Prognostic risk score for end-stage kidney disease in Latin American lupus nephritis: Integrating clinical and histological data

Abstract

Objectives

To develop a clinically applicable risk prediction score for end-stage kidney disease (ESKD) in Latin American patients with lupus nephritis (LN), using clinical and histopathological data obtained at the time of kidney biopsy.

Methods

We conducted a retrospective cohort study of 433 adults (≥18 years) with biopsy-proven LN at Hospital San Vicente Fundación (Medellín, Colombia) between January 2011 and May 2025. ESKD was defined as eGFR <15 mL/min/1.73 m² for ≥3 months, dialysis >3 months, or kidney transplantation. Predictors of ESKD were identified using univariable and multivariable Cox regression and incorporated into a weighted risk score, stratifying patients into low (≤2 points), moderate (3–6), and high (7–10) risk categories.

Results

Eighty-eight patients (20.3%) progressed to ESKD at a median of 3 months post-biopsy. Multivariable analysis identified hypertension (HR 1.73), baseline eGFR <60 mL/min/1.73 m² (HR 4.40), proliferative LN (HR 4.03), mNIH activity index ≥7 (HR 1.56), and chronicity index ≥3 (HR 2.24) as independent predictors of ESKD. The resulting risk score stratified patients into low (n = 80), moderate (n = 215), and high-risk (n = 138) groups, with ESKD incidences of 0%, 11.6%, and 45.7%, respectively (p < 0.001). The model demonstrated good discriminatory performance, with a Harrell’s C-index of 0.83.

Conclusions

We developed a simple yet robust risk score for predicting ESKD in Latin American patients with LN, integrating key clinical and histopathological factors. This tool effectively stratifies patients by risk and may support in guiding treatment decisions in clinical practice.