Using MEST-C Scores and the International Study of Kidney Disease in Children Classification to Predict Outcomes of Henoch–Schönlein Purpura Nephritis in Children

Abstract

Introduction: Henoch–Schönlein purpura nephritis (HSPN) and IgA nephropathy (IgAN) bear similarities in some aspects. The histological classification of HSPN was built on the International Study of Kidney Disease in Children (ISKDC) criteria, while IgAN was established on the 2016 Oxford classification (MEST-C scores). The purpose of this paper was to discuss the predictive value of the ISKDC classification and MEST-C scores in children with HSPN.Methods: We performed a retrospective study of 877 children with HSPN in a single center between 2001 and 2019. The primary outcome was defined as chronic kidney disease—estimated glomerular filtration rate (eGFR) <90 ml/min/1.73 m2.Results: During the follow-up period of 23.3 (10.9–47.9) months, 51 (5.8%) patients reached the primary outcome. As revealed in a Kaplan–Meier plot, segmental glomerulosclerosis (S) (P < 0.001) and tubular atrophy/interstitial fibrosis (T) (P < 0.001) significantly predict poor renal outcome. Other Oxford lesions and the ISKDC classification, however, did not show a significant difference in a worse outcome. In a multivariate Cox model adjusted for pathological and clinical factors, eGFR [hazard ratio (HR) = 2.831, 95% confidence interval (95% CI) = 1.359–5.896], S lesion (HR = 3.936, 95% CI = 2.078–7.457), and T lesion (HR = 4.002, 95% CI = 1.733–9.242) were independent risk factors for the renal outcome.Conclusion: This series constitutes the largest series reported so far in the literature of such patients. According to our findings, S and T of the Oxford classification, which are ignored by the ISKDC classification, could be applied to predict the renal prognosis of children with HSPN.

Bibliometric analysis of IgA vasculitis nephritis in children from 2000 to 2022

“…The researchers pointed out that the updated Oxford classification is applicable to IgAVN, both in children and adults, and may also aid in disease management and kidney outcome prediction of IgAVN ( 3 , 44 ). Wang et al ( 45 ) found that the S and T of Oxford classification can be used to predict the renal prognosis of IgAVN children.…”

Association of the clinicopathological characteristics and proteinuria remission of pediatric IgAV with nephrotic-range proteinuria: A retrospective cohort study

“…Clavé et al (21) studied 170 children with biopsy-proven IgAVN diagnosed between 2007 and 2017, with patients with NS at presentation and those with cellular crescents and chronic lesions at initial renal biopsy being more likely to develop renal damage, highlighting the relationship between clinical and histological manifestations of IgAVN and factors affecting renal regression. In a retrospective study published in 2021, Wang et al discussed the predictive value of ISKDC classification and MEST-C scores on the prognosis of 877 children with IgAVN and found that S and T could be used to predict renal prognosis (22). However, the impact of renal pathological alterations on IgAVN remains controversial.…”

A retrospective study on the characteristics of renal pathological grades in HSPN children with mild to moderate proteinuria

“…First of all, ISKDC is currently the most widely used classification for HSPN and mainly focus on active inflammation which is reflected by crescents formation. Increasing studies argue that the 2016 revised Oxford classification (MEST-C scores) should be recommended for children and adult patients with HSPN (18,32,33). Segmental glomerulosclerosis/adhesion (S) and tubular atrophy/interstitial fibrosis (T), which are not emphasized or included in ISKDC classification, are shown to be the prognostic factor for renal outcomes in those studies.…”