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MEST-C T Score Prognosis IgAN — ESENeph MCQ

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ModerateGlomerulonephritisMEST-C T Score Prognosis IgANESENeph

A 25-year-old man has recurrent episodes of dark urine during febrile illnesses since childhood. Between episodes, he has persistent microscopic haematuria and mild proteinuria (uACR 12 mg/mmol). eGFR is 92 mL/min/1.73m2. Renal biopsy shows mesangial IgA deposits with focal tubular atrophy. MEST-C scoring: M1 E0 S0 T1 C0. According to the Oxford classification, which MEST-C variable carries the WORST prognostic significance?

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Correct answer: C — T1 (tubular atrophy/interstitial fibrosis 26-50%)

In the Oxford (MEST-C) classification of IgA nephropathy, the T score (tubular atrophy/interstitial fibrosis) is the strongest independent predictor of poor renal outcome. T1 indicates 26-50% cortical involvement, and T2 indicates >50%. Tubulointerstitial damage reflects irreversible chronic injury and correlates with the degree of nephron loss. M1 and S1 also predict progression but to a lesser degree. E1 (endocapillary proliferation) predicts response to immunosuppression. C1/C2 (crescents) may also predict poor outcomes, particularly if >25% of glomeruli are affected. This T1 score despite preserved eGFR indicates significant chronic damage that warrants aggressive management.

Reference: Trimarchi et al 2017 – Oxford Classification MEST-C IgAN; KDIGO 2025 – IgAN Guideline