1108 Repeat kidney biopsy for lupus nephritis after induction: histologic and clinical responses in childhood-onset SLE
Bibliographic record
Abstract
Background In children with proliferative lupus nephritis, response to induction treatment is based on clinical parameters. The added benefit of repeat kidney biopsy in defining therapy response remains unclear. Emerging adult data suggests a discordancy between clinical and histological outcomes. In children, we hypothesize that histologic reassessment after induction therapy correlates better with clinical remission. Methods A single-center retrospective observational cohort study was conducted in childhood-onset proliferative lupus nephritis with a repeat biopsy after 5-9 months of induction therapy from 2007 to 2019. LN response was determined clinically. Histologic activity and damage were calculated using National Institutes of Health activity and chronicity indices. Lupus nephritis class transformation and changes in the degree of immune complex deposition were determined. Descriptive statistics and comparison tests were used before and after induction treatment. Results A total of 44 patients were identified. Complete clinical response was achieved in 43% (19/44) after induction and 69% (29/42) at one year. None of the complete responders after induction had histologic activity index of > 2 on repeat biopsy (figure 1). Activity index after induction in complete responders (median 1, range 0-2) was lower than in partial or non-responders (median 2, range 0-10) (p-value < 0.005). Complete clinical response was associated with transformation to a non-proliferative class in 79% (15/19) and a reduction in immune complex deposition in 68% (13/19) on repeat biopsy. Conclusions Unlike adult-onset lupus nephritis, clinical and histologic remission are more congruent after induction therapy in childhood-onset disease. There was good correlation between clinical response and activity index. Lay Summary Lupus nephritis can cause kidney failure. The need to balance risks and benefits of immunosuppression requires stringent monitoring. In adults with lupus, available diagnostics are insufficient to gauge response to initial ”induction” therapy and repeat biopsy studies are necessary to rigorously test novel biomarkers. Here we show that repeat biopsy in children performed 1/2 year into therapy correlates well with clinical response, but there is a subset of children with sub-clinical scarring that would be missed without repeat biopsy - this subset may be at risk long-term for kidney failure.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.001 | 0.002 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.001 | 0.001 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.000 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.000 | 0.000 |
| Insufficient payload (model declined to judge) | 0.001 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".