Clinicopathological correlation of Oxford MEST-C scores for IgA nephropathy in native renal biopsies: A single-center...

IgA nephropathy (IgAN) is a common glomerulonephritis with varied clinical presentations across regions, showing more aggressive progression in Asians. However, its exact prevalence and clinicopathological profile in India remain unclear.

The study included all patients of all age groups with primary IgAN on kidney biopsy from March 2016 to December 2023. Clinical and pathological parameters were noted. The MEST-C scores were correlated with the serum creatinine level, proteinuria, and hematuria.

Of a total of 3,811 native renal biopsies, 218 (5.72%) revealed IgAN, out of which 183 (4.8%) had more than 8 viable glomeruli, allowing MEST-C scoring to be done. The mean age was 32.84 ± 14.22 years, and the male-to-female ratio was 1.5 : 1. At presentation, 53.2% had hypertension, 90% had microscopic hematuria, and 5% had gross hematuria. The mean proteinuria was 3.87 ± 3.67 g/day, with 52% showing nephrotic-range proteinuria and 48% showing nephrotic syndrome manifestation. Oxford MEST-C scoring revealed M1 in 97.8%, E1 in 30.1%, S1 in 60.1%, T1 in 46.4%, T2 in 3.8%, and crescents in 27.8% of biopsies. The mean serum creatinine was significantly higher in cases with E1, S1, T1/2, and C1/2 scores (p < 0.05). Hematuria was significantly higher (p < 0.05) with E1 scores. On follow-up (mean 35 months), patients who presented early with only mesangial hypercellularity had good prognosis while those with endocapillary hypercellularity, crescents, tubular atrophy, and interstitial fibrosis at the time of biopsy had poor prognosis.

IgAN affects young individuals with diverse symptoms and rapid progression. In Western India, most patients present late, highlighting the need for early diagnosis and routine screening to improve outcomes.