Development and validation of a prediction score system in lupus nephritis

Abstract

The risk assessment for developing end-stage renal disease (ESRD) remains unclear in patients with lupus nephritis (LN). The purpose of this study was to develop and validate a prediction rule for estimating the individual risk of ESRD in patients with LN using clinical and pathological data.A total of 599 patients with LN diagnosed by renal biopsy between June 2009 and June 2014 in West China Hospital of Sichuan University were retrospectively followed. Patients were randomly divided into derivation cohort (n = 379) and validation cohort (n = 220). The SLEDAI score was used to evaluate the clinical disease activity. Pathological lesions according to the International Society of Nephrology and the Renal Pathology Society (ISN/RPS) systems were meticulously evaluated. The risk factors for developing ESRD were evaluated using a Cox proportional hazard model with a stepwise backward elimination method.In the derivation cohort, 100 patients (26.5%) developed ESRD during the average 46.0 ± 21.1 months’ follow-up. The final prediction model included cellular crescents, active index >20, glomerular sclerosis, fibrous crescents, interstitial fibrosis, chronic index >5, nephrotic syndrome, and eGFR <45 mL/min as independent risk factors for developing ESRD. To create a prediction rule, the score for each variable was weighted by the regression coefficients calculated using the relevant Cox model. The prediction rule was validated in the validation cohort. During the follow-up period, 45 patients (21.5%) in validation cohort progressed to ESRD.This study developed and validated a new prediction rule using clinical measures and pathological changes for developing ESRD in patients with LN.

Recovery of renal function in patients with lupus nephritis and reduced renal function: the beneficial effect of hydroxychloroquine

“…In previous studies, high levels of creatinine, higher grades of tubular atrophy, anti-Ro antibodies or longer duration of nephritis prior to biopsy were associated with higher risk of ESRD. 4-7,22 In the present study, recovery of renal function was defined as eGFR >60 mL/min/1.73 m 2 at six months and was significantly associated with a lowered probability of ESRD (Figure 1). According to recommendations of the Joint European League against Rheumatism and European Renal Association, the definition of complete remission or partial remission include normal or near normal renal function, and the response should be achieved by six months and no later than 12 months.…”

The relationship between the modified National Institute of Health activity and chronicity scoring system, and the long-term prognosis for lupus nephritis: A retrospective single-center study

“…Similar results were reported elsewhere. 15,[22][23][24][25] Additionally, previous studies also reported that components of the chronicity index, such as total glomerulosclerosis, fibrous crescents, tubular atrophy, and interstitial fibrosis were independent risk factors for a poor renal prognosis. 10,15,24,26 Components of the activity index generated conflicting results in previous studies; cellular crescents, fibrinoid necrosis, and interstitial inflammation were independent risk factors for a poor renal prognosis.…”

“…reported that wire loops and endocapillary lymphocytes were associated with estimated glomerular filtration rate recovery rather than a decline over a 10-year follow-up, suggesting that active lesions were reversible and had a good treatment response for most patients. 15,24,27…”

“…reported that a chronicity index > 5 was a risk factor for developing ESKD. 24 However, these reports evaluated the original NIH scoring system, and follow-up periods were relatively short-term: approximately four years in both studies.…”

Effectiveness and safety of common therapeutic drugs for refractory lupus nephritis: A network meta‑analysis

“…Patients with LN who do not respond to treatment tend to have more irreversible injuries and the condition is more likely to deteriorate in such patients. A cohort study from a Chinese population suggested that the treatment was ineffective in ~26.5% of the population and they eventually developed end-stage renal failure (6). Another study suggested that failure to respond after treatment for one year was an independent predictor of mortality in patients with LN (7).…”