A 55-year-old man with IgA nephropathy (IgAN) undergoes renal biopsy that shows Oxford Classification features: M1 (mesangial hypercellularity), E0, S1 (segmental glomerulosclerosis), T1 (tubular atrophy/interstitial fibrosis 25-50%), C0. Based on these features, what is the expected renal prognosis?
- A Excellent prognosis; S1 without C (crescents) indicates no significant risk of progression
- B Intermediate prognosis; T1 and M1 confer increased risk of progression to ESRD without T2 or C2 features ✓
- C Immediate ESRD risk; T1 alone mandates urgent transplant evaluation
- D Benign prognosis; MEST-C score components must all be T2 or C2 before progression risk exists
Explanation
The Oxford MEST-C classification for IgA nephropathy grades: M (mesangial hypercellularity), E (endocapillary hypercellularity), S (segmental glomerulosclerosis), T (tubular atrophy/interstitial fibrosis; T0 <25%, T1 25-50%, T2 >50%), and C (crescents; C0, C1, C2). Each category that is scored as 1 or 2 independently predicts worse renal outcomes. M1 and T1 individually increase risk of progression; combined M1+T1 with S1 places this patient at intermediate-to-significant risk. T1 alone does not mandate transplant but signals substantial existing fibrosis and warrants aggressive immunosuppression. Not all features need to be at maximum scores to confer risk.
Reference: Robbins & Cotran Pathologic Basis of Disease, 10th ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
Written and medically reviewed by the StethoPrep medical team.