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. 2022 Jan 11;23(1):26.
doi: 10.1186/s12882-021-02653-y.

Utilizing the MEST score for prognostic staging in IgA nephropathy

Yngvar Lunde Haaskjold  1   2 , Rune Bjørneklett  3   4 , Leif Bostad  3   5 , Lars Sigurd Bostad  3   4 , Njål Gjærde Lura  6 , Thomas Knoop  3   7
Affiliations

Utilizing the MEST score for prognostic staging in IgA nephropathy

Yngvar Lunde Haaskjold et al. BMC Nephrol. .

Abstract

Background: The Oxford classification/MEST score is an established histopathologic scoring system for patients with IgA nephropathy (IgAN). The objective of this study was to derive a prognostic model for IgAN based on the MEST score and histopathologic features.

Methods: A total of 306 patients with biopsy-proven primary IgAN were included. Histopathologic samples were retrieved from the Norwegian Kidney Biopsy Registry and reclassified according to the Oxford classification. The study endpoint was end-stage renal disease (ESRD). Patients were subclassified into three risk models based on histologic features (Model A), a composite score calculated from the adjusted hazard ratio values (Model B), and on quartiles (Model C).

Results: The mean follow-up time was 16.5 years (range 0.2-28.1). In total, 61 (20%) patients reached ESRD during the study period. Univariate analysis of M, E, S, T and C lesions demonstrated that all types were associated with an increased risk of ESRD; however, a multivariate analysis revealed that only S, T and C lesions were associated with poor outcomes. Statistical analysis of 15-year data demonstrated that Models A and B were as predictive as the MEST score, with an area-under-the-curve at 0.85. The Harrel c index values were 0.81 and 0.80 for the MEST score and Models A and B, respectively. In the present cohort, adding C lesions to the MEST score did not improve the models prognostic value.

Conclusions: Patients can be divided into risk classes based on their MEST scores. Histopathologic data provide valuable prognostic information at the time of diagnosis. Model B was the most suitable for clinical practice because it was the most user-friendly.

Keywords: IgA nephropathy; Kidney biopsy; MEST score; Prediction model; Prognosis.

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Conflict of interest statement

Thomas Knoop has been principal investigator and Yngvar Lunde Haaskjold has been.

sub-investigator for the Novartis LNP023X2203/APPLAUSE-IgAN trial at Haukeland University Hospital. The remaining authors declare that they have no competing interests.

Figures

Fig. 1
Fig. 1
a-d Kaplan-Meier plots showing cumulative risk of end stage renal disease (ESRD) in the different factors in the MEST score: M (a), E (b), S (c) and T (d)
Fig. 2
Fig. 2
a-c Kaplan-Meier plots showing cumulative risk of end stage renal disease (ESRD) in the different risk models: Model A (a), model B (b) and model C (c)
Fig. 3
Fig. 3
a-b Calibration curves with mean error and 0.9 quantile for MEST and Model B at 5, 10, 15 and 20 years
See this image and copyright information in PMC

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