Prognostic value of modified National Institute of Health activity and chronicity scoring in determining complete renal response in newly diagnosed lupus nephritis: a retrospective single centre study.

Abstract

Early response to therapy is associated with favourable long-term outcome in LN. The working group of revision of ISN/RPS classification guidelines for LN recommended modified National Institute of Health (NIH) activity and chronicity scoring system to evaluate active and chronic lesions. Data on usefulness of modified NIH scoring system to determine complete renal response (CR) in LN are sparse. We retrospectively studied 80 LN patients diagnosed from June/2018 to April/2020, who has followed up for more ≥ 6months in our hospital. CR was defined by inactive urinary sediment, urine PCR of 0.5g/g in a 24h urine collection and normalization/stabilization of renal function. Pathologic lesions were described as per revised 2018 ISN/RPS classification and the modified NIH scoring system. Patients were grouped by AI (low, 0-5; moderate, 6-11; high, 12-24) and CI (low, 0-2; moderate, 3-5; high, 6-12). Time to event was analysed using Kaplan-Meier curves. Prognostic variables for CR were analysed by multivariable Cox proportional hazard models. With a median follow-up of 8months, 50 patients (62.5%) achieved CR. Kaplan-Meier curves showed lower CR with high AI groups (p value = 0.001) and moderate/high CI groups (p value < 0.001). Moderate and high CI with HR of 0.088 (0.034-0.229) p value < 0.001 and Glomerulosclerosis Score with HR of 0.155 (0.072-0.331) p value < 0.001 were significant determinant of CR. Moderate and high CI scores were associated with lower chances of CR in LN. Glomerulosclerosis of CI was significant determinant of CR.