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Alí Duarte, MD @aliduarte.bsky.social · 25/02/2026

Grateful to the legendary Sanjeev Sethi for partnering with our team.

Alí Duarte, MD @aliduarte.bsky.social · 25/02/2026

16/16 Bottom line: MCCS and NIH-CI are comparable and add prognostic signal beyond clinical data—with IF/TA doing most of the heavy lifting—and performance was consistent in Class V LN. MCCS may offer a practical edge by aligning chronicity grading across glomerular diseases.

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Alí Duarte, MD @aliduarte.bsky.social · 25/02/2026

15/16 Robustness check: performance held across key subgroups—including Class V (membranous) LN—with no meaningful interaction effects. In other words: the prognostic signal wasn’t just a proliferative-LN story.

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Alí Duarte, MD @aliduarte.bsky.social · 25/02/2026

14/16 Clinical pearl: even mild IF/TA mattered—and moderate/severe IF/TA aligned with a striking jump in ESKD risk versus no fibrosis. If you track one chronic lesion meticulously, make it IF/TA.

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Alí Duarte, MD @aliduarte.bsky.social · 25/02/2026

13/16 Lesion-level insight: IF/TA (interstitial fibrosis/tubular atrophy) was the only component that stayed independently predictive across renal outcomes in multivariable models.

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Alí Duarte, MD @aliduarte.bsky.social · 25/02/2026

12/16 Decision-curve analysis: adding either NIH-CI or MCCS produced net benefit for identifying 5-year ESKD risk vs clinical variables alone. Translation: chronicity scores capture risk information not visible in routine clinical variables.

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Alí Duarte, MD @aliduarte.bsky.social · 25/02/2026

11/16 Do these scores add value beyond routine clinical inputs (age/sex/eGFR/proteinuria)? Yes. Adding either score improved discrimination for PR500, CRR, and ESKD prediction. Mortality prediction didn’t meaningfully improve.

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Alí Duarte, MD @aliduarte.bsky.social · 25/02/2026

10/16 MCCS grades are especially clinician-friendly: compared with minimal chronicity, severe MCCS (8–10) meant dramatically lower remission and a markedly higher risk of ESKD.

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Alí Duarte, MD @aliduarte.bsky.social · 25/02/2026

9/16 Core result: higher chronicity = worse renal outcomes. Each 1-point increase in chronicity → lower remission likelihood and higher ESKD risk. MCCS showed a very similar pattern.

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Alí Duarte, MD @aliduarte.bsky.social · 25/02/2026

8/16 Cohort snapshot: 307 patients. Within 1 year: PR500 ~47%, CRR ~43%. Over follow-up: ESKD ~20%, deaths ~11%. NIH-CI and MCCS were highly correlated.

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Alí Duarte, MD @aliduarte.bsky.social · 25/02/2026

7/16 Methods: sex-stratified, age-adjusted Cox models; model discrimination via Harrell’s C-index; plus decision-curve analysis for 5-year ESKD (competing-risk aware).

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Alí Duarte, MD @aliduarte.bsky.social · 25/02/2026

6/16 Outcomes were clinically grounded: • PR500 (proteinuria <500 mg/day) • CRR (PR500 + eGFR within ±15%) • ESKD (sustained eGFR ≤15 / dialysis / transplant) • Death

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Alí Duarte, MD @aliduarte.bsky.social · 25/02/2026

5/16 Design: single-center retrospective cohort (Mayo Clinic), renal specimens 1992–2023, biopsy-proven active LN; first biopsy used. Real-world data with a long runway.

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Alí Duarte, MD @aliduarte.bsky.social · 25/02/2026

4/16 Two “languages” of chronicity: • NIH-CI = glomerulosclerosis + fibrous crescents + interstitial fibrosis + tubular atrophy (0–12) • MCCS = glomerulosclerosis + interstitial fibrosis + tubular atrophy + arteriosclerosis; graded minimal→severe (0–10)

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Alí Duarte, MD @aliduarte.bsky.social · 25/02/2026

3/16 Why this matters: chronic lesions (glomerulosclerosis, tubular atrophy, interstitial fibrosis) are largely irreversible and track with worse long-term renal outcomes. We need better risk stratification than labs alone.

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Alí Duarte, MD @aliduarte.bsky.social · 25/02/2026

2/16 New study in Kidney International Reports (2026): “Evaluating Chronicity Scores for Outcomes in Patients With Lupus Nephritis”—with co–senior author Sanjeev Sethi, who reviewed all biopsies.

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Alí Duarte, MD @aliduarte.bsky.social · 25/02/2026

1/16 In lupus nephritis (LN), “activity” gets the spotlight—but chronic scarring often decides the long game. So: which chronicity score best predicts outcomes—NIH Chronicity Index (NIH-CI) or the Mayo Clinic Chronicity Score (MCCS)? buff.ly/tvebmPZ

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