MEST-C T Score Prognosis IgAN — ESENeph MCQ

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HardGlomerulonephritisMEST-C T Score Prognosis IgANESENeph

A 50-year-old man with IgA nephropathy and CKD G3b has a kidney biopsy showing MEST-C scores of M1 E0 S1 T2 C0. Which histological feature carries the strongest prognostic significance for CKD progression?

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Correct answer: E — T (tubular atrophy/interstitial fibrosis)

The Oxford/MEST-C classification grades IgAN histology. Of all components, T score (tubular atrophy and interstitial fibrosis) is the most consistent predictor of long-term renal outcomes across multiple validation studies. T2 (>50% of cortex affected) carries the worst prognosis. While all MEST-C components contribute to risk assessment, chronic tubulointerstitial damage reflects irreversible nephron loss. The KDIGO 2025 IgAN guideline uses MEST-C alongside clinical parameters for risk stratification but emphasises that histology alone should not dictate specific treatment choices.

Reference: KDIGO 2025 – IgAN Guideline; Trimarchi et al 2017 – Oxford Classification Update