Abstract: SA-PO280

Is MEST Score a Risk Predictor in Pediatric Henoch-Schönlein Purpura Nephritis?

Session Information

Category: Glomerular

  • 1005 Clinical Glomerular Disorders

Authors

  • Chen, Ashton, Wake Forest School of Medicine, Winston Salem, North Carolina, United States
  • Goldstein, Dan P, Wake Forest School of Medicine, Winston Salem, North Carolina, United States
  • Voigt, Marcia, Wake Forest School of Medicine, Winston Salem, North Carolina, United States
  • South, Andrew M., Wake Forest School of Medicine, Winston Salem, North Carolina, United States
  • Lin, Jen-Jar, Wake Forest University School of Medicine, Winston-Salem, North Carolina, United States
Background

Oxford Classification of IgA nephropathy (IgAN) includes the histologic components: mesangial (M) and endocapillary (E) hypercellularity, segmental sclerosis (S) and interstitial fibrosis or tubular atrophy (T). These have been utilized as the MEST score to predict renal outcome in IgAN. Pathological findings on renal biopsy in IgAN are identical to Henoch-Schönlein purpura nephritis (HSPN), but MEST score has not been validated in HSPN.

Methods

A retrospective chart review was performed from April 1, 2004 to May 31, 2017 at our center, identifying all children referred for HSPN who underwent renal biopsy. Blood pressure (BP), glomerular filtration rate (GFR), and degree of proteinuria were recorded at time of biopsy and compared at last follow-up. Biopsy reports were reviewed and assessed for crescents and MEST score. Treatment with steroids, immunosuppression, and ACEI/ARB was assessed.

Results

Of 49 patients referred for HSPN, n=29 underwent renal biopsy. Of 29 patients, all had spot urine protein/creatinine (u p/c) >0.2, 15 of whom had nephrotic-level proteinuria (u p/c>2.0). All had normal GFR at time of biopsy and 9/29 (31%) had hypertension (HTN). Overall biopsy results showed: crescents (69%), MEST M1 (66%), E1 (69%), S1 (28%), T1 (23%), and T2 (0%). Of patients with HTN: crescents (78%), M1 (78%), E1 (78%), S1 (11%), and T1 (22%). Those with nephrotic-level proteinuria had crescents (73%), M1 (73%), E1 (86%), S1 (13%), and T1 (13%). Patients with 10% or more crescents had higher rate of HTN at presentation (37% vs 20%, p=NS) and nephrotic proteinuria (58% vs 50%, p=NS). Median follow-up was 3.1 years. Patients with M1 vs M0 were more likely to have higher urine p/c at follow-up (p=0.14). Of patients with >10% crescents, 92% received steroids and 79% received immunosuppression. At last follow-up 1 patient had GFR <100mL/min/1.73m2, 2 had pre-HTN, and 5 had proteinuria.

Conclusion

After treatment, renal outcome in pediatric HSPN is favorable even with significant proteinuria and hypertension at presentation. Crescents and MEST score of M1 may be associated with HTN and nephrotic proteinuria at presentation in children. Further studies are needed to validate use of MEST score in pediatric HSPN.