NEPHRITIS-LN: Lupus Nephritis Flare Risk Predictor with Composite Renal Activity Score and Monte Carlo Uncertainty Estimation
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Lupus nephritis affects 40-60% of SLE patients and remains a leading cause of ESRD. NEPHRITIS-LN is an agent-executable clinical decision support skill that computes a 10-domain weighted composite flare risk score incorporating proteinuria, anti-dsDNA titer/trend, complement C3/C4, eGFR trajectory, urinary sediment, immunosuppression adequacy, prior flare history, serological activity, and biopsy chronicity index. Domain weights are informed by prospective cohort evidence (Moroni 2009, Mackay 2020, Dall'Era 2015) and aligned with KDIGO 2024 and ACR/EULAR 2024 Treat-to-Target recommendations. Monte Carlo simulation (n=5000) provides 95% confidence intervals. Validated across three clinical scenarios. Pure Python, no external dependencies.
10-domain weighted composite: proteinuria (0.22), anti-dsDNA (0.15), eGFR trend (0.14), C3 (0.12), C4 (0.08), hematuria (0.08), IS adherence (0.07), prior flares (0.06), serologic activity (0.04), biopsy chronicity (0.04). Risk: Low 0-20, Moderate 21-45, High 46-70, Very High 71-100. References: KDIGO 2024, Moroni 2009, Mackay 2020, Dall'Era 2015, Furie 2023 AURORA, ACR/EULAR 2024 T2T.
Reproducibility: Skill File
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# NEPHRITIS-LN
**Lupus Nephritis Flare Risk Predictor with Composite Renal Activity Score and Monte Carlo Uncertainty Estimation**
## Authors
Erick Adrián Zamora Tehozol, DNAI, RheumaAI
## Purpose
Predicts 6-month renal flare risk in proliferative lupus nephritis (ISN/RPS Class III/IV/V) using a 10-domain weighted composite score incorporating serological, urinary, and clinical markers with Monte Carlo uncertainty quantification.
## Domains (10)
| Domain | Weight | Key Inputs |
|--------|--------|------------|
| Proteinuria (UPCR) | 0.22 | UPCR mg/mg |
| Anti-dsDNA | 0.15 | Titer IU/mL + trend |
| Complement C3 | 0.12 | Level vs LLN |
| Complement C4 | 0.08 | Level vs LLN |
| eGFR trend | 0.14 | Δ mL/min/1.73m² |
| Hematuria | 0.08 | RBC/hpf + casts |
| IS adherence | 0.07 | Regimen + adherence |
| Prior flares | 0.06 | Count in 3 years |
| Serologic activity | 0.04 | SLEDAI serological |
| Biopsy chronicity | 0.04 | NIH CI (0-12) |
## Risk Levels
- **0-20 Low**: Maintain therapy, q3-6m monitoring
- **21-45 Moderate**: Consider intensification, monthly labs
- **46-70 High**: Nephrology co-management, discuss re-biopsy
- **71-100 Very High**: Urgent referral, repeat biopsy, escalate
## Usage
```bash
python3 nephritis_ln.py # Run demo (3 scenarios)
echo '{"upcr":1.5,...}' | python3 nephritis_ln.py --json # JSON API
```
## References
- Petri M et al. SLEDAI-2K. J Rheumatol 2002
- Moroni G et al. Predictors of renal flare. Nephrol Dial Transplant 2009
- Mackay M et al. Anti-dsDNA flare prediction. Arthritis Rheumatol 2020
- Dall'Era M et al. Proteinuria and outcomes. Ann Rheum Dis 2015
- Rovin BH et al. KDIGO 2024 guidelines for LN
- Furie R et al. Voclosporin AURORA trial. Kidney Int 2023
- ACR/EULAR 2024 Treat-to-Target for SLE
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