#2683 Characterizing the NIH activity and chronicity indices in two independent lupus nephritis cohorts: a critical analysis
Notice bibliographique
Résumé
Abstract Background and Aims The inclusion of National Institutes of Health (NIH) activity and chronicity indices (AI and CI) in the International Society of Nephrology/Renal Pathology Society (ISN/RPS) classification of lupus nephritis (LN) aims to provide a more precise characterization of the amount of active and chronic lesions next to the lupus histological class. These indices were based on expert opinion over 40 years ago and their clinical usefulness today is uncertain. The NIH AI is based on six lesions (range 0–24) and the NIH CI on four lesions (range 0–12). The aim of this study is to investigate how the NIH AI and CI scores are represented in two large international LN cohorts; which lesions mostly determine the value of the indices; and what their relation is to LN histological class. Method We collected renal biopsies of patients diagnosed with LN, confirmed by light microscopy and immunofluorescence. Cohort 1 included 90 patients from Italy and The Netherlands, while cohort 2 comprised 104 patients from the UK (Table). We excluded biopsies that had fewer than 10 scorable glomeruli, those from transplanted kidneys, or with a concomitant glomerular disease. We calculated the NIH AI and CI according to the 2018 ISN/RPS classification revision. We used the Spearman coefficient to explore correlations among the NIH indices and the active and chronic lesions. Mann Whitney U test was used to investigate differences in NIH AI and CI distribution between classes III and IV and other classes (I, II and V), and between adult and pediatric populations. Results The NIH AI score was usually medium-low, reaching a maximum value of 16 in both cohorts, while the NIH CI had a more even distribution and reached a maximum value of 10. The NIH AI score was significantly higher in classes III and IV compared to the other classes (P < .001); the latter mostly had a NIH AI score of 0. The NIH CI showed higher scores in classes III and IV only in cohort 2 (P < .001). Despite the lack of significant difference in the distribution of histological classes, adults presented a higher NIH CI compared to pediatric patients in both cohorts (P < .001). Endocapillary hypercellularity was present in more than 70% of biopsies and showed a strong correlation with neutrophils/karyorrhexis (rs = 0.842, P < .001); both categories were also strongly correlated, especially in cohort 2, with cellular/fibrocellular crescents (rs = 0.610 and 0.635, P < .001). Fibrinoid necrosis was quite rare to encounter (13.3% and 8.7% of the biopsies, in cohorts 1 and 2, respectively) and showed a correlation with cellular/fibrocellular crescents (rs = 0.302, P = .004 in cohort 1). Among chronic lesions, total glomerulosclerosis, tubular atrophy and interstitial fibrosis were present in about half of the renal biopsies and had a strong correlation with each other (P < .001); fibrous crescents were less frequently encountered and had the strongest correlations with NIH CI (rs = 0.390, P < .001), NIH AI (rs = 0.256, P = .009) and cellular/fibrocellular crescents (rs = 260, P = .008) in cohort 2. Conclusion This study revealed key limitations of the NIH indices, such as the restricted range of attainable NIH AI scores, the strong relationship between the NIH AI and histological classes, the major role of the endocapillary hypercellularity in driving the NIH AI, and the likely independent value of the NIH CI across different classes. All these aspects raise doubts about their effectiveness in accurately reflecting the extent of activity and chronicity in LN biopsies and predicting patient outcomes. It is crucial to further investigate whether potential modifications to these indices could lead to a more balanced and reliable scoring system.
Récupéré en direct depuis OpenAlex et désinversé. Les résumés ne sont pas conservés dans cette base de données : les index inversés représentent 8,6 Go des 9,3 Go de texte de la base, et le serveur dispose de 13 Go libres.
Comment cette classification a été obtenuedéplier
Prédiction machine sur la base complète
Imitation des enseignantsNi prévalence calibrée, ni vérité terrain. Validation humaine à venir. Le volet Gemma est une étiquette directe du modèle pour chaque travail de la base, lue sur la notice réduite au titre. Le volet Codex est un classifieur appris des 10 348 étiquettes directes de Codex et calibré sur les taux pondérés de l'échantillon; les champs sans appui suffisant ne portent aucun appel Codex. Le mode candidate est l'union des deux volets; le consensus est leur intersection. Ces sorties portent le statut machine_predicted_unvalidated et ne sont pas des étiquettes humaines.
Scores du classifieur distillé par catégorie (deux têtes)
| Catégorie | Codex | Gemma |
|---|---|---|
| Métarecherche | 0,014 | 0,027 |
| Méta-épidémiologie (sens strict) | 0,001 | 0,000 |
| Méta-épidémiologie (sens large) | 0,001 | 0,002 |
| Bibliométrie | 0,004 | 0,003 |
| Études des sciences et des technologies | 0,001 | 0,001 |
| Communication savante | 0,002 | 0,001 |
| Science ouverte | 0,001 | 0,001 |
| Intégrité de la recherche | 0,001 | 0,001 |
| Charge utile insuffisante (le modèle a refusé de juger) | 0,003 | 0,000 |
Scores machine (provisoires)
Les deux têtes enseignantes du modèle étudiant, lues sur ce travail. Un score ordonne la base pour la relecture; il n'affirme jamais une catégorie, et le statut de validation accompagne chaque rangée tel quel.
Scores de référence d'un modèle non mature (critères de maturité non atteints, 7 itérations). Un score ordonne; il n'affirme jamais une catégorie.
score_only:v0-immature-baseline · tel quel depuis la passe de notation : score_only signifie que le nombre peut ordonner les travaux, et qu'aucune étiquette de catégorie n'en découleClassification
machine, non validéePrédiction automatique; un appel candidat d’une seule source (Gemma direct ou Codex distillé), pas un consensus.
Le détail, modèle par modèle et score par score, se trouve en fin de page sous « Comment cette classification a été obtenue ».