121. mest-C Score in Adult Henoch-Schönlein Purpura Nephritis

Wong, Nikki; Kang, Amy; McAdoo, Stephen P; Cook, Terry; Pusey, Charles D.

doi:10.1093/rheumatology/kez058.061

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“…The MEST-C criteria comprise of mesangial hypercellularity (with M0 and M1) corresponding to ≤ 50% and > 50% of the glomeruli showing hypercellularity, respectively), endocapillary proliferation (de ned as E0, absence or E1, presence), segmental glomerulosclerosis (de ned as S0, absence or S1, presence), tubular atrophy/interstitial brosis (with T0, T1, and T2 corresponding to ≤ 25%, 26%-50%, and > 50% of cortical area involvement, respectively), cellular/ brocellular crescents (with C0, C1, and C2 corresponding to their absence, presence in ≥ 1 and < 25% of glomeruli, and presence in ≥ 25% of the glomeruli, respectively). This classi cation has been validated for use in HSPN in previous adults and pediatric studies 25,26 . However, patients who had missing data, no glomerulus presented in the renal biopsy specimens or an initial eGFR < 60 mL/min/1.73 m 2 were excluded.…”

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confidence: 99%

Endocapillary Proliferation was Associated with Unfavorable Outcomes in Children with Henoch-Schönlein Purpura Nephritis and IgA Nephropathy

Chanvitan

Tangnararatchakit

Saisawat

et al. 2020

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Abstract Introduction: There are limited data on the outcomes in children with Henoch-Schönlein purpura nephritis (HSPN) and IgA nephropathy (IgAN) in limited-resource countries. This study was aimed to evaluate the outcome of HSPN and IgAN and to evaluate the pathological findings associated with unfavorable outcomes.Materials and methods: This was a retrospective study conducted in children (≤18 years) diagnosed with HSPN or IgAN, had estimated glomerular filtration rate (eGFR) ≥ 60 mL/min/1.73 m2 and underwent renal biopsy between year 2002 - 2018 at Ramathibodi Hospital, Bangkok, Thailand. Clinical outcomes were graded according to the outcome classification by Counahan, as follows: favorable [A, normal; B, minor urinary abnormalities (proteinuria < 1 g/1.73 m2/day)]; unfavorable [C, active renal disease (proteinuria > 1 g/1.73 m2/day and/or hypertension); D, renal insufficiency (eGFR < 60 mL/min/1.73 m2 or died)]. Pathologies were graded according to Oxford classification.Results: A total of 47 patients (28 HSPN and 19 IgAN) were included with means of age at 9.4 ± 2.8 vs 11.3 ± 4.3 years, respectively. After a median follow-up time of 50 months, proportions of favorable outcomes in the patients with HSPN and IgAN were 82.1% (23/28) and 89.5% (17/19), respectively (p-value = 0.685). In multivariate analysis, only endocapillary proliferation (E) was associated with unfavorable outcomes in both diseases with the odds ratio (95% CI) of 12.46 (1.36 - 114.51, p-value = 0.026).Conclusion: The clinical outcomes of most patients with HSPN and IgAN were favorable and comparable. Endocapillary proliferation (E) was the only factor associated with poor outcome in both diseases.