{
  "abstract": "Objective Lupus nephritis (LN) is associated with a poorer prognosis in Latin American populations. However, the contributing risk factors contributing to this remain to be fully elucidated. This study aimed to develop a prognostic model for poor renal outcomes in patients of mestizo descent.Methods We conducted a multicentre, retrospective analysis including 290 adult mestizo patients with incident, biopsy-proven pure proliferative LN (International Society of Nephrology/Renal Pathology Society (ISN/RPS) class III or IV) from nine Chilean hospitals. Clinical, biological and histological variables were assessed. The primary outcome was a composite of stage IV/V chronic kidney disease, dialysis or death. Predictive variables were selected using multivariable Cox regression, and prognostic scores were derived accordingly. Internal validation was performed via bootstrapping. External validation included 93 Mexican patients, with model performance assessed using Harrel’s concordance index.Results Two baseline factors were independently associated with poor renal outcome: estimated glomerular filtration rate <30 mL/min/m 2 (HR 3.82, 95% CI 2.15 to 6.78; p<0.001) and histological chronicity index >2 (HR 2.01, 95% CI 1.18 to 3.43; p=0.01). Patients were stratified into three risk categories according to the presence of none (low risk), one (intermediate risk) or both (high risk) of these factors. The likelihood of the primary outcome increased progressively across these groups: high versus intermediate risk (HR 3.22, 95% CI 1.64 to 6.34; p=0.001), and intermediate versus low risk group (HR 2.41, 95% CI 1.35 to 4.30; p=0.003). The three-tier model was replicated in the validation cohort with a concordance index of 79% (95% CI 71% to 87%; p<0.001) between predicted and observed results.Conclusions Based on two readily available features at the time of diagnosis, the proposed model effectively stratifies Latin American mestizo patients with pure proliferative LN (ISN/RPS class III or IV) into three risk categories for poor renal outcome. This tool may support improved risk-based management in this high-risk population.",
  "authors": [
    {
      "affiliations": [
        "Department of Nephrology and Renal Transplantation, Hospital Barros Luco Trudeau, Santiago, Chile",
        "Universidad de Chile Facultad de Medicina, Santiago, Chile"
      ],
      "name": "Arturo Villalobos Navarro"
    },
    {
      "affiliations": [
        "Department of Nephrology and Renal Transplantation, Hospital Clínic de Barcelona, Barcelona, Spain"
      ],
      "name": "Marc Xipell"
    },
    {
      "affiliations": [
        "Department of Nephrology, UMAE Hospital de Especialidades ‘Dr. Bernardo Sepúlveda G’ Centro Médico Nacional 21 Siglo XXI, Instituto Mexicano del Seguro Social, Mexico City, Mexico"
      ],
      "name": "Estefanía Garduño Hernández"
    },
    {
      "affiliations": [
        "Department of Medicine, Hospital Del Salvador, Santiago, Chile"
      ],
      "name": "Ricardo Valjalo"
    },
    {
      "affiliations": [
        "Department of Medicine, Hospital Clínico San Borja Arriarán, Santiago, Chile"
      ],
      "name": "Francisco Contreras"
    },
    {
      "affiliations": [
        "Department of Medicine, Clinica Davila, Santiago, Chile"
      ],
      "name": "Andrea Ruiz de Arechavaleta"
    },
    {
      "affiliations": [
        "Department of Anatomic Pathology, Hospital Clinico de la Universidad de Chile Jose Joaquin Aguirre, Santiago, Chile"
      ],
      "name": "Paula Segura"
    },
    {
      "affiliations": [
        "Department of Nephrology, Hospital San Juan de Dios, Santiago, Chile"
      ],
      "name": "Daniel Miranda"
    },
    {
      "affiliations": [
        "Department of Nephrology, Pontificia Universidad Católica de Chile, Santiago, Chile"
      ],
      "name": "Eduardo Ávila"
    },
    {
      "affiliations": [
        "Department of Nephrology, Hospital Clinico de la Universidad de Chile Jose Joaquin Aguirre, Santiago, Chile",
        "Department of Nephrology, Hospital San Jose, Santiago, Chile"
      ],
      "name": "María José Hidalgo"
    },
    {
      "affiliations": [
        "Department of Nephrology and Renal Transplantation, General Hospital of Mexico, Mexico City, Mexico"
      ],
      "name": "Juan Daniel Diaz Garcia"
    },
    {
      "affiliations": [
        "Department of Nephrology, UMAE Hospital de Especialidades ‘Dr. Bernardo Sepúlveda G’ Centro Médico Nacional 21 Siglo XXI, Instituto Mexicano del Seguro Social, Mexico City, Mexico"
      ],
      "name": "Fabiola Pazos Pérez"
    },
    {
      "affiliations": [
        "Department of Nephrology, UMAE Hospital de Especialidades ‘Dr. Bernardo Sepúlveda G’ Centro Médico Nacional 21 Siglo XXI, Instituto Mexicano del Seguro Social, Mexico City, Mexico"
      ],
      "name": "Diana Valderrama Ávila"
    },
    {
      "affiliations": [
        "Department of Nephrology, UMAE Hospital de Especialidades ‘Dr. Bernardo Sepúlveda G’ Centro Médico Nacional 21 Siglo XXI, Instituto Mexicano del Seguro Social, Mexico City, Mexico"
      ],
      "name": "María Inés Gil Arredondo"
    },
    {
      "affiliations": [
        "Department of Nephrology and Renal Transplantation, Hospital Clínic de Barcelona, Barcelona, Spain"
      ],
      "name": "Elena Guillén"
    },
    {
      "affiliations": [
        "Hospital Clinic de Barcelona Servei de Malalties Autoimmunes, Barcelona, Spain"
      ],
      "name": "Ricard Cervera"
    },
    {
      "affiliations": [
        "Hospital Clinic de Barcelona Servei de Malalties Autoimmunes, Barcelona, Spain"
      ],
      "name": "Gerard Espinosa"
    },
    {
      "affiliations": [
        "Department of Hematology, Hospital Clinic de Barcelona, Barcelona, Spain"
      ],
      "name": "Arturo Pereira"
    },
    {
      "affiliations": [
        "Department of Nephrology and Renal Transplantation, Hospital Clínic de Barcelona, Barcelona, Spain"
      ],
      "name": "Miquel Blasco"
    },
    {
      "affiliations": [
        "Department of Nephrology and Renal Transplantation, Hospital Clínic de Barcelona, Barcelona, Spain"
      ],
      "name": "Luis F Quintana"
    }
  ],
  "title": "Prediction model for renal outcomes in Latin American Mestizo patients with pure proliferative lupus nephritis",
  "uid": "0875f386-92ff-5eac-aa18-020b612c020f"
}