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. (October 2021)

• Record Type: Journal Article
• Authors: Nakagawa, Shiori; Toyama, Tadashi; Iwata, Yasunori; Oshima, Megumi; Ogura, Hisayuki; Sato, Koichi; Yamamura, Yuta; Miyakawa, Taro; Kitajima, Shinji; Hara, Akinori; Sakai, Norihiko; Shimizu, Miho; Wada, Takashi
• Is Part Of: Lupus. Volume 30:Number 11(2021)
• Page Start: 1739
• Page End: 1746
• Publication Date: 2021-10
• Subjects: Lupus nephritis -- systemic lupus erythematosus -- kidney failure -- pathology; Systemic lupus erythematosus -- Periodicals; 616.772005
• DOI: 10.1177/09612033211034234
• Languages: English
• ISSNs: 0961-2033

Abstract

Background: The revision of International Society of Nephrology/Renal Pathology Society (ISN/RPS) classification guidelines for lupus nephritis (LN) was suggested by a working group, who recommended a modified National Institute of Health (NIH) activity and chronicity scoring system to evaluate active and chronic LN lesions. However, whether this approach was useful for estimating long-term prognosis for LN patients is unclear. Methods: We conducted a retrospective cohort study in Japanese subjects with biopsy-proven LN, between 1977 and 2018. Pathologic lesions were evaluated based on ISN/RPS 2003 classifications and the modified NIH scoring system. Patients were grouped by activity index (low, 0–5; moderate, 6–11; high, 12–24), and chronicity index (low, 0–2; moderate, 3–5; high, 6–12). The primary outcome was a composite of end-stage kidney disease (ESKD) or all-cause death, and the secondary outcome was ESKD alone. Results: Sixty-six subjects with a median age of 31 years were included. During median follow-up (11.5 years), 15 patients reached the primary outcome: 10 had ESKD, four had died, and one had ESKD and died. Kaplan–Meier analysis showed that the cumulative primary outcome incidence increased with a higher chronicity index (log-rank trend p < 0.001). From multivariable survival analysis, moderate (hazard ratio [HR] 6.17, 95% confidence interval [CI] 1.14 to 33.20; p = 0.034) and high chronicity indices (HR 20.20, 95% CI 1.13 to 359.82; p = 0.041) were risk factors for the primary outcome. Conclusion: Moderate and high chronicity indices were associated with an increased ESKD risk for LN.