MeSsAGe risk score: tool for renal biopsy decision in steroid-dependent nephrotic syndrome

Chang Yien Chan, Lourdes Paula Resontoc, Md Abdul Qader, Yiong Huak Chan, Isaac Desheng Liu, Perry Yew Weng Lau, Mya Than, Wee Song Yeo, Alwin Hwai Liang Loh, Puay Hoon Tan, Changli Wei, Jochen Reiser, Subhra K. Biswas, Kar Hui Ng, Hui Kim Yap

Research output: Contribution to journalArticlepeer-review

1 Scopus citations


Background: A lack of consensus exists as to the timing of kidney biopsy in children with steroid-dependent nephrotic syndrome (SDNS) where minimal change disease (MCD) predominates. This study aimed at examining the applicability of a biomarker-assisted risk score model to select SDNS patients at high risk of focal segmental glomerulosclerosis (FSGS) for biopsy. Methods: Fifty-five patients with SDNS and biopsy-proven MCD (n = 40) or FSGS (n = 15) were studied. A risk score model was developed with variables consisting of age, sex, eGFR, suPAR levels and percentage of CD8 + memory T cells. Following multivariate regression analysis, total risk score was calculated as sum of the products of odds ratios and corresponding variables. Predictive cut-off point was determined using receiver operator characteristics (ROC) curve analysis. Results: Plasma suPAR levels in FSGS patients were significantly higher, while percentage of CD45RO + CD8 + CD3 + was significantly lower than in MCD patients and controls. ROC analysis suggests the risk score model with threshold score of 16.7 (AUC 0.84, 95% CI 0.72–0.96) was a good predictor of FSGS on biopsy. The 100% PPV cut-off was >24.0, while the 100% NPV was <13.3. Conclusion: A suPAR and CD8 + memory T cell percentage-based risk score model was developed to stratify SDNS patients for biopsy and for predicting FSGS.

Original languageEnglish (US)
Pages (from-to)477-483
Number of pages7
JournalPediatric Research
Issue number4
StatePublished - Mar 1 2019
Externally publishedYes

ASJC Scopus subject areas

  • Pediatrics, Perinatology, and Child Health


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