The Oxford Classification of IgA nephropathy (IgAN) includes the following four histologic components: mesangial (M) and endocapillary (E) hypercellularity, segmental sclerosis (S) and interstitial fibrosis/tubular atrophy (T). These combine to form the MEST score and are independently associated with renal outcome. Current prediction and risk stratification in IgAN requires clinical data over 2 years of follow-up. Using modern prediction tools, we examined whether combining MEST with cross-sectional clinical data at biopsy provides earlier risk prediction in IgAN than current best methods that use 2 years of follow-up data. We used a cohort of 901 adults with IgAN from the Oxford derivation and North American validation studies and the VALIGA study followed for a median of 5.6 years to analyze the primary outcome (50% decrease in eGFR or ESRD) using Cox regression models. Covariates of clinical data at biopsy (eGFR, proteinuria, MAP) with or without MEST, and then 2-year clinical data alone (2-year average of proteinuria/MAP, eGFR at biopsy) were considered. There was significant improvement in prediction by adding MEST to clinical data at biopsy. The combination predicted the outcome as well as the 2-year clinical data alone, with comparable calibration curves. This effect did not change in subgroups treated or not with RAS blockade or immunosuppression. Thus, combining the MEST score with cross-sectional clinical data at biopsy provides earlier risk prediction in IgAN than our current best methods.

Consistently, it has been reported that persons with disabilities face multiple challenges in societies and thus it is important that deliberate intervention programs are initiated to empower them to overcome exclusion. The United Nations has taken the lead through the Sustainable Development Goals (SDGs) project, which is a framework for assisting countries and donors in their efforts to alleviate poverty. This article documented the experiences of persons with disabilities with respect to global efforts towards poverty reduction via SDGs. Face-to-face interviews were conducted with 48 individuals with disabilities (hearing loss n = 11, visual impairment n = 15, and physical disability n = 22) who were drawn from four districts in the Northern Region of Ghana. Analysis of the interview data revealed common themes related to hardship, poverty, limited access to education, and underemployment. The results indicated that the SDG project engendered little tangible improvement in the lives of persons with disabilities. The need for concerted efforts to address barriers faced by individuals with disabilities is discussed extensively.

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