Towards an Interdisciplinary Consensus Definition of "Refractory Lupus Nephritis": A Kickoff Survey
Bibliographic record
Abstract
Background: There is no consensus for the definition of “Refractory Lupus Nephritis (RLN)”, which leads to confusion and overuse of this term for patients not responding to immunotherapy as expected. However, definition criteria, time of assessment and how to exclude drug non-adherence remain under debate. The aim of this working group of LNTN is to approach a consensus definition to avoid over- or underuse of immunotherapy, to standardize patient management, and patient selection for clinical trials and research. Methods: We initiated a Delphi consensus process to define consensus criteria for RLN. Initially we developed a Delphi questionnaire encompassing 25 questions on individual or composite criteria of treatment response, additional definition criteria including eGFR, urinary sediment, serum complement or autoantibodies, a preference for albuminuria or proteinuria, and timing of assessment depending on the type of medication used. We questioned the role of a re- or protocol biopsy in defining RLN and its timing as well as whether demographics, genetics, or comorbidities should be considered. We also inquired about evaluation of drug non-adherence prior to labeling as RLN. Results from the first Delphi round will be reported. Results: To date, 256 LN specialists participated in the survey and 148 completed all questions. The 256 participants included 85 nephrologists, 60 rheumatologists, 20 internists and 108 did not specify. Regionally, 56 were from North America, 15 South America, 48 from Europe, 20 from Asia and 8 from Africa. The vast majority of participants had 6 or more years of clinical practice experience and reported an intermediate or high level of expertise in treating lupus nephritis. Responses are currently being analyzed and will be presented on site. Conclusion: This kick-off survey is the starting point for the next rounds of the Delphi consensus process to ultimately arrive at an interdisciplinary consensus definition of RLN to support standardized patient management and clinical research, and to avoid unnecessary exposures to toxic and costly second or third line LN medications.
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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 | 0.071 | 0.056 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.001 | 0.001 |
| Bibliometrics | 0.004 | 0.002 |
| Science and technology studies | 0.001 | 0.002 |
| Scholarly communication | 0.002 | 0.004 |
| Open science | 0.001 | 0.007 |
| Research integrity | 0.001 | 0.002 |
| Insufficient payload (model declined to judge) | 0.002 | 0.001 |
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".