A new study looked at the effectiveness of the modified National Institute of Health (mNIH) activity and chronicity scoring system for predicting end-stage kidney disease (ESKD) among Latin American individuals with  lupus nephritis (LN). 

This retrospective study included 412 Colombian participants with biopsy-confirmed LN. The median age at the time of biopsy was 29 years. The study cohort was predominantly females, accounting for 87.6% of the participants. Of the 412 participants, 84 (20.4%) progressed to ESKD after a median time of three months following the biopsy. Additional analysis showed that participants who did not respond to induction therapy treatment at 6 months had a significantly increased the risk of ESKD. Furthermore, non-response to immunosuppressive therapies were more common in individuals who developed ESKD (52.9%) compared to those who did not (24.9%). These findings were consistent with prior research. Overall, mNIH activity and chronicity indices identified a correlation with a heightened risk of ESKD. Additionally, the presence of fibrous crescents and fibrinoid necrosis were found to be significant predictors, leading to faster progression to ESKD and ultimately a shortened kidney lifespan.

This study highlights the predictive value of kidney biopsy in LN and the need for improved predictors for poor long-term kidney outcomes, given that current therapies for LN are not sufficiently effective at inducing remission. While the mNIH’s scoring system has utility as a valuable prognostic tool for assessing ESKD risk, larger scale studies with more diverse patient populations are needed. 

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