LP-208 Mesangial lupus nephritis: long term outcomes
Bibliographic record
Abstract
Background Mesangial lupus nephritis is considered benign with minimal potential for developing advanced chronic kidney disease (CKD). However, some patients still develop advanced CKD and end-stage renal disease (ESRD). Our objective was to describe the factors associated with the development of CKD stage IV or worse in patients with LN II. Methods Patients with mesangial LN and ≥ 1 year follow-up were retrieved from the Toronto Lupus Clinic. Biopsy was performed because of proteinuria (n=55), rising serum creatinine (n=24), active urinary sediment (n=6) and generalized lupus activity (n=6). Patients with ESRD at baseline were excluded. Individuals were followed over time for the development of advanced CKD. Results Of 91 eligible patients, 10 developed advanced CKD during follow-up, 7 CKD stage IV and 3 ESRD. Baseline characteristics in Table 1. In 81/91 patients, there was no significant deterioration of the renal function after 16.8 years. Proteinuria was mild (1.17±0.89g). Fifteen patients had a repeat biopsy; histologic transformation was demonstrated in 10 (7 proliferative nephritis, 2 membranous, 1 advanced glomerulosclerosis). Sixty-three patients (67.7%) had normal renal function while 19.4% had CKD stage III (eGFR=30–59ml/min/1.73m2) at last visit. Seven patients developed CKD IV (4 had impaired kidney function at baseline). Proteinuria was mild (<1g/day). Four had a repeat biopsy; 2 developed membranous nephropathy. Renal function remained stable (eGFR=24.2±4.3ml/min/1.73m2) after a mean of 18.5 years. Three patients developed ESRD after 8.6, 10.3 and 16.8 years respectively. Two had a repeat biopsy demonstrating histologic transformation (proliferative nephritis, advanced glomerulosclerosis). Conclusions Advanced CKD developed in 11% of LN II patients but the progression was slow. In most cases, kidney function was impaired at diagnosis while proteinuria was mild. These findings imply that mesangial disease can occasionally lead to CKD and underlines the need for close monitoring. Treatment should not be based on the level of proteinuria alone.
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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 | 0.001 | 0.000 |
| Scholarly communication | 0.001 | 0.001 |
| Open science | 0.000 | 0.001 |
| Research integrity | 0.001 | 0.001 |
| Insufficient payload (model declined to judge) | 0.002 | 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".