Abstract: SA-PO0664
Association of Mesangial Hypercellularity, Endocapillary Hypercellularity, Segmental Sclerosis, Tubular Atrophy, and Crescent Formation (MEST-C)-Based Steroid Response Scores with Kidney Prognosis in Patients with IgAN at the National Kidney and Transplant Institute (NKTI): A Retrospective Cohort Study from January 2018 to December 2023
Session Information
- Glomerular Diseases: Clinical, Outcomes, and Therapeutics Research - Other
October 24, 2026 | Location: Exhibit Hall A, Convention Center
Abstract Time: 10:00 AM - 12:00 PM
Category: Glomerular Diseases
- 1402 Glomerular Diseases: Clinical, Outcomes, and Therapeutics
Authors
- Amat, Maria Cristina, National Kidney and Transplant Institute, Quezon City, NCR, Philippines
- Villanueva, Russell T., National Kidney and Transplant Institute, Quezon City, NCR, Philippines
Background
IgA nephropathy (IgAN) is the most common primary glomerular disease worldwide and accounts for 34.4% of renal biopsies in the Philippines. While prognostic tools exist, data are lacking regarding the use of the Oxford classification in determining treatment strategy, specifically with steroid therapy. The MEST-C based Steroid Response Scores represent a novel approach to predict steroid responsiveness, though validation in diverse populations remains limited.
Methods
This single center retrospective cohort included Filipino adults with biopsy proven IgAN at the National Kidney and Transplant Institute from January 2018 to December 2023. Patients on other immunosuppressants or with secondary causes of IgAN were excluded. Each of the 55 steroid treated patients was assigned an SRS (low, medium, high) based on M1, E1, S1, and C1–2 lesions and an SNRS (low vs high) based on T0 vs T1–2 lesions. The primary outcome was clinical steroid responsiveness, defined as the absence within 1 year of any of the following: ≥40% decline in estimated glomerular filtration rate (eGFR), progression to end stage renal disease (ESRD), death, or shift to other immunosuppressants.
Results
Among 215 IgAN patients, 55 (25.6%) received steroids; their mean age was 33.4 years, 56.4% were female, and mean baseline eGFR was 67.1 mL/min/1.73 m2. Half were steroid responsive (50.9%). High SNRS strongly predicted nonresponse (70.4% of nonresponders vs 21.4% of responders, p=0.001), ≥40% eGFR decline (75.0% vs 25.0%, p=0.002), and ESRD (82.4% vs 17.7%, p=0.001). In contrast, SRS showed only a weak association with overall response (p=0.040) and did not significantly predict eGFR decline or ESRD. In multivariable logistic regression including SRS, creatinine, and eGFR, no variable remained an independent predictor of nonresponse (Nagelkerke R2≈0.15).
Conclusion
In this Filipino IgAN cohort, tubulointerstitial chronicity captured by SNRS is a robust predictor of steroid nonresponse and adverse renal outcomes, whereas SRS based on active glomerular lesions has limited prognostic utility. SNRS may help identify patients in whom steroids are unlikely to be beneficial and who may require alternative or intensified non steroidal therapies.