Comparison of Lupus Nephritis Onset Before and After Age 50: Effect on Presentation and Outcomes in an Inception Cohort
Bibliographic record
Abstract
Objective Renal involvement in systemic lupus erythematosus (SLE) most commonly occurs in women in the reproductive age group; however, it may theoretically start at any age. In this study, we aimed to explore the effect of lupus nephritis (LN) stratified by age of onset, with a cutoff at 50 years, on clinical presentation and disease outcomes. Methods We included 246 inception cohort patients who developed LN during follow-up. We classified patients based on the age of LN onset into group 1 (< 50 years; 205 patients) and group 2 (≥ 50 years, late-onset LN; 41 patients). Outcomes included complete proteinuria recovery (CPR) at 1 year, an adverse composite outcome (end-stage renal disease, a sustained ≥ 40% decline in estimated glomerular filtration rate [eGFR], or death), subsequent LN flares, and any increase in nonrenal Systemic Lupus International Collaborating Clinics/American College of Rheumatology Damage Index (SDI). The association with outcomes was studied using the Cox proportional hazards model. Results At baseline, the median age was 31.4 (IQR 25.2-38.5) years for group 1 and 58.4 (IQR 53.9-64.5) years for group 2 ( P < 0.01). Group 2 (late-onset LN) patients had a higher median creatinine level ( P = 0.03), lower median eGFR ( P < 0.01) and proteinuria levels ( P = 0.01), and a lower median SLE Disease Activity Index 2000 (SLEDAI-2K) score ( P = 0.04). In the Cox models, there were no significant differences between the 2 groups in terms of achieving CPR or developing the adverse composite outcome. However, late-onset LN was associated with higher odds of any increase in nonrenal SDI and showed a trend for fewer subsequent flares. Conclusion Late-onset LN is not associated with significant differences in short- or long-term renal outcomes.
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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 | 0.002 | 0.003 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.001 | 0.001 |
| Bibliometrics | 0.001 | 0.001 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.001 | 0.001 |
| Open science | 0.001 | 0.001 |
| Research integrity | 0.001 | 0.001 |
| 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".