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Does MEST-C score predict outcomes in pediatric Henoch-Schönlein purpura nephritis?
Adam Jimenez1, Ashton Chen2, Jen-Jar Lin2
1Wake Forest School of Medicine, Winston-Salem, NC, 27157, USA. aljimene@wakehealth.edu.
Insights
The Oxford Classification's MEST-C scoring system, specifically the S1 score, can predict long-term kidney outcomes in children diagnosed with Henoch-Schönlein purpura nephritis (HSPN). This aids in managing pediatric kidney disease.
Area of Science:
- Pediatric Nephrology
- Renal Pathology
- Glomerular Diseases
Background:
- Henoch-Schönlein purpura nephritis (HSPN) increases children's risk for chronic kidney disease (CKD).
- Current HSPN grading lacks outcome predictive power.
- The MEST-C scoring system shows promise for predicting outcomes in pediatric HSPN.
Purpose of the Study:
- To evaluate the utility of the MEST-C scoring system in predicting outcomes in pediatric HSPN.
- To determine if MEST-C scores can identify children at higher risk for CKD, hypertension, or proteinuria.
Main Methods:
- Retrospective analysis of 32 children with HSPN undergoing renal biopsy.
- Utilized logistic regression and ROC curves to assess MEST-C's predictive ability.
- Defined composite outcome as hypertension, CKD, or proteinuria.
Main Results:
- The S1 score was significantly associated with the composite outcome (OR 7.9).
- S1 accurately predicted outcomes with an AUC of 0.72.
- Achieved 58.3% sensitivity and 85.0% specificity for outcome prediction.
Conclusions:
- The S1 score effectively predicts adverse renal outcomes in children with HSPN.
- Findings suggest MEST-C scoring can improve risk stratification in pediatric HSPN.
- Further validation studies are recommended to confirm these predictive capabilities.
Background:
Children with Henoch-Schönlein purpura nephritis (HSPN) have an increased risk of chronic kidney disease (CKD). Renal biopsy diagnostic of HSPN is graded using the International Study of Kidney Disease in Children criteria, which do not predict outcomes. The 2016 Oxford Classification's MEST-C scoring system predicts outcomes in adults with histologically identical IgA nephropathy, but evidence of its utility in pediatric HSPN is lacking. Our hypothesis was that MEST-C scores predict outcomes in children with HSPN.
Methods:
A retrospective cohort analysis of data from 32 children with HSPN who underwent renal biopsy was performed. We used logistic regression and receiver operator characteristic curves to analyze the ability of MEST-C to predict the composite outcome of hypertension (blood pressure ≥ 95% for age/sex/height), CKD (estimated glomerular filtration rate < 90 mL/min/1.73 m2), or proteinuria (urine protein-to-creatinine ratio > 0.2 mg/mg).
Results:
The median age at diagnosis was 7.9 years (IQR 5.8, 11.7); 56% were male, 19% were Hispanic, and 9% were Black. After a median follow-up of 2.7 years, 38% of patients (n = 12) reached the outcome. S1 score was significantly associated with the outcome (OR 7.9, 95% CI 1.5-42.6). S1 accurately predicted the outcome (area under the curve 0.72, 95% CI 0.55-0.88) with 58.3% sensitivity and 85.0% specificity, indicating a positive predictive value of 70.0% and a negative predictive value of 77.3%.
Conclusions:
S1 accurately predicted our composite outcome of hypertension, CKD, and proteinuria in a diverse cohort of U.S. children with HSPN. Further investigation is warranted to validate these findings.
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