Introduction

This guideline relates to multicystic dysplastic kidney (MCDK) in paediatric patients (<18 years). MCDK occurs in 1 in 3000-4000 live births and is most often diagnosed antenatally.

‘Uncomplicated MCDK’ refers to the context where the contralateral kidney shows compensatory hypertrophy, normal cortico-medullary differentiation and no urinary tract dilation. Uncomplicated MCDK is most often associated with normal long term health outcomes. The natural history of a kidney affected by MCDK is of gradual reduction in size until it is completely involuted.

When to refer

All referrals for MCDK will be considered by our team.

• All referrals for patients <12 months of age with uncomplicated MCDK will be triaged for review within 3-6 months.
  
• All referrals for patients >12 months of age with uncomplicated MCDK will be triaged for review within 12 months.

Wait time for appointments 

Specialist Clinic wait times 

(Please note, non-urgent referrals for patients over the age of 16 may be declined if it is likely they will not be seen before their 18^th birthday.)

Services available closer to home

Alternative paediatric nephrology services available in Victoria:

• Monash Children's Hospital

Referral criteria/required information

Starred items (*) are mandatory.

• *Details of clinical concern requiring nephrologist input, including duration of symptoms and details of all treatments offered to date.
• *Current height and weight
• *Observations including BP
• Blood tests (not required in uncomplicated MCDK):
  • Electrolytes, urea, creatinine (EUC)
  • Calcium, magnesium, phosphate, albumin
• Urine tests (not routinely required in uncomplicated MCDK):
  • Urine microscopy
  • Early morning urine total protein: creatinine ratio (NOT an albumin:creatinine ratio)
• *Renal ultrasound report – REQUIRED (referrals not including an ultrasound report will be rejected)
• *The referral must detail that the referring clinician has arranged a repeat renal ultrasound to be performed according to the following guidance.
  • <3 months of age at referral – repeat in 3 months
  • <12 months of age at referral – repeat in 6 months
  • <2 years of age at referral – repeat in 12 months
  • >2 years of age – not required (RCH will arrange at the time of first appointment)

All future ultrasounds are to be copied to Department of Nephrology, Royal Children’s Hospital, Fax (03) 9345 5054 or email: kidney@rch.org.au, but must be followed up by the requesting doctor if specialist review is delayed.

Failure to include reports of pathology and radiology investigations will result in the referral being returned to the referring doctor for resubmission.

Referrals from public hospitals MUST INCLUDE the name and contact details of a consultant supervising paediatrician/neonatologist and GP. The patient remains in the care of the referrer until such time that they are seen in the Kidney Clinic.

How to refer

Specialist Clinics referral

Please complete the above and submit via:

• Facsimilie (03) 9345 5034 or
• Email screferrals@rch.org.au
• Emergencies only call ED admitting officer or Nephrologist on-call via (03) 9345 5522

Suggested pre-referral management

• So long as the contralateral kidney shows compensatory hypertrophy and normal parenchymal appearances, and the child is normotensive and otherwise healthy, specialist review is non-urgent.
• Surgical removal of the MCDK is not routinely required.
• Families should be counselled at the point of referral regarding the symptoms and signs of urinary tract infections (UTI), however the increased risk of UTI in uncomplicated MCDK is low.
  • Antibiotic UTI prophylaxis is not required in uncomplicated MCDK.
• Severe/fulminant pelvi-ureteric junction obstruction (PUJO) may resemble MCDK on ultrasound. Any ambiguity in the report should be clarified by the referrer with the reporting radiologist.
  • If there is ongoing concern for PUJO, please discuss with paediatric Urology prior to ordering further tests.

Information for families

Your child’s referral will be triaged based on the information received in the referral. Your referrer will continue to monitor and manage your child’s care prior to and after your consultation. If there is a change in the clinical situation, a new referral explaining the need for re-triage of the referral is required. If you are seen elsewhere, please cancel your appointment with our service so that we can provide service to another child on our wait list.

Resources and links

• Monash Children’s Multicystic Dysplastic Kidney Parent Info Sheet
  
• infoKID Website
  
  

Acknowledgements

The development of this guideline was coordinated by the Department of Nephrology. Guideline reviewed in June 2026.