BASELINE PARAMETERS OF IGA NEPHROPATHY USING THE OXFORD MEST SCORE: INSIGHTS FROM THE I-TANGIBLE REGISTRY

Introduction:

IgA nephropathy (IgAN) is the most prevalent primary glomerulonephritis globally. The Oxford MEST-C scoring system is a recognized tool for assessing histological severity in IgAN and holds potential for use in prognostic staging. This report presents the baseline data of patients with IgAN from the I-TANGIBLE STUDY, the first registry of patients with primary glomerular diseases from India.

Methods:

In the multi-centre I-TANGIBLE STUDY, funded by ICMR, we assessed clinical and histopathological variables in patients with IgAN. Clinical details encompass patient demographics (age, sex, height, weight), presenting symptoms, duration of symptoms, history of diabetes and hypertension, serum albumin, serum creatinine, 24-hour urine protein, and macrohematuria. The histopathological evaluation included mesangial expansion, mesangial hypercellularity, segmental sclerosis, endocapillary hypercellularity, tubular atrophy, interstitial fibrosis, and the presence of crescents, as captured by the MEST-C score.

Results:

The study included 328 IgA nephropathy patients (Table 1) with a mean age of 36.17 ±0.66 years. There was a male preponderance of males (62.5%), and the most common presenting symptom was pedal oedema. The average duration of symptoms was 10.1±1.14 months. A history of hypertension and diabetes was present in 167 (50.9%) and 28 (8.5 %) of the patients, respectively. Nephrotic-range proteinuria, haematuria and kidney dysfunction (eGFR of <60 ml/min/1.73m2) were observed in 90 (27.43%), 77 (23.5%) and 222 (67.68%) of the patients, respectively. The serum albumin, serum creatinine, and Proteinuria (g/day)/ Urine PCR (g/g) were 3.69 (3, 4.1) g/dl, 1.64(1.08, 2.46) mg/dl and 2 (1.21,3.59) g/day, respectively.  Histopathological scoring was unavailable for 52 (15.6%) cases due to advanced sclerosis. The rest of the cases revealed mesangial hypercellularity (score 0: 33.3 %, score 1: 66.7 %), endocapillary proliferation (score 0: 71.01%, score 1: 28.9%), segmental glomerulosclerosis (score 0: 55.4 %, score 1: 44.6%), tubular atrophy and interstitial fibrosis (score 0: 62.3%, score 1: 31.5 %, score 2: 6.2%), and the presence of crescents (score 0: 64.8 %, score 1: 26.1%, score 2: 9.1%).

Conclusions:

We highlight the feasibility of establishing a multicentric registry for IgA Nephropathy in resource-limited settings. Two-thirds of the patients had kidney dysfunction at presentation, and one-third of them had significant IFTA and presence of crescents.

I have no potential conflict of interest to disclose.

I did not use generative AI and AI-assisted technologies in the writing process.