Because patients with MCD tend to have very severe proteinuria, clinicians must be alert for the presence of related complications. As in all cases of nephrotic syndrome, patients are at risk for systemic thromboses. In addition, infection may occur because of multiple factors, including urinary losses of immunoglobulins, alternative complement factor B, and hemolytic factor D. If there is significant edema, the risk of cellulitis increases.

The gold standard for diagnosis of MCD is renal biopsy. In children, however, MCD accounts for such an overwhelming majority of nephrotic syndromes that it is often diagnosed on a presumptive basis, with renal biopsy not performed unless empiric treatment fails. In adults, the differential diagnosis for nephrotic syndrome is very broad, and thus in the absence of a clear underlying cause (such as long-standing diabetes mellitus), renal biopsy is essential for optimization of management.