What is your approach to using NIH activity and chronicity indices from renal biopsy in tailoring immunosuppression to a patient with new lupus nephritis?   

I find the NIH activity and chronicity extremely valuable in LN management. If a patient has a high AI, I’m much more likely to be aggressive with corticosteroids to help stop the inflammation in its tracks. I will, of course, use a concomitant immunosuppressive/immunomodulatory agent as well ...

Among the two scores in the biopsy which help the most are the chronicity scores as they help in discussing prognosis with the patient and considering de-escalating immunosuppression to minimize side effects especially if the patient has been on immunosuppression for a long time. Activity scores ar...

While the current NIH scoring system provides useful information, it may be important to mention the limitations of the NIH scoring system. The consensus report on the revised International Society of Nephrology/Renal Pathology Society (ISN/RPS) classification highlights the need for better classifi...