Abstract: FR-PO0714
MEST-C Scoring Does Not Predict Clinical Outcomes in IgA Vasculitis with Nephritis
Session Information
- Pediatric Nephrology: CKD, ESKD, and Glomerular Diseases
November 07, 2025 | Location: Exhibit Hall, Convention Center
Abstract Time: 10:00 AM - 12:00 PM
Category: Pediatric Nephrology
- 1900 Pediatric Nephrology
Authors
- Hoch, Virginia, Nemours Children's Hospital Delaware, Wilmington, Delaware, United States
- Yang, Sandra G., Thomas Jefferson University Sidney Kimmel Medical College, Philadelphia, Pennsylvania, United States
- Onder, Ali Mirza, Nemours Children's Hospital Delaware, Wilmington, Delaware, United States
Background
Children diagnosed with IgA vasculitis with nephritis (IgAVN) with persistent nephrotic range proteinuria or acute kidney injury typically undergo renal biopsy to better elucidate the severity of disease and tailor treatment regimens. These biopsies are generally graded per the Oxford classification (i.e., “MEST-C” scoring), which has been validated for prognostication in IgA nephropathy (IgAN). This retrospective study was conducted to investigate whether MEST-C scoring can predict clinical outcomes in pediatric IgAVN patients, specifically the likelihood of disease remission and/or progression to end state renal disease (ESRD).
Methods
Thirty-one pediatric patients diagnosed with biopsy-proven IgAVN from 2013 to 2023 were included. We retrospectively collected clinical and histopathologic variables at diagnosis and during two years of follow-up. The primary outcome was lack of remission at 6 months follow-up. Secondary outcomes were progression to ESRD and lack of remission at last data point. To assess for association with outcomes, we performed logistic regressions to assess for predictors of outcome.
Results
At 6 months follow-up, 16 patients (51.6%) had not achieved complete remission. There were no significant differences in MEST-C scores between these groups (P>0.05 for all histological categories). Three patients (9.6%) progressed to ESRD during the two year study period. While all three patients in the ESRD group had the same MEST-C score (M1E1S1T0C1), there were no statistical differences in any of the five scores compared to the non-ESRD group (P>0.05 for M, E, S, T, and C scores). Furthermore, there were no significant differences in remission rates between the “elevated” versus “low” MEST-C score groups at 6 months (P = 0.44) or at final follow-up (P = 0.43).
Conclusion
We found no significant differences in clinical outcomes based on MEST-C scoring among IgAVN patients. Prognostication in IgAVN may benefit from a revision of pathological scoring that is distinct from that used for IgAN.