Rodelo-Ceballos Joaquín Roberto, Aguirre Lina, González Luis Alonso
Division of Nephrology, Department of Internal Medicine, School of Medicine, Universidad de Antioquia, Hospital Universitario de San Vicente Fundación, Medellín, Colombia.
Division of Rheumatology, Department of Internal Medicine, School of Medicine, Universidad de Antioquia, Medellín, Colombia.
Lupus. 2025 Apr;34(4):381-394. doi: 10.1177/09612033251325315. Epub 2025 Mar 4.
ObjectiveTo assess the effectiveness of the modified National Institute of Health (mNIH) activity and chronicity scoring system in predicting the progression to end-stage kidney disease (ESKD) in Latin American lupus nephritis (LN) patients.MethodsWe retrospectively analyzed 412 patients with biopsy-proven LN. ESKD was defined as an estimated glomerular filtration rate (eGFR) < 15 mL/min/1.73 m for ≥3 months, dialysis for >3 months, or kidney transplant. Univariable and multivariable Cox proportional hazards regression analyses were performed to evaluate the predictive value of the mNIH activity and chronicity indices for ESKD.Results84 patients (20.4%) progressed to ESKD at a median of 3.0 months after biopsy. The mNIH activity and chronicity indices were significantly higher in patients who progressed to ESKD compared to those who did not [7 (5-10) versus 4 (1-7), < .001; and 3 (1-5) versus 0 (0-2), < .001, respectively]. Multivariable Cox regression analysis revealed that the mNIH activity index (HR 1.17, 95% CI 1.05-1.29), and the mNIH chronicity index (HR 1.21, 95% CI 1.05-1.40) were independently associated with a higher risk of ESKD, adjusting for age, sex, ethnicity, and eGFR. Furthermore, fibrinoid necrosis (HR 4.09, 95% CI 1.54-10.86) and fibrous crescents (HR 2.36; 95% CI 1.06-5.27), components of the activity and chronicity indices, respectively, were also associated with a shorter time to ESKD.ConclusionsIn Latin American LN patients, the mNIH activity and chronicity indices are associated with an increased risk of ESKD. Among the components of these indices, shorter time to ESKD was mainly driven by fibrinoid necrosis and fibrous crescents.
评估改良的美国国立卫生研究院（mNIH）活动度和慢性化评分系统对预测拉丁美洲狼疮性肾炎（LN）患者进展至终末期肾病（ESKD）的有效性。
我们回顾性分析了412例经活检证实为LN的患者。ESKD定义为估计肾小球滤过率（eGFR）<15 mL/min/1.73 m²持续≥3个月、透析>3个月或肾移植。进行单变量和多变量Cox比例风险回归分析，以评估mNIH活动度和慢性化指数对ESKD的预测价值。
84例患者（20.4%）在活检后中位3.0个月进展至ESKD。进展至ESKD的患者的mNIH活动度和慢性化指数显著高于未进展者[分别为7（5 - 10）对4（1 - 7），P <.001；3（1 - 5）对0（0 - 2），P <.001]。多变量Cox回归分析显示，在调整年龄、性别、种族和eGFR后，mNIH活动度指数（HR 1.17，95%CI 1.05 - 1.29）和mNIH慢性化指数（HR 1.21，95%CI 1.05 - 1.40）与ESKD风险较高独立相关。此外，活动度和慢性化指数的组成部分纤维蛋白样坏死（HR 4.09，95%CI 1.54 - 10.86）和纤维性新月体（HR 2.36；95%CI 1.06 - 5.27）也与至ESKD的时间较短相关。
在拉丁美洲LN患者中，mNIH活动度和慢性化指数与ESKD风险增加相关。在这些指数的组成部分中，至ESKD时间较短主要由纤维蛋白样坏死和纤维性新月体驱动。
