not responding to medical management ⁴.