Abstract Background and Aims IgA nephropathy is the most common cause of glomerular disease worldwide. Natural history and clinical progression of this condition are highly heterogenous and can vary from asymptomatic haematoproteinuria, to a rapidly progressive glomerulonephritis that results in end-stage kidney disease (ESKD). The OXFORD MEST-C score is a set of consensus criteria that have been correlated with renal outcomes independent of baseline clinical features, proteinuria and blood pressure control. This is the first observational study carried out in the Maltese Islands that aims to evaluate the epidemiology and the histopathological distribution in Malta. Method All patients with biopsy-proven IgA nephropathy between January 2013 and July 2019 in our centre were recruited into this longitudinal retrospective observational study. Baseline data at time of biopsy included demographics, laboratory data and the MEST-C score. Study end-points included death, doubling of serum creatinine and ESKD. Data was censored on 31/12/2019. Results A total of 46 patients were recorded over this 6 year period, with a median follow-up of 2.7 years (Standard deviation 1.9). The median age of our cohort at time of biopsy was 46.1 years (Standard deviation 16.1). In total, 71.7% were males, 34.8% were hypertensive and 6.5% diabetic at baseline. At time of biopsy, 89.1% had an active sediment, 54.3% had established chronic kidney disease (CKD), 17.4% presented with acute kidney injury (AKI), 13% had a history of synpharyngitic haematuria, while 4.3% had a history of Henoch–Schönlein (HSP). In our cohort, 8 patients (17.4%) had progression of CKD. 4 of them had doubling of creatinine with 3 reaching ESKD. 1 patient died. Table 1 shows the distribution of histopathological findings in our cohort: Conclusion Despite the limited study sample, short follow-up time, and absence of treatment data, our results demonstrate that the distribution of histopathological variants in our cohort is similar to that reported elsewhere in the literature1. Barbour SJ, Espino-Hernandez G, Reich HN, Coppo R, Roberts IS, Feehally J, et al. The MEST score provides earlier risk prediction in IgA nephropathy. Kidney Int. 2016 Jan;89(1):167–75.