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Abstract: SA-PO440

Does MEST-C Score Predict Outcomes in Pediatric Henoch Schönlein Purpura Nephritis?

Session Information

  • Pediatric Nephrology - II
    October 27, 2018 | Location: Exhibit Hall, San Diego Convention Center
    Abstract Time: 10:00 AM - 12:00 PM

Category: Pediatric Nephrology

  • 1600 Pediatric Nephrology


  • Jimenez, Adam, Wake Forest School of Medicine, Winston-Salem, North Carolina, United States
  • Chen, Ashton, Wake Forest Baptist Health, Winston Salem, North Carolina, United States
  • Lin, Jen-Jar, Wake Forest Baptist Health, Winston Salem, North Carolina, United States
  • South, Andrew M., Wake Forest Baptist Health, Winston Salem, North Carolina, United States

Children with Henoch-Schönlein purpura nephritis (HSPN) are at risk for long-term negative renal outcomes. HSPN renal biopsies have been graded using the International Study of Kidney Disease in Children criteria, which is limited by a lack of correlation with outcomes. The MEST-C scoring system by 2016 Oxford Classification has been shown to predict poor outcomes in IgA nephropathy (IgAN) but its utility in predicting outcomes in HSPN is incompletely described. Our hypothesis is that MEST-C score predicts outcomes in US children with HSPN.


Data of 32 children with HSPN referred to pediatric nephrology who underwent renal biopsy between April 1, 2004 and March 1, 2018 were reviewed. Logistic regression analysis was used to compare MEST-C scores to a composite outcome at the last known follow-up visit: hypertension (systolic or diastolic blood pressure ≥95% for age/sex/height), chronic kidney disease (glomerular filtration rate <90 mL/min/1.73 m2), or proteinuria (urine protein-to-creatinine ratio >0.2 mg/mg).


Their median baseline age was 7.9 years (IQR 5.9); 56% were male, 16% were Hispanic, 12.5% African-Americans, and 71.5% Caucasians. 31% of patients had a S1 score. After a median follow up of 2.7 years (IQR 4.3), 34% of patients reached the outcome. Of the MEST-C components, only S1 was significantly associated with the outcome (OR 10.5, 95% CI 1.9 to 59.4). ROC analysis revealed that an S1 score predicted the outcome (AUC 0.75, 95% CI 0.58 to 0.91) with 63.6% sensitivity (95% CI 30.8 to 89.1%) and 85.7% specificity (63.7 to 97.0%), indicating a positive predictive value of 70.0% (34.8 to 93.3%) and a negative predictive value of 81.8% (59.7 to 94.8%).


Our study demonstrated that MEST-C score, specifically S1, strongly predicted the development of hypertension, proteinuria, and chronic kidney disease in HSPN children in the US. Further investigation in larger, multi-center studies are warranted to validate our findings.