MEST-C pathological score and long-term outcomes of child and adult patients with Henoch-Schonlein purpura nephritis

Abstract

BackgroundHenoch-Schonlein purpura nephritis (HSPN), a small-vessel vasculitis, shares renal pathological features with immunoglobulin A nephropathy. Oxford classification of immunoglobulin A nephropathy pathology has been updated to the MEST-C score, but its application in HSPN remains unresolved.MethodsTwo hundred and thirteen patients with biopsy-proven HSPN were retrieved from the Seoul National University Hospital between 2000 and 2017. Renal outcome risks (i.e., end-stage renal disease or doubling of serum creatinine) were evaluated according to MEST-C scores after stratification by age: 113 children aged <18years (9.23.6years) and 100 adults aged <greater than or equal to>18years (38.618.3years). We pooled our data with four previous cohort studies in which MEST or MEST-C scores were described in detail.Results Twenty-one child (19%) and 16 adult (16%) patients reached the renal outcome during the median follow-up periods of 12years and 13years, respectively (maximum 19years). In children, M1 and T1/T2 scores revealed worse renal outcomes than did M0 and T0 scores, respectively, whereas the T score was the only factor related to worse outcomes in adult patients after adjusting for multiple clinical and laboratory variables. The pooled data showed that M1, S1, and T1/T2 in children and E1 and T1/T2 in adults were correlated with poorer renal outcomes than those of their counterpart scores.Conclusions The Oxford classification MEST-C scores can predict long-term renal outcomes in patients with HSPN.