A 28-year-old man presents with haematuria, proteinuria (1.8 g/day), and hypertension. Serum creatinine is 1.6 mg/dL. Renal biopsy shows mesangial IgA deposits on immunofluorescence. Electron microscopy shows paramesangial electron-dense deposits. Oxford MEST-C score: M1 E0 S1 T1 C0. What does this Oxford classification indicate about prognosis?
- A Endocapillary hypercellularity (E0) indicates good prognosis
- B Mesangial hypercellularity, segmental sclerosis, and tubular atrophy/interstitial fibrosis predict faster progression to ESRD ✓
- C The C0 score is the most important adverse predictor
- D Oxford classification does not influence treatment decisions
Explanation
The Oxford MEST-C classification (Mesangial hypercellularity M, Endocapillary hypercellularity E, Segmental glomerulosclerosis S, Tubular atrophy/interstitial fibrosis T, Crescents C) identifies lesions that independently predict renal outcome in IgA nephropathy. M1 (mesangial hypercellularity), S1 (segmental sclerosis), and T1/T2 (tubular atrophy ≥25%) are adverse prognostic markers. E1 (endocapillary hypercellularity) predicts responsiveness to immunosuppression. C (crescents) predicts rapid decline. This patient's M1 S1 T1 profile indicates significant risk of progression.
Reference: Harrison's Principles of Internal Medicine, 21st ed.
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Written and medically reviewed by the StethoPrep medical team.