THE NEW OXFORD ‘MEST’ SCORING SYSTEM IN IgA NEPHROPATHY AND THE EFFECT OF LOW-DOSE STEROID WITH MYCOPHENOLATE MOFETIL (MM) IN THE TREATMENT OF IgA NEPHROPATHY

Abstract

Primary IgA nephropathy is characterised by recurrent episodes of gross haematuria concomitant with upper respiratory tract infections or other mucosal inflammatory processes. AIMS Assess the histopathological changes in the kidneys after giving MM with low-dose steroids. SETTINGS AND DESIGN Mesangial hypercellularity-in < or > 50% glomeruli (M0 or M1); Endocapillary hypercellularity-present (E0)/absent (E1); Segmental sclerosis present (S0)/(S1) absent; Tubular atrophy/interstitial fibrosis-0-25% (T0), 26-50% (T1), > 50% (T2). METHODS AND MATERIALS IgA Nephropathy patients receiving MM with low-dose steroids (Group M) and conventional therapy (Group C), biopsied and scored as per Oxford MEST classification were included. The treatment response was assessed for Mesangial hypercellularity, Endocapillary hypercellularity, Segmental sclerosis/adhesions and Tubular atrophy/interstitial fibrosis. STATISTICAL ANALYSIS USED SPSS version 16, Independent sample T test, paired sample T test, one-way ANOVA and McNemar Chi-square tests. RESULTS Of the total enrolled 46 subjects, 32 were included in Group M and 14 were included in Group C. In the Group M, mean proteinuria significantly decreased from 1650 mg to 900 mg, mean eGFR increased from 66 mL/min. to 72 mL/min. (p=.001). In the Group C, mean proteinuria decreased significantly from 1300 mg to 1050 mg (p=0.1), mean eGFR decreased from 72 mL/min. to 69 mL/min. (p=0.25). CONCLUSIONS Mesangial hypercellularity and endocapillary hypercellularity have direct correlation with proteinuria. Therapy with MM and steroids is effective in retarding the proteinuria, microhaematuria and progression of the disease in IgAN; reversing the mesangial hypercellularity and endocapillary hypercellularity and preventing the progression of segmental sclerosis and tubular atrophy. KEY MESSAGES Mesangial hypercellularity and endocapillary hypercellularity have direct correlation with proteinuria. Therapy with MM and steroids is effective in retarding the proteinuria, microhaematuria, progression of the disease in IgAN, reversing the mesangial hypercellularity and endocapillary hypercellularity and preventing the progression of segmental sclerosis and tubular atrophy.